运动对慢性心衰患者心肺功能的影响

目的：评价医疗体育运动对慢性心衰心肺功能的影响。方法：采用分级踏车试验检测79例慢性心衰患的心肺功能，对比观察运动指导对慢性心衰患心肺功能及血流动力学的影响。结果：运动组较传统疗养组VO2max,VO2max/kg,VO2max/HR,HRmax及VEmax平均值增高，除HRmax外，差异有显性（P＜0．05）；每搏量，心率，平均血压显改善（P＜0．05）。无氧阈时运动组心肺功能指标上升（P＜0．05）。结论：运动能改善慢性心衰患的运动贮量，减轻疲劳和呼吸困难，对预后有重要意义。     

急性心肌梗塞运动试验的临床价值

目的：研究急性心肌梗塞（AMI）患者平板运动试验的评定心功能、指导康复作用。方法：16例AMI病人（平均56．5岁）在发病4周后按照Bruce方案进行症状限止平板运动试验。结果：VO2max3～12（平均7．3±3．8）METs；HRmax106～186（平均152．7±29．7）次／分；运动试验阳性12例．其中ST段下移、VO2max＜4METs者6例（50％）；ST段抬高、VO2max＜4METs者5例（31．2％）；没有1例发生意外。结论：AMI病人的运动试验对评定心功能、指导康复有较大临床意义；只要掌握适应证、禁忌证，运动中严密监护．AMI病人运动试验是安全的。     

冠心病患者自我监督下的运动锻炼处方

冠心病患者的运动锻炼在医生指导下进行好,但自我进行也不难。因为“心率”可代表心肌耗氧量,运动锻炼强度多以心率为标准,只要了解各年龄组的最大心率,即可选择自己锻炼的心率～靶心率。从各年龄组的最大心率看,平日多以(170～180)减年龄的为冠心病运动锻炼的靶心率,此公式之差相当于最大心率的70％左右。     

156例平板运动试验与冠状动脉造影结果对照分析

目的将平板运动试验的结果与冠状动脉造影（CAG）的结果对照，探讨平板运动试验与冠状动脉病变的相关关系。方法选择临床拟诊冠心病（CHD）患者156例，2周内行平板运动试验与CAG检查。将平板运动试验的结果与CAG的结果对照分析。结果①156例患者中，平板运动试验阳性67例，其中CAG阳性50例，CAG阴性17例。平板运动试验阴性89例，其中CAG阴性75例，CAG阳性14例。平板运动试验检出CHD的敏感性为75．3％（67／89），特异性为81．5％（75／92），阳性预测值74．6％（50／67），阴性预测84.3％（75／89），预测准确性80．1％（125／156），假阳性率为25．4％（17／67），假阴性率为15．7％（14／89）。②平板运动试验阳性率与冠状动脉病变支数有关；平板运动中ST段下移程度、出现时间及持续时间与冠状动脉狭窄程度有关。③女性平板运动试验假阳性率高于男性（P〈0．05）。结论平板运动试验是目前诊断冠心病较理想的非创伤性的检查方法，并可估测冠状动脉病变程度，适合临床广泛应用。     

老年慢性心力衰竭患者临床特点及遵循指南优化药物治疗现状

目的：探讨老年慢性心力衰竭（简称心衰）患者临床特点、病因分布及治疗现状,以促进遵循指南规范药物治疗。方法：对1226例年龄／〉65岁心衰患者病历资料进行回顾性分析,包括年龄、性别、血压、心率、纽约心功能分级（NYHA分级）、病因构成、遵循指南优化药物治疗情况等进行分析。结果：1226例患者中,男性510例（41．6％）,年龄（71．4±6．4）岁;女性716例（58．4％）,年龄（77．3±9．6）岁（P〈0．05）。男性舒张压为（85．6±16．8）mmHg、女性为（95．3±18．4）mmHg（P〈0．05）;男性心率为（82±21）次／min、女性为（98±26）次／min（P〈0．05）。NYHA分级≥Ⅲ级女性高于男性（P〈0．05）。心衰最常见病因：冠心病31．5％、高心病27．0％、肺心病13．7％、老年瓣膜病12．4％、心肌病9．3％、风心病6．1％。治疗以血管紧张素转换酶抑制剂／血管紧张素受体拮抗剂（68．1％）、β受体阻滞剂（63．3％）、利尿剂（73．9％）、洋地黄（69．2％）、醛固酮受体拮抗剂（54．5％）为主。但β受体阻滞剂随着NYHA分级增加而使用量减少。结论：老年心衰患者在年龄、舒张压、心率、NYHA分级有性别差异。病因以冠心病最常见。药物治疗与指南推荐尚有差距。     

