间歇高强度有氧运动对脑卒中合并冠心病患者运动耐力的影响

Effect of Intermittent High Intensity Aerobic Exercise on Exercise Endurance of Patients with Stroke Complicated with Coronary Heart Disease

目的:观察间歇高强度有氧运动强度对脑卒中合并冠心病患者运动耐力及日常生活能力的影响。方法:选择上海市第四康复医院2015年2月—2017年12月收治的脑卒中合并冠心病患者180例,按照随机数字表法分为对照组、中强度组和高强度组,每组60例。3组均给予脑卒中合并冠心病的常规药物治疗,对照组只给予常规康复治疗,主要包括:脑卒中肢体运动功能锻炼、心脏康复训练以及物理治疗等,每周训练5次,每次持续1~2 h,共持续治疗3个月。中强度组在对照组基础上接受以CPET评估结果为指导的中等强度的有氧运动训练,患者在放松及热身5 min后,使用C580R坐靠式脚踏车进行功率踏车训练,运动强度:60%峰值功率(PP),每天训练1次,每次10组,3 min/组,组间休息1 min,共40 min,隔天训练1次,3次/周,共治疗3个月。高强度组在对照组基础上接受以CPET评估结果为指导的高强度有氧运动训练,运动强度调整为80%PP,训练方式同中强度组。在治疗前、治疗3个月后采用最大代谢当量(METs)、左心室射血分数(LVEF)评估心肺功能;采用CPET峰值功率(PP)、运动持续时间(ED)、峰值摄氧量(peak VO2)、无氧阈值(AT)评价患者运动耐力;采用Barthel指数评价患者日常生活活动能力。结果:治疗前,3组PP、ED、peak VO2、AT、LVEF、METs及Barthel评分均无明显区别,差异无统计学意义(P>0.05)。与治疗前比较,3组治疗3个月后PP、ED、peak VO2、AT、LVEF、METs、Barthel均明显升高,差异具有统计学意义(P<0.05);与对照组比较,中、高强度组治疗3个月后PP、ED、peak VO2均明显更高,高强度组治疗3个月后AT、LVEF均明显更高,差异具有统计学意义(P<0.05),而中强度组治疗3个月后AT、LVEF则无明显差别,差异无统计学意义(P>0.05);与中强度组比较,高强度组治疗3个月后PP、ED、peak VO2、METs、LVEF均明显更高,差异具有统计学意义(P<0.05)。结论:高强度间歇有氧运动能有效改善脑卒中合并冠心病患者心功能及运动耐力,提高患者日常生活活动能力,改善患者预后,值得临床推广。

Objective:To observe the effect of intermittent high intensity aerobic exercise on exercise endurance and activities of daily living in patients with stroke complicated with coronary heart disease.Methods:A total of 180 patients with stroke complicated with coronary heart disease,were treated in Shanghai Fourth Rehabilitation Hospital,from February 2015 to December 2017.The patients were randomly divided into the control group,the medium intensity group and the high intensity group according to the method of random number table,with 60 cases in each group.All the three groups were given routine drug treatment of stroke complicated with coronary heart disease.The control group was only given routine rehabilitation treatment,including stroke limb motor function exercise,cardiac rehabilitation training and physicotherapy,five times a week,treatment for 1 to 2 hours each time,continuous treatment for three months.On the basis of the control group,the patients in the medium intensity group were given the aerobic exercise training guided by the results of cardiopulmonary exercise test(CPET)evaluation.After 5 minutes of relaxation and warm-up,the patients used C580R riding bicycle for power treadmill training.The aerobic exercise intensity was 60%peak power(PP),10 groups were trained each time,3 minutes for each group,and 1 minute for rest in different groups,continuous training for 40 minutes,once a day,once every other day,three times a week,continuous treatment for three months.On the basis of the control group,the patients in the high intensity group were given the aerobic exercise training guided by the results of CPET evaluation,the training method was the same as the medium intensity group,but only the intensity of aerobic exercise was adjusted to 80%PP.The cardiopulmonary function was evaluated by maximum metabolic equivalents(METs)and left ventricular ejection fraction(LVEF),and the exercise endurance was evaluated by CPET peak power(PP),exercise duration(ED),peak oxygen uptake(peak VO2)and anaerobic threshold(AT).The activities of daily living of the patients was evaluated by Barthel index.Results:There was no significant difference in the scores of PP,ED,peak VO2,AT,LVEF,METs and Barthel index in the three groups before treatment(P>0.05).Compared with before treatment,the PP,ED,peak VO2,AT,LVEF,METs and Barthel index in the three groups increased significantly after treatment for three months,and the difference was statistically significant(P<0.05).Compared with the control group,the PP,ED and peak VO2 in the medium and high intensity groups were significantly higher after treatment for three months,the AT and LVEF in the high intensity group were significantly higher after treatment for three months,and the difference was statistically significant(P<0.05),but there was no significant difference in AT and LVEF in the medium intensity group after treatment for three months(P>0.05).Compared with the medium intensity group,the PP,ED,peak VO2,METs and LVEF in the high intensity group were significantly higher after treatment for three months,and the difference was statistically significant(P<0.05).Conclusion:Intermittent high intensity aerobic exercise can effectively improve the cardiac function and exercise endurance of stroke patients with coronary heart disease,improve the activities of daily living,and improve the prognosis of patients,which is worthy of clinical application.