无氧阈强度运动治疗对慢性缺血性心脏病患者运动耐力的影响

目的 探讨无氧阈强度运动治疗对血管重建后的慢性缺血性心脏病患者运动耐力的影响.方法 43例完全血管重建后的慢性缺血性心脏病患者(3例冠脉搭桥,22例陈旧性心肌梗死及18例不稳定性心绞痛),实施了心肺运动负荷试验(CPET)和3个月的无氧阈强度的运动治疗,其中32例患者完成了运动治疗; 3个月后复查CPET,比较患者运动耐力的前后变化.结果 无氧阈运动强度心率[(97±9)次/min]显著小于传统运动康复的最小运动强度心率[(112±7)次/min],小于运动试验的最初缺血强度心率[(115±11)次/min];3个月后运动处方执行组无氧阈氧耗量从(10.7±2.4 ) ml·min-1·kg-1到(12.6±2.9) ml·min-1·kg-1(P=0.04),有氧运动负荷能力从(37±18) J/s到(47±13) J/s(P=0.04),峰值氧耗量从(15.3±3.1) ml·min-1·kg-1到(20.6±4.2) ml·min-1·kg-1(P=0.02)及峰值运动负荷能力(68±12) J/s到(87±14) J/s(P=0.01),均明显增加;运动处方未执行组的无氧阈氧耗量从(11.0±2.7) ml·min-1·kg-1到(11.3±2.8) ml·min-1·kg-1,有氧运动负荷能力从(38±11) J/s到(37±9) J/s,峰值氧耗量从(15.3±2.9) ml·min-1·kg-1到(16.2±3.1) ml·min-1·kg-1] 和峰值运动负荷能力从(65±13) J/s到(73±16) J/s增加,差异均无统计学意义.结论 无氧阈强度显著小于慢性缺血性心脏病患者运动最初出现缺血时的强度;无氧阈强度运动治疗能有效地提高慢性缺血性心脏病患者的氧代谢水平和运动耐受力.

Abstract：

Objective To investigate the effects of exercise therapy at the intensity of anaerobic threshold (AT) for exercise tolerance in patients with chronic stable coronary artery disease. Methods Forty-three patients with chronic stable coronary artery disease (3 patients after coronary arterial bypass graft (CABG) surgery, 22 patients with old myocardial infarction and 18 unstable angina pectoris undergoing successful percutaneous coronary intervention (PCI) finished twice cardiopulmonary exercise test (CPET) and followed their rehabilitation program for 3 months. Thirty-two patients finished their aerobic exercise therapy based on their individual anaerobic thresholds while 11 patients had no exercise therapy. Results The heart rate at AT intensity (97±9 /min) was lower than their traditional minimal target heart rate (112±7 /min) and lower than heart rate (115±11 /min) at ischemic threshold post-CPET. The O2 consumption (10.7±2.4 to 12.6±2.9 ml·min-1·kg-1) （P=0.04） and workload (37±18 to 47±13 J/s) （P=0.04）at AT level and the O2 consumption (15.3±3.1 to 20.6±4.2 ml·min-1·kg-1,P=0.02) and workload（68±12 and 87±14 J/s, P=0.01）at peak levelmarkedly increased after 3 months in the exercise group. And the O2 consumption（15.3±2.9 to 16.2±3.1 ml·min-1·kg-1）and workload（65±13 to 73±16 J/s）at peak level mild increased after 3 months in the non-exercise group, but their O2 consumption （11.0±2.7 to 11.3±2.8 ml·min-1·kg-1）and workload （38±11 to 37±9 J/s）at AT level had no obvious change. Conclusion AT exercise intensity was lower than ischemic threshold post-CPET. Exercise therapy at the intensity of anaerobic threshold can improve oxygen capacity and exercise tolerance.

Effects of exercise therapy at the intensity of anaerobic threshold for exercise tolerance in patients with chronic stable coronary artery disease

Objective To investigate the effects of exercise therapy at the intensity of anaerobic threshold (AT) for exercise tolerance in patients with chronic stable coronary artery disease. Methods Forty-three patients with chronic stable coronary artery disease (3 patients after coronary arterial bypass graft (CABG) surgery, 22 patients with old myocardial infarction and 18 unstable angina pectoris undergoing successful percutaneous coronary intervention (PCI) finished twice cardiopulmonary exercise test (CPET) and followed their rehabilitation program for 3 months. Thirty-two patients finished their aerobic exercise therapy based on their individual anaerobic thresholds while 11 patients had no exercise therapy. Results The heart rate at AT intensity (97±9 /min) was lower than their traditional minimal target heart rate (112±7 /min) and lower than heart rate (115±11 /min) at ischemic threshold post-CPET. The O2 consumption (10.7±2.4 to 12.6±2.9 ml·min-1·kg-1) （P=0.04） and workload (37±18 to 47±13 J/s) （P=0.04）at AT level and the O2 consumption (15.3±3.1 to 20.6±4.2 ml·min-1·kg-1,P=0.02) and workload（68±12 and 87±14 J/s, P=0.01）at peak levelmarkedly increased after 3 months in the exercise group. And the O2 consumption（15.3±2.9 to 16.2±3.1 ml·min-1·kg-1）and workload（65±13 to 73±16 J/s）at peak level mild increased after 3 months in the non-exercise group, but their O2 consumption （11.0±2.7 to 11.3±2.8 ml·min-1·kg-1）and workload （38±11 to 37±9 J/s）at AT level had no obvious change. Conclusion AT exercise intensity was lower than ischemic threshold post-CPET. Exercise therapy at the intensity of anaerobic threshold can improve oxygen capacity and exercise tolerance.