Eur Heart J. 1998 Mar;19(3):466-75. doi: 10.1053/euhj.1997.0736.
Beneficial effects of physical training on exercise tolerance, autonomic and skeletal muscle function and limb blood flow have been demonstrated in chronic heart failure. Because this rehabilitation is expensive, may involve risk, and has unknown effects on prognosis, the possibility of predicting benefit on the basis of individual patient data is intriguing. The most suitable exercise training programme has not yet been established.
We reviewed the progress of 134 stable heart failure patients studied in randomized controlled trials of physical training. A significant training effect (+13% peak oxygen consumption, +17% exercise duration) was associated with improved autonomic indices (resting catecholamines and hormones, heart rate variability), without significant side-effects. No ventilatory, haemodynamic, autonomic or clinical factor at baseline was a predictor of outcome. Similar beneficial effects were observed in both male and female patients. The improvement in oxygen consumption after 16 weeks training was higher than after 6 weeks (+2.6 +/- 3.0 vs +0.3 +/- 3.1 ml.kg.min-1, P < 0.05). The combination of cycle ergometer with calisthenic exercises was more beneficial than cycle ergometer alone (+2.7 +/- 4.2 vs 1.2 +/- 2.0 ml.kg.min-1, P < 0.01). The presence of nonsustained ventricular tachycardia did not preclude a training effect. Patients older than 70 years were able to train, although less effectively than the younger ones. No difference in exercise gain was observed whether the patients trained in the hospital or at home.
The positive effects of physical rehabilitation in chronic stable heart failure patients are confirmed. No baseline patient factor was significantly correlated with outcome. A tailored, moderate, home-based, combined cycle ergometer, plus calisthenic exercise training seems safe and beneficial in a large cohort of heart failure patients, with similar benefits in a variety of conditions and different hospital settings.
体育锻炼对慢性心力衰竭患者的运动耐力、自主神经和骨骼肌功能以及肢体血流具有有益作用。由于这种康复治疗费用高昂，可能存在风险，且对预后的影响尚不清楚，因此基于个体患者数据预测获益的可能性很有吸引力。目前尚未确定最合适的运动训练方案。
我们回顾了134例稳定型心力衰竭患者在体育锻炼随机对照试验中的研究进展。显著的训练效果（峰值耗氧量增加13%，运动持续时间增加17%）与自主神经指标改善（静息儿茶酚胺和激素、心率变异性）相关，且无明显副作用。基线时的通气、血流动力学、自主神经或临床因素均不能预测结局。男性和女性患者均观察到类似的有益效果。16周训练后的耗氧量改善高于6周后（分别为+2.6±3.0与+0.3±3.1 ml·kg·min⁻¹，P<0.05）。踏车测力计与健身操相结合的训练方式比单独使用踏车测力计更有益（分别为+2.7±4.2与1.2±2.0 ml·kg·min⁻¹，P<0.01）。非持续性室性心动过速的存在并不妨碍训练效果。70岁以上的患者能够进行训练，尽管效果不如年轻患者。患者在医院或家中训练，运动获益无差异。
证实了体育康复对慢性稳定型心力衰竭患者的积极作用。没有基线患者因素与结局显著相关。在大量心力衰竭患者队列中，量身定制的、适度的、基于家庭的、踏车测力计加健身操的联合运动训练似乎安全有益，在各种情况和不同医院环境中均有类似益处。