运动激发试验过程中目标运动强度指标的对比分析

目的比较运动激发试验中FEV1预计的最大运动功率(WRpeak)与实际WRpeak的差异,并探讨新的运动强度指标。方法共入组39例患者,进行运动激发试验及运动前后常规肺功能检测,比较各运动强度指标预计值与实测值的差异。结果患者的实测WRpeak明显低于预计WRpeak,差异有统计学意义(P0.001);实测最大运动心率(HRmax)明显低于预计HRmax,差异有统计学意义(P0.001)。但HRmax变异率低于WRpeak变异率,差异有统计学意义(P0.05)。WRpeak、HRmax与最大通气量(MVV)具有相关关系(P0.05)。结论用FEV1预计的WRpeak与实际WRpeak有统计学差异,但运动心率的差异较小,用最大预计心率来确定目标运动强度比FEV1预计的目标运动强度更接近受试者的实际最大运动强度。     

运动对心绞痛患者的康复作用

目的：观察运动对心绞痛患的康复作用。方法：48例心绞痛患被随机分为A，B两组，所有病例均接受心绞痛常规药物治疗，A组患同时进行运动训练，隔日1次，运动靶心率为该病人运动试验能达到的最大心率的75％－85％，运动持续时间30分钟左右；B组患采取自然生活。结果：随访1年，A组在心绞痛发作频率，持续时间，缺血性心电图，心功能改善方面均优于B组（P＜0．05）。A组运动期间未发生心肌梗死，猝死。结论：运动康复对心绞痛患安全有效，应大力提倡。     

PCI术后冠心病患者运动靶心率简易计算法与无氧阈法的一致性评价

目的:评价对于接受经皮冠状动脉介入治疗（PCI）的冠心病患者,简易计算法所得的靶心率与通过心肺运动试验（CPET）所得的无氧阈靶心率的一致性。方法:该研究为诊断性试验。纳入2011年10月至2021年4月北京大学人民医院心内科收治的初次行PCI的冠心病患者,并进一步根据性别、年龄（<60岁组和≥60岁组）、是否曾发生心...     

运动疗法对病态窦房结综合症的影响及疗效

目的：采用运动疗法治疗临床症状较轻的病态窦房结综合症（SSS），探索适当的运动训练强度，观察临床疗效。方法：以动态有氧训练对16例SSS患者进行治疗，靶心率=（最大心率-静态心率）×0．5～0.8＋静态心率）。结果：经运动疗法六个疗程后，患者的平均静态心率和动态心率均有提高，心律失常现象明显减少（P＜0．01），临床症状明显改善。结论：适当的运动锻炼可提高SSS患者的心率，改善其症状。     

体外反搏＋功率车运动对冠心病的康复疗效

冠心病康复运动中功率车被普遍应用，我院同时应用体外反搏（ECP）十功率车运动治疗26例冠心病人，收到满意疗效，现报告如下：l对象与方法：1．王对象冠心病人46例，为1995～1997年我院住院病人，均符合全国冠心病诊断标准，有不同程度ST－T改变。随机分为A、B二组。A组（体外反搏十功率车运动）26例，男20例，女6例；年龄45～65（平均55）岁；病程10±5年。B组（单纯体外反搏）20例，男12例，女8例；年龄46～63（平均54．5）岁；病程10±5年。心功能≥IV级及有体外反搏及运动禁忌病者除外。1．2方法体外反搏仪选用广州医疗器械厂产W…     

Is brisk walking an adequate aerobic training stimulus for cardiac patients?

