Lavie C J, Milani R V, Littman A B
Department of Internal Medicine, Ochsner Clinic, New Orleans, Louisiana.
J Am Coll Cardiol. 1993 Sep;22(3):678-83. doi: 10.1016/0735-1097(93)90176-2.
The aim of this study was to determine the effects of cardiac rehabilitation and exercise training on plasma lipids, indexes of obesity and exercise capacity in the elderly and to compare the benefits in elderly patients with coronary heart disease with benefits in a younger cohort.
Despite the well proved benefits of cardiac rehabilitation and exercise training, elderly patients with coronary heart disease are frequently not referred or vigorously encouraged to pursue this therapy. In addition, only limited data are available for these elderly patients on the benefits of cardiac rehabilitation on plasma lipids, indexes of obesity and exercise capacity.
At two large multispecialty teaching institutions, baseline and post-rehabilitation data including plasma lipids, indexes of obesity and exercise capacity were compared in 92 elderly patients (> or = 65 years, mean age 70.1 +/- 4.1 years) and 182 younger patients (< 65 years, mean 53.9 +/- 7.4 years) enrolled in phase II cardiac rehabilitation and exercise programs after a major cardiac event.
At baseline, body mass index (26.0 +/- 3.9 vs. 27.8 +/- 4.2 kg/m2, p < 0.001), triglycerides (141 +/- 55 vs. 178 +/- 105 mg/dl, p < 0.01) and estimated metabolic equivalents (METs) (5.6 +/- 1.6 vs. 7.7 +/- 3.0, p < 0.0001) were lower and high density lipoprotein cholesterol was greater (40.4 +/- 12.1 vs. 37.5 +/- 10.4 mg/dl, p < 0.05) in the elderly than in younger patients. After rehabilitation, the elderly demonstrated significant improvements in METs (5.6 +/- 1.6 vs. 7.5 +/- 2.3, p < 0.0001), body mass index (26.0 +/- 3.9 vs. 25.6 +/- 3.8 kg/m2, p < 0.01), percent body fat (24.4 +/- 7.0 vs. 22.9 +/- 7.2%, p < 0.0001), high density lipoprotein cholesterol (40.4 +/- 12.1 vs. 43.0 +/- 11.4 mg/dl, p < 0.001) and the ratio of low density to high density lipoprotein cholesterol (3.6 +/- 1.3 vs. 3.3 +/- 1.0, p < 0.01) and a decrease in triglycerides that approached statistical significance (141 +/- 55 vs. 130 +/- 76 mg/dl, p = 0.14) but not in total cholesterol or low density lipoprotein cholesterol. Improvements in functional capacity, percent body fat and body mass index, as well as lipids, were statistically similar in the older and younger patients.
Despite baseline differences, improvements in exercise capacity, obesity indexes and lipids were very similar in older and younger patients enrolled in cardiac rehabilitation and exercise training. These data emphasize that elderly patients should not be categorically denied the psychosocial, physical and risk factor benefits of secondary coronary prevention including formal cardiac rehabilitation and supervised exercise training.
本研究旨在确定心脏康复和运动训练对老年人血浆脂质、肥胖指标及运动能力的影响，并比较老年冠心病患者与年轻队列患者在接受治疗后的获益情况。
尽管心脏康复和运动训练的益处已得到充分证实，但老年冠心病患者常常未被转诊或积极鼓励接受这种治疗。此外，关于心脏康复对老年患者血浆脂质、肥胖指标及运动能力的益处，仅有有限的数据。
在两家大型多专科教学机构中，对92例老年患者（≥65岁，平均年龄70.1±4.1岁）和182例年轻患者（<65岁，平均53.9±7.4岁）进行了比较，这些患者在经历重大心脏事件后参加了二期心脏康复和运动项目，比较了他们的基线数据和康复后的数据，包括血浆脂质、肥胖指标及运动能力。
基线时，老年患者的体重指数（26.0±3.9 vs. 27.8±4.2 kg/m²，p<0.001）、甘油三酯（141±55 vs. 178±105 mg/dl，p<0.01）和估计代谢当量（METs）（5.6±1.6 vs. 7.7±3.0，p<0.0001）较低，高密度脂蛋白胆固醇较高（40.4±12.1 vs. 37.5±10.4 mg/dl，p<0.05）。康复后，老年患者的METs（5.6±1.6 vs. 7.5±2.3，p<0.0001）、体重指数（26.0±3.9 vs. 25.6±3.8 kg/m²，p<0.01）、体脂百分比（24.4±7.0 vs. 22.9±7.2%，p<0.0001）、高密度脂蛋白胆固醇（40.4±12.1 vs. 43.0±11.4 mg/dl，p<0.001）以及低密度与高密度脂蛋白胆固醇之比（3.6±1.3 vs. 3.3±1.0，p<0.01）均有显著改善，甘油三酯有所下降但接近统计学显著性（141±55 vs. 130±76 mg/dl，p = 0.14），总胆固醇和低密度脂蛋白胆固醇则无变化。老年患者和年轻患者在功能能力、体脂百分比、体重指数以及脂质方面的改善在统计学上相似。
尽管存在基线差异，但参加心脏康复和运动训练的老年患者和年轻患者在运动能力、肥胖指标及脂质方面的改善非常相似。这些数据强调，不应断然拒绝老年患者从包括正规心脏康复和有监督的运动训练在内的二级冠心病预防中获得的心理社会、身体及危险因素方面的益处。
