Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy.Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training,the effects and underlying mechanisms of exercise remain unclear.Thus,the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol.This review summarizes the latest exercise prescription treatments for 26 different diseases:musculoskeletal system diseases(low back pain,tendon injury,osteoporosis,osteoarthritis,and hip fracture),metabolic system diseases(obesity,type 2 diabetes,type 1 diabetes,and nonalcoholic fatty liver disease),cardio-cerebral vascular system diseases(coronary artery disease,stroke,and chronic heart failure),nervous system diseases(Parkinson’s disease,Huntington’s disease,Alzheimer’s disease,depression,and anxiety disorders),respiratory system diseases(chronic obstructive pulmonary disease,interstitial lung disease,and after lung transplantation),urinary system diseases(chronic kidney disease and after kidney transplantation),and cancers(breast cancer,colon cancer,prostate cancer,and lung cancer).Each exercise prescription is displayed in a corresponding table.The recommended type,intensity,and frequency of exercise prescriptions are summarized,and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Physical exercise intensity prescription to improve health and fitness in overweight and obese subjects: A review of the literature

Obesity is one of the greatest public health challenges of the 21st century. Overweight and obesity drastically increase a person’s risk of developing chronic non-communicable diseases (NCDs), including cardiovascular disease, cancer and diabetes. Furthermore, obesity is already responsible for 2% -8% of health costs and 10% -13% of deaths in several industrialized countries. Lifestyle modifications involving changes in exercise, diet and psychological support are effective in reducing the incidence of overweight. Moreover, positive effects of physical activity (PA) for weight loss and prevention of weight regain are well documented. It was recognized that health benefits regarding both psychological and physiological aspects, such as improving cardiorespiratory and muscular fitness and/or decreasing depression symptoms, can be obtained from numerous activities. Public health institutions (American College of Sports Medicine, World Health Organization) provide recommendations for PA (volume, frequency, intensity and type of exercise) to achieve positive effects, at all ages and for many diseases and disorders situations. Although exercise under guidelines can be safely performed by obese subjects, several questions still need to be fully answered. In facts, the exercise program should be tailored according to an individual’s habitual physical activity, physical function, health status, exercise responses, and stated goals. Thus, this review analyzes the intensity of PA parameters. In the last years, research has been focused on the individualization of the right intensity in which different types of subjects’ condition must undergo to achieve the health goals. Aerobic exercise has been commonly used to reach weight loss goal. Prescription of aerobic exercise in clinical practice is frequently based on the percentage of maximum heart rate (%HRmax), heart rate reserve (%HRreserve), rating of perceived exertion (RPE), maximal oxygen consumption (%VO2max) and for unhealthy subjects, peak oxygen consumption (%VO2peak). It has been shown that unhealthy subjects, such as individuals affected by diabetes, obesity and cardiovascular diseases have a reduced maximal aerobic exercise capacity. For instance, using the formula based on percentage of HRmax or VO2max, it could be prescribed heavy exercises, which would result not appropriated and fully functional for the specific individual goal. To avoid this problem, another approach to individualize aerobic exercise could be to consider the gas exchange parameters such us aerobic gas exchange threshold (AerTGE). AerTGE corresponds to the first increase in blood lactate during incremental exercise. This review offers an overview of the different methods to assess exercise intensity, considering the different subjects health characteristics, in order to choose the right methods to achieve the health goals in obese and overweight subjects.

Aerobic Threshold for Exercise Prescription

The Aerobic Threshold (AerT), is an aged cardiovascular parameter not commonly used to evaluate the heart’s performance in athletes. It indirectly evaluated by ventilator parameters during Cardio Pulmonary Test (CPT). Considering that” exercise as prescription therapy “for the diseases, includes training normally established around at the 40% of the peak VO2, this parameter could be taken in care as initial level for the effort prescribed. The aim of the study was to estimate the behavior of the AerT and also Anaerobic Threshold (AT), VO2max in sedentary people. A group of athletes coming from different sports at the same and highest dynamic component were enrolled as control. A group of 41 athletes (16 soccer, 10 basket and 15 cyclists) and 9 healthy subjects were submitted to a CPT. The AerT, AT (assessed by Vslope method) and VO2max were evaluated. The statistical analysis was performed with T student test (P < 0.05 significant). As expected in sedentary all the values were lower than athletes, however for Aer T value appears to be not significantly inferior respect of this one, with the exclusion of the comparison with the cyclists. In sedentary the AerT measure seems to give additional information in evaluating the cardiovascular performance. The VO2max and AT remain the main parameters in defining the athletes performance. Therefore we cannot exclude any further utility of the AerT in normal subject but regularly trained.

