Fujimoto S, Uemura S, Tomoda Y, Yamamoto H, Matsukura Y, Hashimoto T, Dohi K
First Department of Internal Medicine, Nara Medical University.
J Cardiol. 1997 Feb;29(2):85-93.
The effects of early physical training on heart rate variability and autonomic nerve activity in acute myocardial infarction were studied in 20 patients (men, mean age 57 +/- 11 years) successfully treated by direct coronary angioplasty. Patients were randomly divided into the physical training group (training group: 10 patients) and conventional rehabilitation group (non-training group: 10 patients). Exercise tolerance (VO2 peak and anaerobic threshold: AT), heart rate variability indices, serum levels of catecholamines, and 24-hour urinary excretion of catecholamines were measured on the 14th and 28th days. The conventional cardiac rehabilitation program was followed by each group, and the training group patients were also instructed to follow a training program using the bicycle ergometer (80% AT, 10 min, 2 times a day) for 2 weeks from the 15th day. Autonomic nerve activity was assessed by non-spectral (24-hour averaged normal RR intervals: mean NN, standard deviation of normal RR intervals over 24 hours: SDNN and standard deviation of the mean RR intervals for each 5 min periods over 24 hours: SDANN) and spectral [high frequency power (HF) 0.15-0.40 Hz; represents parasympathetic activity, and the low/high frequency power (L/H ratio); represents sympathetic activity] indices of heart rate variability. There were no cardiac events during physical training. Comparison of the 14th and 28th day in the training group showed that the VO2 peak and VO2 AT significantly increased, SDNN and SDANN significantly increased, HF (82.5 +/- 56.2 to 131.1 +/- 99.8 msec2) increased and the L/H ratio (3.9 +/- 2.2 to 2.6 +/- 1.3) decreased significantly during the night-time, and serum noradrenalin concentration (0.47 +/- 0.11 to 0.35 +/- 0.13 ng/ml) and urinary noradrenalin excretion (195.6 +/- 130.7 to 139.6 +/- 73.3 micrograms/day) significantly decreased. In contrast, the non-training group showed no significant changes. These results suggest early physical training may be safe and improves the autonomic nerve balance and exercise tolerance in patients with acute myocardial infarction.
对20例经直接冠状动脉血管成形术成功治疗的患者（男性，平均年龄57±11岁）进行了研究，以探讨早期体育锻炼对急性心肌梗死患者心率变异性和自主神经活动的影响。患者被随机分为体育锻炼组（锻炼组：10例患者）和传统康复组（非锻炼组：10例患者）。在第14天和第28天测量运动耐力（峰值摄氧量和无氧阈值：AT）、心率变异性指标、儿茶酚胺血清水平以及24小时尿儿茶酚胺排泄量。每组均遵循传统的心脏康复方案，锻炼组患者还从第15天开始接受使用自行车测力计的锻炼方案（80%AT，10分钟，每天2次），为期2周。通过心率变异性的非频谱指标（24小时平均正常RR间期：平均NN、24小时内正常RR间期的标准差：SDNN以及24小时内每5分钟时间段平均RR间期的标准差：SDANN）和频谱指标[高频功率（HF）0.15 - 0.40Hz；代表副交感神经活动，以及低频/高频功率比值（L/H比值）；代表交感神经活动]评估自主神经活动。体育锻炼期间未发生心脏事件。锻炼组第14天和第28天的比较显示，峰值摄氧量和VO2 AT显著增加，SDNN和SDANN显著增加，HF（82.5±56.2至131.1±99.8msec2）增加，夜间L/H比值（3.9±2.2至2.6±1.3）显著降低，血清去甲肾上腺素浓度（0.47±0.11至0.35±0.13ng/ml）和尿去甲肾上腺素排泄量（195.6±130.7至139.6±73.3μg/天）显著降低。相比之下，非锻炼组无显著变化。这些结果表明，早期体育锻炼可能是安全的，并可改善急性心肌梗死患者的自主神经平衡和运动耐力。
