渐进式抗阻训练对脑梗死后上肢痉挛性偏瘫患者血流变及运动耐力的影响

Effect of progressive resistance training on hemorheology and exercise tolerance in patients with upper limb spastic hemiplegia after cerebral infarction

目的探讨以健康行动过程取向理论(health action process orientation theory,HAPA)模式为基础的渐进式抗阻训练在脑梗死后上肢痉挛性偏瘫患者中的应用。方法选取开封市中医院2020年9月至2022年5月93例脑梗死后上肢痉挛性偏瘫患者为研究对象,按照随机数字表分为训练组和模式组。训练组46例予渐进式抗阻训练,模式组47例在训练组基础上行HAPA干预,对比两组健康行为、血液流变学、运动耐力。结果干预3个月末,模式组健康责任(28.15±4.15)分、自我实现(28.05±4.08)分、运动锻炼(25.36±3.44)分、压力管理(25.28±3.14)分高于训练组(21.07±2.40)分、(20.88±2.62)分、(17.91±2.33)分、(18.12±2.27)分(P<0.001);模式组血浆黏度(1.05±0.17)mPa·s、全血高切黏度(4.85±1.02)mPa·s、全血低切黏度(7.41±1.08)mPa·s水平低于训练组(1.32±0.24)mPa·s、(5.51±1.21)mPa·s、(8.68±1.26)mPa·s(P<0.05);模式组峰值摄氧量(VO_(2)peak)(20.92±3.27)mL/(kg·min)、无氧阈值(AT)(101.29±18.13)W、运动持续时间(ED)(447.25±66.51)s、6 min步行距离试验(6MWT)(402.05±33.73)m水平高于训练组(14.23±3.42)mL/(kg·min)、(85.57±15.36)W、(370.68±62.73)s、(327.25±30.13)m(P<0.001)。结论以HAPA模式为基础的渐进式抗阻训练可改善脑梗死后上肢痉挛性偏瘫患者血液流变学,提升其运动耐力,调节健康行为。

Objective To explore the application of progressive resistance training based on the health action process orientation theory(HAPA)in patients with upper limb spastic hemiplegia after cerebral infarction.Methods A total of 93 patients with upper limb spastic hemiplegia after cerebral infarction treated in Kaifeng Hospital of Traditional Chinese Medicine from September 2020 to May 2022 were recruited.They were randomly divided into the training group(n=46)and the model group(n=47).Progressive resistance training was given to all patients,and those in model group were additionally managed by HAPA intervention.The health behavior,hemorheology,and exercise endurance were compared between the two groups.Results At the end of 3 months of intervention,the scores of health responsibility(28.15±4.15)points VS(21.07±2.40)points,self-realization(28.05±4.08)points VS(20.88±2.62)points,exercise(25.36±3.44)points VS(17.91±2.33)points and stress management(25.28±3.14)points VS(18.12±2.27)points in the model group were significantly higher than those in the training group(P<0.001).Plasma viscosity(1.05±0.17)mPa·s VS(1.32±0.24)mPa·s,whole blood high shear viscosity(4.85±1.02)mPa·s VS(5.51±1.21)mPa·s and whole blood low shear viscosity(7.41±1.08)mPa·s VS(8.68±1.26)mPa·s in the model group were significantly lower than those inthetraining group(P<0.05).Peak VO_(2)(VO_(2)peak,(20.92±3.27)mL/(kg·min)VS[14.23±3.42]mL/(kg·min)),anaerobic threshold(AT,[101.29±18.13]W VS[85.57±15.36]W),exercise duration(ED),[447.25±66.51]s VS[370.68±62.73]s and 6-min walking distance test(6MWT,[402.05±33.72]m VS[327.25±30.13]m)in the model group were significantly higher than those in the training group(P<0.001).Conclusion Progressive resistance training based on the HAPA model can improve hemorheology and exercise tolerance,and regulate healthy behaviors in patients with upper limb spastic hemiplegia after cerebral infarction.