McKelvie R S, Teo K K, McCartney N, Humen D, Montague T, Yusuf S
Division of Cardiology and Preventive Cardiology, Hamilton Civic Hospitals Research Centre, Hamilton General Hospital, Ontario, Canada.
J Am Coll Cardiol. 1995 Mar 1;25(3):789-96. doi: 10.1016/0735-1097(94)00428-S.
Congestive heart failure is a potentially debilitating disorder that affects a significant number of patients. The age-adjusted death rate has doubled over the past decade. Patients live an average of 4 to 5 years, and nearly all suffer from fatigue and breathlessness, which limits exercise capacity and produces a poor quality of life. Patients have usually been advised to avoid exercise because of concerns that they would experience a further decline in cardiac function. However, it has been demonstrated that exercise capacity is not related to the degree of left ventricular systolic dysfunction. This has led to the suggestion that peripheral changes in skeletal muscle and blood supply may play a major role in determining the exercise capacity of patients with congestive heart failure. Studies have demonstrated abnormalities of skeletal muscle blood flow, metabolism and structure, all of which are consistent with the impaired performance observed in these patients. Although the effects of exercise training have been examined in only a relatively few number of patients, the results have been promising. Exercise training has been found to improve exercise capacity and reduce symptoms. However, to our knowledge no data exist as to the impact of exercise training on left ventricular function, hospital stay or mortality in this population. Even though the early results are promising, they require confirmation of feasibility, clinical benefit and safety in larger, long-term randomized trials. It should be determined whether training has a long-term beneficial impact on measures more closely related to daily activities and quality of life. Ultimately, it would be important to determine whether training has an impact on mortality and morbidity.
充血性心力衰竭是一种可能使人衰弱的疾病，影响着大量患者。在过去十年中，年龄调整后的死亡率翻了一番。患者的平均寿命为4至5年，几乎所有人都患有疲劳和呼吸急促，这限制了运动能力并导致生活质量低下。由于担心运动后心脏功能会进一步下降，患者通常被建议避免运动。然而，已经证明运动能力与左心室收缩功能障碍的程度无关。这表明骨骼肌和血液供应的外周变化可能在决定充血性心力衰竭患者的运动能力方面起主要作用。研究表明骨骼肌血流、代谢和结构存在异常，所有这些都与这些患者观察到的功能受损一致。虽然仅在相对较少的患者中研究了运动训练的效果，但结果很有前景。已发现运动训练可提高运动能力并减轻症状。然而，据我们所知，尚无关于运动训练对该人群左心室功能、住院时间或死亡率影响的数据。尽管早期结果很有前景，但它们需要在更大规模的长期随机试验中确认可行性、临床益处和安全性。应该确定训练是否对与日常活动和生活质量更密切相关的指标有长期有益影响。最终，确定训练是否对死亡率和发病率有影响将很重要。
