Balady G J, Jette D, Scheer J, Downing J
Evans Memorial Department of Clinical Research, Boston University Medical Center, Massachusetts 02118, USA.
J Cardiopulm Rehabil. 1996 Jan-Feb;16(1):38-46. doi: 10.1097/00008483-199601000-00005.
Using information collected prospectively from a multicenter cardiac rehabilitation database, this study was designed to evaluate baseline exercise tolerance and subsequent change in functional capacity among consecutive patients enrolled in supervised cardiac rehabilitation stratified according to age and gender. In addition, the study evaluated change in functional capacity among those with the lowest initial exercise tolerance (<5 METS) and assessed patient factors that correlate to the highest relative improvements in functional capacity after training.
A total of 778 patients performed an initial exercise test upon entry into cardiac rehabilitation, during which peak heart rate, blood pressure, and estimated peak MET levels were derived, and ischemic responses were evaluated. After 10 +/- 2 weeks of supervised prescribed exercise, 500 patients who completed the program performed follow-up exercise testing.
The subjects included 558 men (72%) and 220 women (28%) of whom 492 (63%) were <65 years, 241 (31%) were 65 to 75 years, and 45 (6%) were >75 years. At baseline, the peak initial MET level for men was 8.6 +/- 3.4 METS and for women was 6.0 +/- 2.6 METs. The peak initial MET level declined with age: age <65 = 8.9 +/- 3.4 METS; age 65 to 75 = 6.6 +/- 2.6 METS; and age >75 = 5.7 +/- 2.9 METS. When stratified according to age and gender, the baseline exercise tolerance for men significantly (P <.0001) declined with age and was higher than that of women <65 and 65 to 75 years of age. After training, the relative improvement in exercise tolerance for each age and/or gender subgroup was: age <65: men 36%, women 41%; age 65 to 75: men 36%, women 50%; and age >75: men 36%, women 32%. Among 163 patients with an initial peak MET level <5, exercise tolerance rose from 4.1 +/- 0.7 to 8.3 +/- 3.5 METS (P <.0001). Multivariate analysis demonstrated that the greatest change in exercise tolerance with training was associated with those compliant patients with initial peak METS <5. No significant net change in the occurrence of exercise-induced ischemia was observed.
Among consecutive patients enrolled in cardiac rehabilitation, baseline exercise tolerance differs relative to age and gender, with male gender and younger age demonstrating the highest functional capacity. Exercise training yielded significant improvements in exercise tolerance among men and women of every age group including those older than 75 years, and particularly among those with an initial peak MET level <5. Thus, referral to cardiac rehabilitation programs should be advocated for both men and women, and should not be limited by age.
本研究利用从多中心心脏康复数据库前瞻性收集的信息，旨在评估连续纳入监督性心脏康复的患者的基线运动耐量以及根据年龄和性别分层后的功能能力的后续变化。此外，该研究评估了初始运动耐量最低（<5代谢当量）者的功能能力变化，并评估了与训练后功能能力相对改善最大相关的患者因素。
共有778名患者在进入心脏康复时进行了初始运动测试，在此期间得出峰值心率、血压和估计的峰值代谢当量水平，并评估缺血反应。在接受10±2周的监督性规定运动后，500名完成该计划的患者进行了随访运动测试。
受试者包括558名男性（72%）和220名女性（28%），其中492名（63%）年龄<65岁，241名（31%）年龄在65至75岁之间，45名（6%）年龄>75岁。基线时，男性的初始峰值代谢当量水平为8.6±3.4代谢当量，女性为6.0±2.6代谢当量。初始峰值代谢当量水平随年龄下降：年龄<65岁 = 8.9±3.4代谢当量；年龄65至75岁 = 6.6±2.6代谢当量；年龄>75岁 = 5.7±2.9代谢当量。按年龄和性别分层时，男性的基线运动耐量随年龄显著下降（P<.0001），且高于65岁及以下和65至75岁的女性。训练后，每个年龄和/或性别亚组的运动耐量相对改善情况为：年龄<65岁：男性36%，女性41%；年龄65至75岁：男性36%，女性50%；年龄>75岁：男性36%，女性32%。在163名初始峰值代谢当量水平<5的患者中，运动耐量从4.1±0.7提高到8.3±3.5代谢当量（P<.0001）。多变量分析表明，训练后运动耐量变化最大与初始峰值代谢当量<5的依从性患者相关。未观察到运动诱发缺血发生率的显著净变化。
在连续纳入心脏康复的患者中，基线运动耐量因年龄和性别而异，男性和较年轻患者的功能能力最高。运动训练使各年龄组的男性和女性，包括75岁以上者，尤其是初始峰值代谢当量水平<5者的运动耐量有显著改善。因此，应提倡男性和女性转诊至心脏康复计划，且不应受年龄限制。
