高强度间歇与中强度持续训练对患者心脏康复效果的Meta分析

Effects of high intensity interval training and moderate continuous training on cardiac rehabilitation:a meta-analysis

目的探讨高强度训练与中强度训练在Ⅱ期心脏康复患者中的应用效果。方法根据检索词检索PubMed、Embase、Cochrane Library、Medline、中国知网、万方数据库、中国生物医学数据库,检索时限为建库至2018年11月。结果最终纳入9篇文献,其中,英文文献8篇,中文文献1篇,共473例患者。在Ⅱ期心脏康复运动中,高强度间歇训练与中强度持续训练比较,可以显著提高患者峰值摄氧量[MD=2.13,95%CI(0.71,3.55),Z=2.94,P<0.01],提高左心室射血分数[MD=3.38,95%CI(1.31,5.46),Z=3.19,P<0.01];与中强度持续训练相比,高强度间歇训练在6 min步行测试[MD=30.10,95%CI (-1.31,61.52),Z=1.88,P=0.06]、改善左心室舒张末容积[SMD=0.14,95%CI(-0.40,0.69),Z=0.51,P=0.61]、提高高密度脂蛋白[SMD=0.09,95%CI(-0.79,0.97),Z=0.21,P=0.83]、降低低密度脂蛋白[SMD=-0.20,95%CI(-0.78,0.38),Z=0.68,P=0.50]、改善生活质量[MD=0.37,95%CI(-8.25,8.99),Z=0.08,P=0.93]方面,差异无统计学意义。亚组分析表明,与中强度持续训练相比,高强度间歇训练可以提高心力衰竭伴射血分数下降患者的峰值摄氧量[MD=2.35,95%CI(0.11,4.58),Z=2.05,P=0.04]、左心室射血分数[MD=3.46,95%CI(0.96,5.96),Z=2.72,P<0.01]。结论在Ⅱ期心脏康复中,高强度间歇训练与中强度持续训练相比,可有效提高患者的峰值摄氧量和左心室射血分数,但在改善患者生活质量、脂质代谢方面二者无明显差别。

Objective To explore the effects of high intensity interval training(HIIT) and moderate continuous training(MCT) in patients with cardiac rehabilitation Phase Ⅱ. Methods PubMed,Embase,Cochrane Library,CNKI,Wanfang database and China Biomedical Database were searched from inception to November 2018. Results Finally 9 articles were included,including 8 in English and 1 in Chinese,with a total of 473 patients. In the PhaseⅡ cardiac rehabilitation,HIIT compared with MCT significantly improved peak oxygen uptake [MD=2.13,95%CI(0.71,3.55),Z=2.94,P<0.01],improved the left ventricular ejection fraction[MD=3.38,95%CI(1.31,5.46),Z=3.19,P<0.01]. There were no differences in 6 min walking test [MD=30.10,95%CI(-1.31,61.52),Z=1.88,P=0.06],left ventricular end-diastolic volume [SMD=0.14,95%CI(-0.40, 0.69),Z=0.51,P=0.61],HDL [SMD=0.09,95%CI(-0.79,0.97),Z=0.21,P=0.83],LDL[SMD=-0.20,95%CI(-0.78,0.38),Z=0.68,P=0.50] and quality of life [MD=0.37,95%CI(-8.25,8.99),Z =0.08,P =0.93] between HIIT and MCT. Compared with MCT,subgroup analysis showed that HIIT significantly improved peak oxygen uptake in patients with heart failure accompanied by decreased ejection fraction[MD=2.35,95%CI(0.11,4.58),Z=2.05,P=0.04] and left ventricular ejection fraction [MD=3.46,95%CI(0.96,5.96),Z=2.72,P<0.01]. Conclusion In Phase Ⅱ cardiac rehabilitation,HIIT compared with MCT,can effectively improve the peak oxygen uptake and left ventricular ejection fraction,but there are no differences in improving patients’ quality of life and lipid metabolism.