Reconsideration of Exercise Prescription in the Context of “Healthy China 2030” Blueprint

On the basis of “Healthy China 2030” Blueprint, this paper conducts an in-depth analysis of the current situation of insufficient physical activities on the background of China’s social development, explores the role of exercise prescription in improving the performance of the national’s functional quality during national fitness and physical medicine integration, provides reasonable exercise advice and programs for different populations, and analyzes and summarizes the development trend and direction of exercise prescriptions.

Immersible ergocycle prescription as a function of relative exercise intensity

Purpose: The purpose of this study was to establish the relationship between various expressions of relative exercise intensity percentage of maximal oxygen uptake(%VO_(2max)), percentage of maximal heart rate(%HR_(max)), %VO_2 reserve(%VO_2R), and %HR reserve(%HRR)) in order to obtain the more appropriate method for exercise intensity prescription when using an immersible ergocycle(IE) and to propose a prediction equation to estimate oxygen consumption(VO_2) based on IE pedaling rate(rpm) for an individualized exercise training prescription.Methods: Thirty-three healthy participants performed incremental exercise tests on IE and dryland ergocycle(DE) at equal external power output(Pext). Exercise on IE began at 40 rpm and was increased by 10 rpm until exhaustion. Exercise on DE began with an initial load of 25 W and increased by 25 W/min until exhaustion. VO_2 was measured with a portable gas analyzer(COSMED K4b^2) during both incremental tests. On IE and DE, %VO_2R, %HRmax, and %HRR at equal Pext did not differ(p > 0.05).Results: The %HRR vs. %VO_2R regression for both IE and DE did not differ from the identity line %VO_2R IE = 0.99 × HRR IE(%) + 0.01(r^2= 0.91, SEE = 11%); %VO_2R DE = 0.94 × HRR DE(%) + 0.01(r^2= 0.94, SEE = 8%). Similar mean values for %HRmax, %VO_2R, and %HRR at equal Pext were observed on IE and DE. Predicted VO_2 obtained according to rpm on IE is represented by: VO_2(L/min) = 0.000542 × rpm2-0.026 × rpm + 0.739(r = 0.91, SEE = 0.319 L/min).Conclusion: The %HRR–%VO_2R relationship appears to be the most accurate for exercise training prescription on IE. This study offers new tools to better prescribe, control, and individualize exercise intensity on IE.

Non-exhaustive double effort test is reliable and estimates the firs ventilatory threshold intensity in running exercise

Purpose: The present study aimed to investigate the reliability of the non-exhaustive double effort(NEDE) test in running exercise and its associations with the ventilatory thresholds(VT_1 and VT_2) and the maximal lactate steady state(MLSS).Methods: Ten healthy male adults(age: 23 ± 4 years, height: 176.6 ± 6.4 cm, body mass: 76.6 ± 10.7 kg) performed 4 procedures:(1) a ramp test for VT_1 and VT_2 determinations measured by ratio of expired ventilation to O_2 uptake(VE/VO_2) and expired ventilation to CO_2 output(VE/VCO_2) equivalents, respectively;(2) the NEDE test measured by blood lactate concentration(NEDE_(LAC)) and heart rate responses(NEDE_(HR));(3) a retest of NEDE for reliability analysis; and(4) continuous efforts to determine the MLSS intensity. The NEDE test consisted of4 sessions at different running intensities. Each session was characterized by double efforts at the same running velocity(E1 and E2, 180 s), separated by a passive recovery period(90 s rest). LAC and HR values after E1 and E2(in 4 sessions) were used to estimate the intensity equivalent to"null delta" by linear fit. This parameter represents, theoretically, the intensity equivalent to maximal aerobic capacity.Results: The intraclass correlation coefficient indicated significant reliability for NEDE_(LAC)(0.93) and NEDE_(HR)(0.79)(both p < 0.05). There were significant correlations, no differences, and strong agreement with the intensities predicted by NEDE_(LAC)(10.1 ± 1.9 km/h) and NEDE_(HR)(9.8 ± 2.0 km/h) to VT_1(10.2 ± 1.1 km/h). In addition, despite significantly lower MLSS intensity(12.2 ± 1.2 km/h), NEDE_(LAC) and NEDE_(HR) intensities were highly correlated with this parameter(0.90 and 0.88, respectively).Conclusion: The NEDE test applied to running exercise is reliable and estimates the VT_1 intensity. Additionally, NEDE intensities were lower but still correlated with VT_2 and MLSS.

