Afzal A, Brawner C A, Keteyian S J
Henry Ford Heart and Vascular Institute and Department of Internal Medicine, Detroit, MI, USA.
Prog Cardiovasc Dis. 1998 Nov-Dec;41(3):175-90. doi: 10.1016/s0033-0620(98)80054-6.
Patients with heart failure challenge the clinician with a constellation of difficult clinical, pathophysiologic, and psychologic issues. As a result, until recently, exercise training was not considered a safe and effective treatment strategy to be used in these patients. However, in the past 10 years, data from both randomized and nonrandomized trials showed that regular exercise training in patients with stable Class II and III heart failure can safely improve exercise tolerance, attenuate an overactivated sympathetic nervous system, partially reverse skeletal muscle abnormalities, and enhance health-related quality of life. These outcomes are achievable with a relatively moderate dose of physical activity, such as 30 to 60 minutes of walking or cycling 3 to 5 days per week at an intensity equivalent to 60% to 70% of peak oxygen consumption. Sufficiently powered trials are needed to assess morbidity, mortality, and cost-effectiveness endpoints relative to exercise training in patients with heart failure.
心力衰竭患者给临床医生带来了一系列棘手的临床、病理生理和心理问题。因此，直到最近，运动训练仍未被视为适用于这些患者的安全有效的治疗策略。然而，在过去10年中，随机试验和非随机试验的数据均表明，对稳定的II级和III级心力衰竭患者进行规律的运动训练能够安全地提高运动耐量，减弱过度激活的交感神经系统，部分逆转骨骼肌异常，并提高健康相关生活质量。通过相对适度的体力活动剂量即可实现这些结果，例如每周3至5天、每次30至60分钟的步行或骑行，强度相当于峰值耗氧量的60%至70%。需要有足够效力的试验来评估与心力衰竭患者运动训练相关的发病率、死亡率和成本效益终点。