Walking is the most common aerobic training modality utilized in cardiac rehabilitation programs. However, it remains unclear whether or not brisk walking is of a sufficient intensity to improve aerobic fitness in this population. In this study, we investigated whether men and women with coronary artery disease can achieve an exercise intensity that is sufficient to induce a training effect, ie, a training heart rate (THR), defined as >/= 70% of measured maximal heart rate (HRmax), via brisk walking on a flat surface. One hundred forty-two outpatient volunteers from the William Beaumont Hospital Cardiac Rehabilitation Program (Royal Oak, MI) and the University of Wisconsin-La Crosse Exercise and Health Program (La Crosse, WI) were asked to walk one mile as briskly as possible on measured tracks. Heart rate was monitored throughout the walk via radiotelemetry. The percentage of patients within each gender and phase of rehabilitation who attained a THR were assessed using peak or symptom-limited exercise testing to determine the HRmax. All of the women and 90% of the men achieved a THR, averaging 85 +/- 8% and 79 +/- 10% of HRmax, respectively (mean +/- SD). There was no difference in the percentage of phase II or phase III cardiac rehabilitation program patients who achieved a THR. These findings suggest that brisk walking is of a sufficient intensity to elicit a THR in all but the most highly fit patients with coronary disease. Thus, physicians and allied health professionals can prescribe brisk walking on a flat surface to their cardiac patients with confidence that this intensity will achieve cardiorespiratory and health benefits.     

心脏术后恢复期患者的运动处方及实施方案

目的:探讨心脏术后恢复期患者安全有效而又实用的运动处方及实施方案。方法:21例心脏术后患者均接受医疗体操、缓慢步行、功率自行车、跑台等运动训练,从低运动强度开始,逐渐增加运动量,运动强度为最大心率的70%-85%.或RPE12-14级,并采用症状限制性心电图运动试验对训练前、后的各项指标进行比较。结果:心脏术后恢复期患者均能顺利完成本处方所规定的运动量,且无1例发生异常情况。康复运动训练后,患者运动时间延长、最大运动负荷增加、安静及同等负荷运动时心率减慢、血压及二项乘积(间接心肌耗氧量)下降(P<0.05-<0.01),安静及运动诱发的最大ST段下移改善(P<0.01)。结论:此运动处方对于心脏术后恢复期患者是安全、有效的。     

Comparative study of exercise-induced ischaemia in coronaropathy and aortic stenosis

OBJECTIVE: To compare exercise and recovery data between a population of patients with proven CAD and patients with pure aortic stenosis (AS). PATIENTS AND METHODS: Exercise testing results (bicycle ergometry) of 45 patients with AS (34 men, 66+/-12 years, 56+/-20 mmHg peak-to-peak gradient and valve area 0.78+/-0.48cm2) were compared to exercise testing results of 50 patients with CAD (41 men, 65+/-9 years, greater or equal to 70% stenosis on one vessel in 62%, two vessels in 30%, three vessels in 8%). RESULTS: During exercise, 38% patients with AS and 82% patients with CAD had clinical symptoms. In the AS group, exercise duration was longer, heart rate (HR) was higher, maximal systolic and diastolic blood pressure were lower than in CAD group. The increase of systolic blood pressure was lower in the AS group (34+/-21 mmHg versus 47+/-27 mmHg, p<0.02). Maximal load achieved was not significantly different. Exercise ST depression appeared in 76% of AS group and 88% of CAD group (NS). No difference was found in ST depression, Detrano index and ST segment/HR slope. During recovery, no difference was found in HR variations. Clockwise rotation of the ST/HR recovery loop was more frequent in CAD group (35 patients versus 19 patients, p<0.001). CONCLUSION: Most of the exercise and recovery data are similar in patients with AS and CAD. Significant discriminating criteria were the increase of systolic blood pressure during exercise and ST/HR recovery loop.     