传统功法处方对公众免疫干预效果的研究综述

该文通过文献检索的方式,对与中国传统功法相关的运动处方进行综述,论述了中国传统功法处方作为干预手段对免疫系统、特定人群、特定疾病3个方面的干预效果。根据文献显示,目前很多研究已经证明中国传统功法处方对免疫系统的各项指标,如IgG、IgA、IgM、白细胞介素、NK细胞、T淋巴细胞等有着积极干预效果;对于特定人群如老年人、妇女、青少年、残疾人等群体的常见健康问题也有着较好的改善效果;对于国内常见疾病如糖尿病、高血压、呼吸系统疾病以及癌症等疾病在改善症状或调节情绪方面也有着不错的干预效果。

体医结合背景下高校女大学生异常身体姿态现状调查与运动处方的制定研究

文章从体医结合背景出发,结合运动处方的实施效果和现实意义,通过对高校女大学生异常身体姿态现状调查,了解当代女大学生的生活习惯等对体态的影响,根据大学生自身情况和锻炼需求,借鉴运动处方在全民健身中推广应用的经验与模式,以科学健身为原则,加强对女大学生身体姿态的重视程度,为女大学生提供运动处方的计划方案,有利于提高女大学生的体质健康水平。

健康管理下不同体质人群运动处方的研究

当今社会,健康管理日益受到人们关注,而个体之间的生理差异导致了不同体质的存在。体质是中医学的核心概念之一,指个体在遗传、环境和生活方式等多方面因素的影响下所表现出来的身体特征和功能状态。因此,针对不同体质人群的个性化健康管理显得尤为重要。运动是一种重要的健康管理手段,不同体质人群在运动适应性和运动处方上存在差异,然而目前相关研究尚不充分。该研究基于健康管理的视角,旨在探讨为不同体质人群制定个性化运动处方的可行性与有效性。

精准化运动处方对脑卒中患者焦虑和抑郁状态及认知功能的疗效及机制初探:一项随机对照试验

背景在目前的康复环境下,脑卒中患者的情绪问题以及认知功能障碍较肢体、言语、吞咽等问题隐匿,在临床康复中不被重视,但会造成不良后果,影响康复结局。目前临床治疗上主要依靠药物改善症状,但收效甚微,还会引起一系列的不良反应。目的观察精准化运动处方对脑卒中患者焦虑、抑郁状态以及认知功能的疗效,并初步分析其作用机制。方法选取2022年1月—2023年3月在常州市德安医院康复科住院的脑卒中患者84例,按照随机数字表法分为对照组(42例)和试验组(42例)。对照组给予常规康复治疗,试验组在常规康复的基础上同时实施精准化运动处方,该处方根据心肺运动试验(CPET)的结果精准制订,处方共执行12周。比较两组患者康复训练前后焦虑自评量表(SAS)、抑郁自评量表(SDS)、简易智力状态检查量表(MMSE)评分,以及血浆同型半胱氨酸(Hcy)水平,并将康复训练前患者Hcy水平和SAS、SDS、MMSE评分进行Pearson相关性分析。结果试验组42例患者均顺利完成CPET,以及12周的精准化运动处方康复,无不良事件发生。康复训练前,两组患者SAS、SDS、MMSE评分和Hcy水平比较,差异均无统计学意义(P>0.05)。康复训练后,试验组SAS、SDS评分和Hcy水平均较治疗前降低(P<0.05),且均低于对照组(P<0.05);MMSE评分较治疗前升高(P<0.05),且高于对照组(P<0.05)。对照组康复训练前后SAS、SDS、MMSE评分和Hcy水平比较,差异均无统计学意义(P>0.05)。Pearson相关性分析结果显示,康复训练前,患者Hcy水平和SAS、SDS评分呈正相关关系(r值分别为0.420、0.507,P<0.05),与MMSE评分无相关关系(r=0.079,P=0.473)。结论精准化运动处方能显著改善脑卒中患者的焦虑、抑郁状态以及认知功能,该运动处方可以作为一种新颖治疗方案在临床推广应用。Hcy可能是精准化运动处方改善脑卒中患者焦虑、抑郁的作用机制之一,关于Hcy是否和该处方改善认知功能有关,有待进一步研究。

