适量运动对心房颤动患者预后的影响:系统综述与Meta分析

目的 分析适量运动对于心房颤动(房颤)患者的运动能力以及远期临床预后的影响。方法 通过检索中国知网,万方,维普,Pubmed,OVID,Cochrane Central Register of Controlled Trials (CENTRAL),web of science数据库,纳入对房颤患者进行适量体育活动干预的临床试验。本研究的主要终点为静息心率,最大心率,6 min步行试验,最大运动功率,全因死亡率以及卒中发生率,用以评估适量运动对房颤患者活动耐力以及预后的影响。结果 本研究共纳入7项试验,2 452例患者,试验组为适量运动干预组,对照组为不活跃组。适量运动并不会显著增加患者的静息心率(MD=-1.68,P=0.70)以及最大心率(RD=9.72,P=0.11)。运动训练可显著提高房颤患者的运动能力,明显增加6 min步行距离(MD=59.07,95%CI=11.70-106.44,P<0.05),并且在一定程度上提高运动功率(MD=17.96,95%CI=-6.30-42.22,P=0.15)。适量运动对房颤患者的远期预后不会造成不良影响,适量运动组对比不活跃组,全因死亡率为15.7% vs 14.2%(RD=0.03,95%CI=-0.18-0.25,P=0.75);卒中发生率5.0% vs 2.9%(RD=0.02,95%CI=-0.06-0.09,P=0.69),两组差异无统计学意义。结论 适量运动可在一定程度上提高房颤患的活动耐力,且不增加卒中以及全因死亡率。

Effects of moderate exercise on the prognosis of patients with atrial fibrillation:A systematic review and Meta-analysis

Objective To analyze the effects of moderate exercise on exercise capacity and long-term clinical prognosis of patients with atrial fibrillation. Methods The databases of CNKI, Wanfang, VIP, Pubmed, OVID, Cochrane Central Register of Controlled Trials (CENTRAL) and web of science were searched for clinical trials of moderate physical activity intervention on patients with atrial fibrillation. The main endpoints of this study involved the resting heart rate, maximum heart rate, 6-minute walk test, maximum exercise power, all-cause mortality and stroke incidence to evaluate the effects of moderate physical activity on activity tolerance and prognosis of patients with atrial fibrillation. Results A total of 7 trials including 2 452 patients were included. The experimental group was the moderate exercise group, and the control group was the inactive group. Moderate exercise did not significantly increase the resting heart rate (MD=-1.68, P=0.70) and maximum heart rate (RD=9.72, P=0.11). Exercise training could significantly improve the exercise capacity of patients with atrial fibrillation, increase the 6-minute walking distance (MD=59.07, 95%CI=11.70-106.44, P<0.05), and improve the exercise power to a certain extent (MD=17.96, 95%CI=-6.30-42.22, P=0.15). Moderate exercise had no adverse effects on the long-term prognosis of patients with atrial fibrillation. Compared with inactive group, moderate exercise group had 15.7% vs 14.2% (RD=0.03, 95%CI=-0.18-0.25, P=0.75) in all-cause mortality and 5.0% vs 2.9% (RD=0.02, 95%CI=-0.06-0.09, P=0.69) in stroke incidence, and the differences in two groups were not statistically significant. Conclusion Moderate exercise can improve the activity tolerance of patients with atrial fibrillation without increasing stroke and all-cause mortality.