Reduction of submaximal exercise myocardial oxygen demand post-walk training program in coronary patients due to improved physical work efficiency

To assess the effects of walk training on external work efficiency and the determinants of myocardial oxygen demand (MVO₂), we measured total somatic oxygen consumption (VO₂), heart rate (HR), and systolic blood pressure (SBP) in eight male coronary (CAD) patients during submaximal treadmill walking before and after at least 14 weeks of prescribed exercise. Each patient was tested before and after training at the individually determined horizontal treadmill speed that induced ischemic ST segment depression in the pretraining test. Although maximal oxygen uptake (VO₂ max) did not increase significantly with training, submaximal exercise HR and the product of HR and SBP were significantly (p < 0.05) reduced by 10% (120 → 108/min) and 16% (185 × 10² → 156 × 10²), respectively, and none of the patients had ischemic ECG changes after training. The reductions in the cardiac response to exercise were due primarily to a 10% decrease (18.9 → 17.1 ml/kg/min, p < 0.05) in somatic oxygen requirements (VO₂), indicating that the patients became more efficient walkers and reduced their MVO₂ in proportion to the decreased total VO₂. Thus, enhancement of external work efficiency, an extracardiac factor, can lessen myocardial energy costs (MVO₂) and thereby raise the exercise threshold for cardiac ischemia in CAD patients even when aerobic capacity (VO₂ max) is not increased.     

Demonstration of training effect during chronic beta-adrenergic blockade in patients with coronary artery disease

Attenuation of exercise-induced increases in heart rate and cardiac output by chronic beta-adrenergic blockade has been thought to compromise benefit of exercise training in patients with coronary artery disease (CAD). To assess this important issue, 35 CAD patients were evaluated by a 3-month walk-jog-cycle training program: 14 patients received no beta blocker (group 1), 14 received propranolol, 30-80 mg/day (group 2), and seven patients received propranolol, 120-240 mg/day (group 3). The extent of CAD, resting heart rate before training blood pressure and VO2 max were similar (p = NS) in each group. The maximal exercise heart rate (mean +/- SD, 147 +/- 21 beats/min in group 1 vs 120 +/- 10 beats/min in group 2 and 115 +/- 12 beats/min in group 3 (both p less than 0.05 vs group 1). The VO2 max before training was 25 +/- 5.0 ml/kg/min in group 1 vs 23 +/- 3.2 ml/kg/min in group 2 and 26 +/- 2.8 ml/Kg/min in group 3 (all p = NS). Training consisted of three 1-hour periods per week at a heart rate of 70-85% of the maximal pretraining heart rate. In each group, VO2 increased (p less than 0.05) after training: group 1, 27%; group 2, 30%; group 3, 46%. The double product was unchanged after training (p = NS) in each group. These data indicate that substantial training effects may be achieved in CAD patients despite therapeutic doses of beta blockers and a reduced training HR. Thus, there appears to be no indication to reduce beta blockers in CAD patients engaged in cardiac rehabilitation.     

Electrocardiographic responses to deer hunting activities in men with and without coronary artery disease

To evaluate the cardiac demands of hunting deer, continuous ambulatory electrocardiograms were obtained in men with and without coronary artery disease (CAD) and compared with their responses to maximal treadmill testing. A volunteer sample of 25 middle-aged men (mean +/- SD 55 +/- 7 years of age), 17 of whom had known CAD, completed the study. Peak heart rate (HR) during 7 different deer hunting activities was expressed as the mean percentage of the maximal HR (HRmax) attained during treadmill testing. Periods of sustained sinus tachycardia were identified. Arrhythmias and ST-segment depression during deer hunting that were not apparent during treadmill testing were documented. Overall, 22 of 25 subjects demonstrated HR responses >85% HRmax for 1 to 65 minutes. Ten subjects exceeded the HRmax achieved during treadmill testing for 1 to 5 minutes. The relative HR response during ambulatory activity in the field was inversely related to cardiorespiratory fitness, expressed as METs (r = -0.59; p = 0.0020). Three subjects had ischemic electrocardiograms during deer hunting, but not during treadmill testing. Complex arrhythmias in the field not detected by treadmill testing included ventricular bi-trigeminy, ventricular couplets, and 8 runs of ventricular tachycardia (3 to 28 beats) in 3 subjects with documented CAD. In conclusion, deer hunting can evoke sustained HRs, ischemic ST-segment depression, and threatening ventricular arrhythmias in excess of those documented during maximal treadmill testing. The strenuous nature of deer hunting coupled with presumed hyperadrenergia and superimposed environmental stresses may contribute to the excessive cardiac demands associated with this activity.     

