抗阻训练对卒中慢性期患者呼吸功能、运动耐力及负性情绪的影响

Effects of Resistance Training on Respiratory Function,Exercise Endurance and Negative Emotion in Stroke Patients at Chronic Stage

目的观察中低强度上下肢抗阻训练对卒中慢性期患者呼吸功能、运动耐力及负性情绪的影响。方法前瞻性连续入组上海市金山区众仁老年护理医院2019年6月-2020年12月收治的卒中慢性期患者,随机分为研究组和对照组。2组均给予常规康复训练,包括转移训练、功率车训练、平衡及步行能力训练,研究组在此基础上给予中低强度上下肢抗阻训练。以上训练均每次30 min,每日1次,每周5 d,共8周。于治疗前、治疗8周后采用CORTEX心肺功能测试系统评估患者的呼吸功能相关指标,包括用力肺活量(forced vital capacity,FVC)、第1秒用力呼气量(forced expiratory volume in first second,FEV1)、呼气峰值流速(peak expiratory flow,PEF)和FEV1与FVC的比值(FEV1/FVC);采用6分钟步行测试(si x-minute walk test,6MWT)评估患者运动耐力;采用医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)评估患者焦虑(HADS-A)和抑郁(HADS-D)情绪。比较2组治疗前后上述指标的差异。结果研究共入组40例患者,研究组和对照组各20例。治疗前2组基线数据及各项评估指标差异均无统计学意义。治疗后,研究组FVC、FEV1、PEF、6MWT、HADS-A和HADS-D较本组治疗前改善,对照组FVC、FEV1、6MWT较本组治疗前提高,差异有统计学意义。组间比较显示,研究组治疗后FVC[2.73(2.44~3.36)L vs.2.46(2.22~2.70)L,P=0.035]、FEV1[2.17(1.92~2.68)L vs.1.94(1.76~2.15)L,P=0.040]及PEF(265.19±34.62 L/min vs.231.03±33.97 L/mi n,P=0.003)优于对照组,6MWT高于对照组(330.89±52.29 m vs.299.02±41.85 m,P=0.039),HADS-A(6.25±2.51分vs.8.45±4.05分,P=0.040)和HADS-D[6.00(3.00~10.00)分vs.9.00(4.00~13.00)分,P=0.036]评分均显著低于对照组。结论在常规康复治疗基础上给予中低强度上下肢抗阻训练,在改善卒中慢性期患者的呼吸功能、运动耐力及负性情绪方面有积极的意义。

Objective To observe the effects of resistance training of upper and lower limbs on respiratory function,exercise endurance and negative emotion in stroke patients at chronic stage.Methods This study prospectively enrolled the consecutive stroke patients at chronic stage who were admitted in Zhongren Geriatric Care Hospital at Jinshan District,Shanghai from June 2019 to December 2020.All the included patients were randomly divided into observation group and control group.Both groups were given routine rehabilitation training,including transfer training,power vehicle training,balance and walking ability training,and the medium-low intensity resistance training of upper and lower limbs were added in the observation group.The above training was 30 minutes each time,once a day,for 8 weeks(5 days a week).Before treatment and after the treatment for 8 weeks,the respiratory function parameters of all patients were assessed by the German CORTEX cardiopulmonary function test system,including forced vital capacity(FVC),forced expiratory volume in the first second(FEV1),peak expiratory flow rate(PEF)and FEV1/FVC ratio,etc.Exercise endurance was assessed by six-minute walk test(6MWT).The hospital anxiety and depression scale(HADS)was used to assess the patients'emotional state.The above indexes of both groups were compared.Results A total of 40 patients were enrolled in this study,with 20 cases per group.Before treatment,there were no statistical differences in baseline data and observation indexes between the two groups.For comparisons within the groups,after treatment,FVC,FEV1,PEF,6MWT,HADS-A and HADS-D in the observation group were improved compared with those before treatment,while FVC,FEV1 and 6MWT in the control group were improved compared with those before treatment,with statistical significance for all the above differences.For comparisons between the two groups,FVC[2.73(2.44-3.36)L vs.2.46(2.22-2.70)L,P=0.035],FEV1[2.17(1.92-2.68)L vs.1.94(1.76-2.15)L,P=0.040]and PEF(265.19±34.62 L/min vs.231.03±33.97 L/min,P=0.003)in observation group were better than those of control group,6MWT was higher than that of control group(330.89±52.29 m vs.299.02±41.85 m,P=0.039),and the scores of HADS-A(6.25±2.51 points vs.8.45±4.05 points,P=0.040)and HADS-D[6.00(3.00-10.00)points vs.9.00(4.00-13.00)points,P=0.036]were lower than those of the control group.Conclusions On the basis of routine rehabilitation,resistance training of the upper and lower limbs can effectively improve the respiratory function,exercise endurance and negative emotion of stroke patients at chronic stage.