Kiilavuori K, Sovijärvi A, Näveri H, Ikonen T, Leinonen H
Department of Medicine, Helsinki University Central Hospital, Finland.
Chest. 1996 Oct;110(4):985-91. doi: 10.1378/chest.110.4.985.
Decreased exercise capacity is the main factor restricting the daily life of patients with chronic congestive heart failure (CHF). We performed a controlled, randomized study to evaluate the effect of dynamic exercise training of moderate intensity on exercise capacity and gas exchange in patients with CHF. Twenty-seven patients with stable CHF, New York Heart Association (NYHA) functional class II and III, were randomized to training (n = 12) and control (n = 15) groups. During a 3-month period, the training group underwent a supervised physical training program using a bicycle ergometer for 30 min 3 times a week at a load corresponding to 50 to 60% of their peak oxygen consumption. Thereafter, they were advised to continue training at home for the next 3 months. The control group did not change their previous physical activity. A graded maximal exercise test with respiratory gas analysis and an endurance test with constant submaximal workload were performed at baseline and after 3 and 6 months. The exercise endurance increased from 14.7 +/- 2.0 to 27.8 +/- 2.7 min (p < 0.01) and the peak oxygen consumption tended to improve from 19.3 +/- 1.6 to 21.7 +/- 2.3 mL/kg/min (p = 0.09) during the supervised training period. At submaximal workloads, minute ventilation was reduced by 16% per se (p < 0.01) and by 7% in proportion to carbon dioxide production (p < 0.05). Oxygen consumption at the anaerobic threshold increased from 10.5 +/- 0.8 to 12.7 +/- 1.0 mL/kg/min (p < 0.05). The positive training effects were associated with an improvement in the NYHA functional class. The effects of supervised training were preserved during the home-based training period. The results indicate that physical training of moderate intensity significantly improves the exercise capacity and reduces the exaggerated ventilatory response to exercise, particularly at submaximal working levels in patients with CHF. This is associated with alleviation of symptoms.
运动能力下降是限制慢性充血性心力衰竭（CHF）患者日常生活的主要因素。我们进行了一项对照随机研究，以评估中等强度动态运动训练对CHF患者运动能力和气体交换的影响。27例病情稳定的CHF患者，纽约心脏协会（NYHA）心功能分级为II级和III级，被随机分为训练组（n = 12）和对照组（n = 15）。在3个月的时间里，训练组接受了一项有监督的体育训练计划，使用自行车测力计，每周3次，每次30分钟，负荷相当于其峰值耗氧量的50%至60%。此后，建议他们在接下来的3个月里在家继续训练。对照组未改变其先前的身体活动。在基线以及3个月和6个月后进行了带有呼吸气体分析的分级最大运动测试和恒定次最大负荷耐力测试。在有监督的训练期间，运动耐力从14.7±2.0分钟增加到27.8±2.7分钟（p < 0.01），峰值耗氧量倾向于从19.3±1.6毫升/千克/分钟提高到21.7±2.3毫升/千克/分钟（p = 0.09）。在次最大负荷下，每分钟通气量本身减少了16%（p < 0.01），与二氧化碳产生量成比例减少了7%（p < 0.05）。无氧阈值时的耗氧量从10.5±0.8毫升/千克/分钟增加到12.7±1.0毫升/千克/分钟（p < 0.05）。积极的训练效果与NYHA心功能分级的改善相关。在家庭训练期间，有监督训练的效果得以保持。结果表明，中等强度的体育训练可显著提高CHF患者的运动能力，并降低对运动过度的通气反应，特别是在次最大工作水平时。这与症状的缓解相关。