血流限制训练干预老年肌少症:生物学机制和应用方案建议

背景:肌少症是一种慢性病,会导致力量丧失和功能下降,增加老年人虚弱、残疾、跌倒和死亡风险。血流限制训练可以有效治疗肌少症,但还缺乏对其优缺点、生物学机制和应用方案的全面回顾。目的:通过回顾血流限制训练干预肌少症的优势、局限性和生物学机制,并基于当前已发表的证据给予应用方案建议。方法:检索各大数据库建库至2023年2月发表的文献。英文检索词:blood flow restriction training、KAATSU、elderly、sarcopenia、muscle等;中文检索词:血流限制训练、加压训练、老年人、肌少症和肌肉等。对纳入的82篇文献进行整理和分析。结果与结论:①血流限制训练作为干预肌少症的一种方法,在外周肌群中有一定的效果,但其应用范围存在局限性,血流限制训练具备较高的可操作性和安全性,并能够提高肌肉力量和身体表现,但血流限制训练亦存在潜在风险,尤其证据报告了其对骨骼肌、心血管和内皮细胞等的不良事件,故需在科学指导下进行,并需进一步研究验证其对肌少症患者的效果。②血流限制训练干预肌少症的生物学机制可能包括:增加肌肉反应性充血导致肌肉肥大、改善肌肉蛋白合成能力、诱导代谢应激适应、促进骨骼肌生长和修复、激活血管内皮生长因子信号通路促进血管生成、促进卫星细胞增殖,但这些机制的具体作用和联合作用需要更深入的研究来确定。③血流限制训练干预肌少症主要受训练和袖带的影响,为避免出现不良事件,建议训练负荷20%-50%1RM,重复次数20-75次,训练频率每周两三次,组间间隔30-60 s,上肢训练使用较小尺寸的袖带且加压值≤140 mmHg,下肢训练使用较大尺寸的袖带且加压值≤180 mmHg,通常选择完全闭塞动脉血流压力值的50%-80%,但老年人血流限制训练频度和组间间隔的研究还需更多探讨,同时袖带加压值的最适选择亦需要进一步研究。

运动疗法在冠心病防治中的应用价值研究

冠心病(CHD)等为代表的心血管疾病是人类的最主要死亡原因。心脏康复(CR)是专门针对心血管疾病患者设计的一种康复治疗计划,旨在帮助患者在术后尽快提升身体机能水平,更快回归社会,其中运动疗法是CR的主要内容。积极进行CR不仅可以降低CHD的发病率和死亡率,提高心肺功能,还能减轻医疗经济负担。本文总结了身体活动水平对CHD患者的影响、目前运动疗法在CR中的具体应用模式和CR中不同运动处方的制定原则,以期为运动疗法更好地应用于CHD患者提供参考。

谁有资格开运动处方,医生、运动健康博士、健身教练还是ChatGPT?

虽然“运动是良药”已被公共健康和临床医学所接受并付诸实践,谁有资格开运动处方仍是个具有争议的话题。本文从制定和应用运动处方“权威性”的角度对“谁有资格”进行了探索,认为虽然运动健康领域学者对运动处方的制定和发展作出了更多贡献,但目前运动和医务专业人士都不具备单独开具运动处方的能力,运动与医学跨学科融合的专业团队是开出科学、有效和个性化运动处方的必须条件,但目前不论在人才培养上还是专业组织架构上都存在巨大挑战。以ChatGPT为代表的新一代人工智能为应对挑战开辟了新方法和新路径,并已显示出了强大的生命力。可以预期,以人工智能为中心,以跨学科、个性化、疾病专业化、技术(可穿戴设备)和行为为理论基础,整合生活方式的新型运动处方体系即将到来。