Heart rate recovery after exercise is a predictor of mortality,independent of the angiographic severity of coronary disease

OBJECTIVES: We sought to determine whether abnormal heart rate recovery predicts mortality independent of the angiographic severity of coronary disease. BACKGROUND: An attenuated decrease in heart rate after exercise, or heart rate recovery (HRR), has been shown to predict mortality. There are few data on its prognostic significance once the angiographic severity of coronary artery disease (CAD) is ascertained. METHODS: For six years we followed 2,935 consecutive patients who underwent symptom-limited exercise testing for suspected CAD and then had a coronary angiogram within 90 days. The HRR was abnormal if < or =12 beats/min during the first minute after exercise, except among patients undergoing stress echocardiography, in whom the cutoff was < or =18 beats/min. Angiographic CAD was considered severe if the Duke CAD Prognostic Severity Index was > or =42 (on a scale of 0 to 100), which corresponds to a level of CAD where revascularization is associated with better long-term survival. RESULTS: Severe CAD was present in 421 patients (14%), whereas abnormal HRR was noted in 838 patients (29%). There were 336 deaths (11%). Mortality was predicted by abnormal HRR (hazard ratio [HR] 2.5, 95% confidence interval [CI] 2.0 to 3.1; p < 0.0001) and by severe CAD (HR 2.0, 95% CI 1.6 to 2.6; p < 0.0001); both variables provided additive prognostic information. After adjusting for age, gender, standard risk factors, medications, exercise capacity, and left ventricular function, abnormal HRR remained predictive of death (adjusted HR 1.6, 95% CI 1.2 to 2.0; p < 0.0001); severe CAD was also predictive (adjusted HR 1.4, 95% CI 1.1 to 1.9; p = 0.008). CONCLUSIONS: Even after taking into account the angiographic severity of CAD, left ventricular function, and exercise capacity, HRR is independently predictive of mortality.     

Effect of long-term exercise training on regional myocardial perfusion changes in patients with coronary artery disease

The cardiac rehabilitation of patients with coronary artery disease (CAD) promotes exercise tolerance, improves left ventricular function, and decreases the heart rate and systolic blood pressure at the same load intensity. Several studies have shown that cardiac rehabilitation improves myocardial perfusion in CAD patients. However, the long-term (> or = 1 year) effect of cardiac rehabilitation on myocardial perfusion is still controversial. The effect of long-term exercise training on myocardial perfusion in CAD patients was assessed using thallium-201 (201Tl) exercise studies at a baseline (4 months after the onset of CAD) and at a 1-year or more follow-up in 58 patients with stable CAD. The subjects had been divided into a training group (n=35) participating in supervised exercise 2 times per week for the follow-up period, and the control group (n=23). There was an improvement in the myocardial perfusion on stress 201Tl scintigraphy in 20 of the 35 (57.1%) trained patients and in 3 of the 23 (13.0%) of the control patients (p<0.001). The number of 201Tl stress myocardial perfusion defect segments was significantly decreased after the cardiac rehabilitation training (231 to 153 segments), but showed no change in the control group (158 to 156 segments) (p<0.01). In spite of no significant differences in the number of involved coronary arteries, it improved (12/17 patients: 70.6%) more in the patients who had trained for more than 2 years compared to the patients who had trained for less than 2 years. The exercise tolerance increased in 25 of the 35 training group patients (71.4%), and in only 3 of the 23 control group patients (13.0%). The peak double products increased from 20,131+/-6,010 to 28,370+/-5,600 (p<0.01) in the training group, and showed no change in the control group (20,567+/-5,112 to 20,964+/-7,728 (NS)). The results indicated that the long-term physical training increased exercise tolerance and the double products of CAD patients. In addition, the training resulted in improved cardiac perfusion as evidenced by 201Tl scintigraphy. The findings suggest that exercise training is an advisable and effective treatment for patients with CAD.