太极拳与健身操运动对原发性高血压患者自主神经系统的影响

The influence of Tai Chi and fitness exercises on autonomic nervous system in patients with essential hypertension

目的观察不同运动干预方式对原发性高血压(EH)患者自主神经系统(ANS)的影响。方法采取随机对照试验设计。2022年3月于北京西罗园社区服务中心和山东淄博万杰康复医院招募102例1、2级EH患者,按1∶1∶1的比例随机分为太极拳组(n=34)、健身操组(n=34)与对照组(n=34);太极拳组和健身操组分别进行太极拳和健身操运动,共12周,3次/周,60 min/次,运动强度控制在40%~60%储备心率,对照组不进行任何运动干预。观察干预前后三组患者血压变异性(BPV)与心率变异性(HRV)相关指标的变化。结果最终80例研究对象完成所有试验流程并纳入分析(太极拳组28例,健身操组30例,对照组22例)。与干预前比较,太极拳组干预后BPV指标24 h收缩压标准差(24hSBPSD)、24 h收缩压变异系数(24hSBPCV)、24 h舒张压标准差(24hDBPSD)、24 h舒张压变异系数(24hDBPCV)下降(P<0.01),HRV指标全部正常RR间期的标准差(SDNN)、相邻RR间期之差的均方根值(RMSSD)、低频功率(LF)、高频功率(HF)、总功率(TP)、心率瞬时变异性的标准差(散点图短轴,SD1)、长期连续RR间期变异性的标准差(散点图长轴,SD2)上升(P<0.05),相邻RR间期差>50 ms的个数占总心跳次数的百分比(pNN50)、LF/HF变化无统计学意义(P>0.05)。与干预前比较,健身操组干预后,BPV指标24hSBPSD、24hSBPCV、24hDBPSD、24hDBPCV下降(P<0.05),HRV指标SDNN、RMSSD、pNN50、LF、HF、TP、SD1、SD2上升(P<0.05),LF/HF变化无统计学意义(P>0.05)。与干预前比较,对照组干预后BPV与HRV各项指标变化无统计学意义(均P>0.05)。与对照组相比,太极拳组干预后24hSBPSD、24hDBPSD、24hDBPCV更低(P<0.05),SDNN、RMSSD、LF、TP、SD2、SD1更高(P<0.05)。与对照组相比,健身操组干预后24hSBPSD、24hDBPSD、24hDBPCV更低(P<0.05),SDNN、RMSSD、pNN50、LF、HF、TP、SD1、SD2更高(P<0.05)。健身操组与太极拳组干预后BPV和HRV各项指标比较,差异无统计学意义(P>0.05)。结论太极拳与健身操运动可以有效降低EH患者的BPV,提高HRV。两种运动对改善EH患者的ANS功能具有积极效果。

Objective To observe the effect of different exercise intervention methods on autonomic nervous system(ANS)in patients with essential hypertension(EH).Methods A randomized controlled trial was designed.In March 2022,102 patients with grade 1 and 2 EH from Beijing Xiluoyuan Community Service Center and Shandong Zibo Wanjie Rehabilitation Hospital were recruited and randomly divided into Tai Chi group(n=34),fitness exercises group(n=34)and control group(n=34)in a 1∶1∶1 ratio.Patients in Tai Chi group and fitness exercises group respectively received 60 minutes of Tai Chi and fitness exercise training three times a week for 12 weeks,with exercise intensity controlled at 40%-60%reserve heart rate.Patients in the control group did not receive any exercise intervention.The changes of blood pressure variability(BPV)and heart rate variability(HRV)of patients before and after the intervention in the three groups were observed.Results Finally 80 participants completed all experimental procedures and were included in the analysis(28 in Tai Chi group,30 in fitness exercises group,and 22 in control group).In the Tai Chi group,BPV indicators such as standard deviation of 24-hour systolic blood pressure(24hSBPSD),coefficient of variation of 24-hour systolic blood pressure(24hSBPCV),standard deviation of 24-hour diastolic blood pressure(24hDBPSD),and coefficient of variation of 24-hour diastolic blood pressure(24hDBPCV)decreased(P<0.01),while HRV indicators such as standard diviation of normal to normal RR intervals(SDNN),root mean square of successive differences(RMSSD),low frequency(LF),high frequency(HF),total power(TP),standard deviation of instantaneous variability of the beat-to-beat heart rate(SD1),and standard deviation of long-term continuous RR interval variability(SD2)increased(P<0.05)after intervention compared with before intervention,and the proportion of successive RR intervals differences>50 ms in relation to the total RR intervals(pNN50)and LF/HF showed no significant changes(P>0.05).In fitness exercises group,BPV indicators such as 24hSBPSD,24hSBPCV,24hDBPSD,and 24hDBPCV decreased(P<0.05),while HRV indicators such as SDNN,RMSSD,pNN50,LF,HF,TP,SD1 and SD2 increased(P<0.05),and LF/HF showed no significant change(P>0.05)after intervention compared with before intervention.There was no significant change in indicators of BPV and HRV after intervention in control group(P>0.05).After intervention,compared with control group,24hSBPSD,24hDBPSD and 24hDBPCV were lower(P<0.05),while SDNN,RMSSD,LF,TP,SD2 and SD1 were higher(P<0.05)in Tai Chi group,24hSBPSD,24hDBPSD,and 24hDBPCV were lower(P<0.05),while SDNN,RMSSD,pNN50,LF,HF,TP,SD1 and SD2 were higher(P<0.05)in fitness exercises group.Compared with fitness exercises group,there was no significant difference in indicators of BPV and HRV after intervention in Tai Chi group(P>0.05).Conclusions Tai Chi and fitness exercises can effectively reduce BPV and increase HRV in EH patients.Two types of exercise have positive effects on improving ANS function in EH patients.