不同强度的运动康复训练对慢性心力衰竭患者疗效及安全性比较

目的:探究高强度间歇训练(HIIT)/中等强度持续训练(MCT)对慢性心力衰竭(CHF)患者的有效性和安全性。方法:254例慢性心力衰竭的患者,以1∶1∶1的比例随机分配至HIIT组、MCT组和常规运动(RRE)组,均训练12周,随访至52周。通过超声心动图比较各组左心室舒张末期内径(LVEDD)、左室射血分数(LVEF)从基线到12周、52周的变化,通过心肺运动试验比较峰值摄氧量(VO2peak)、最大摄氧量时呼吸商的变化,使用医院焦虑和抑郁量表(HADS)、综合情绪量表(GMS)评估生活质量,运动训练的安全性通过严重不良事件(SAE)的比率来评估。结果:基线~12周,HIIT组LVEDD的变化与MCT组LVEDD变化的差异无统计学意义,HIIT组中LVEDD的变化明显大于RRE组(P<0.05);HIIT组和MCT组VO2peak变化明显大于RRE组(均P<0.05);LVEF、最大摄氧量时呼吸商变化在3组间比较差异均无统计学意义。基线~52周,3组患者LVEDD、LVEF、VO2peak及最大摄氧量时呼吸商变化的差异均无统计学意义。在基线、12周和52周时,3组患者生活质量评估,HADS、GMS评分差异均无统计学意义。在随访期间,3组患者之间SAE发生情况差异无统计学意义。结论:HIIT和MCT这两种不同的训练方案都能使患者受益,运动训练可改善患者逆转左心室重构,但本研究中HIIT和RRE对于LVEDD的改善作用并没有明显差异。两种运动方案都在VO2peak上获得明显改善,对于CHF患者的预后具有积极意义。另外,HIIT和MCT的安全性较RRE并没有明显的劣势。

Efficacy and safety of exercise training with different intensities in patients with chronic heart failure

Objective:To explore the effectiveness and safety of high-intensity interval training(HIIT)/medium intensity continuous training(MCT)in patients with chronic heart failure.Methods:254 patients with chronic heart failure were randomly assigned to HIIT,MCT and routine exercise(RRE)groups with a ratio of 1:1:1.All patients were trained for 12 weeks and followed up to 52 weeks.The changes of left ventricular end diastolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)from baseline to 12 weeks and 52 weeks were compared by echocardiography.The changes of peak oxygen uptake(VO 2peak)and respiratory quotient at maximum oxygen uptake were compared by cardiopulmonary exercise test.Hospital Anxiety and Depression Scale(HADS)and general mood scale(GMS)were used to assess the quality of life and the safety of exercise training.Completeness was assessed by the rate of serious adverse events(SAE).Results:From baseline to 12 weeks,there was no significant difference in the changes of LVEDD between HIIT group and MCT group,while the change of LVEDD in the HIIT group was significantly greater than that in the RRE group(P<0.05).The change of VO 2peak in the HIIT group was significantly greater than that in the RRE group(P<0.05),while the changes of LVEF and respiratory quotient at maximal oxygen uptake showed no statistically significant difference.From baseline to 52 weeks,there was no significant difference in LVEDD,LVEF,VO 2peak and respiratory quotient at maximal oxygen uptake.At base line,12 weeks and 52 weeks,there was no significant difference among the three groups in the quality of life assessment.During the follow-up period,there was no statistically significant difference in the incidence of SAE among the three groups.Conclusion:HIIT and MCT,two different training programs,can benefit patients.Exercise training can reverse left ventricular remodeling,but there is no significant difference between them in improving LVEDD.Both exercise programs can improve the VO 2peak of patients,which is of positive significance for the prognosis of chronic heart failure patients.In addition,the security of HIIT and MCT has no obvious disadvantage compared with RRE.