补肺一号方联合呬字诀呼吸操治疗COPD患者的临床研究

目的探讨补肺一号方联合呬字诀呼吸操对慢性阻塞性肺疾病(COPD)患者的临床疗效。方法选取2022年2月至2023年2月福建中医药大学附属第二人民医院收治的COPD稳定期肺气虚证患者90例作为研究对象。按照“就诊时间顺序编号”将对象分为三组,每组30例,试验1组(补肺1号方汤剂治疗),试验2组(补肺1号方汤剂联合呬字诀操锻炼治疗),对照组(吸入硫酸沙丁胺醇气雾剂治疗)。对比外周血Th17、Treg细胞含量、慢性阻塞性肺疾病评估测试评分(CAT)、肺活量(VC)、呼气峰流速(PEF)以及第1秒用力呼气容积(FEV_(1))。结果治疗后,试验2组的外周血Th17细胞含量以及CAT评分低于试验1组与对照组,差异有统计学意义(P<0.05);试验2组比对照组、试验1组的VC、PEF、FEV_(1)数值以及外周血Treg细胞含量更高(P<0.05);试验1组的外周血Th17细胞含量以及CAT评分低于对照组,差异有统计学意义(P<0.05);对照组相比于试验1组,其VC、PEF、FEV_(1)数值以及外周血Treg细胞含量更低(P<0.05)。结论在COPD稳定期患者的治疗中,采用补肺一号方联合呬字诀呼吸操能够有效调节患者肺功能指标,改善外周血Th17、Treg细胞含量,同时改善患者咳嗽、气喘等症状,提升睡眠质量,调整患者精神状态,促进患者康复。

国内外运动处方研究进展的计量学分析

目的本文旨在通过计量学分析探讨近十年国内外运动处方的研究进展,分析该领域国内外关注热点及发展趋势异同点,为我国运动处方制定提供参考意见,以期进一步推动该领域的发展。方法从中国知网和Web of Science数据库中筛选出相关的中英文文献。利用数据库内置的计量统计和可视化显示功能,以及陈超美博士开发的CiteSpace V软件,对文献进行可视化演示分析和知识图谱绘造。结果通过信息检索和甄选,共获得449篇中文文献和2923篇英文文献。分析结果显示,国内外对运动处方研究的关注度呈稳定并有上升趋势,其关注热点主要集中在体医融合领域。相较于国外研究的广泛和细化程度,国内研究相对局限,国外更注重多学科交叉融合研究。其中,慢性病防治是现在研究热点;扩大运动处方适用范围,并不局限于治病领域将会是未来重要研究方向。结论国内的未来研究应加强多学科交叉融合,扩大运动处方研究范围和对象,更加科学合理有效地适用于老年群体,为未来促进老年人身体健康、延年益寿指引方向。

Latest updates on structure and recommendations of cardiac rehabilitation programs in chronic heart failure

Chronic heart failure(HF)is a clinical syndrome with high morbidity and mor-tality worldwide.Cardiac rehabilitation(CR)is a medically supervised program designed to maintain or improve cardiovascular health of people living with HF,recommended by both American and European guidelines.A CR program con-sists of a multispecialty group including physicians,nurses,physiotherapists,trainers,nutritionists,and psychologists with the common purpose of improving functional capacity and quality of life of chronic HF patients.Physical activity,lifestyle,and psychological support are core components of a successful CR program.CR has been shown to be beneficial in all ejection fraction categories in HF and most patients,who are stable under medication,are capable of participating.An individualized exercise prescription should be developed on the basis of a baseline evaluation in all patients.The main modalities of exercise training are aerobic exercise and muscle strength training of different intensity and frequency.It is important to set the appropriate clinical outcomes from the beginning,in order to assess the effectiveness of a CR program.There are still significant limitations that prevent patients from participating in these programs and need to be solved.A significant limitation is the generally low quality of research in CR and the presence of negative trials,such as the rehabilitation after myocardial infarction trial,where comprehensive rehabilitation following myocardial infraction had no important effect on mortality,morbidity,risk factors,or health-related quality of life or activity.In the present editorial,we present all the updated knowledge and recommendations in CR programs.

体医融合背景下运动处方纳入中医学课程的探讨

在体医融合背景下,运动与常规治疗相结合形成慢性疾病防治的良好模式。基于中医对运动防治疾病的独特理解以及社会对运动处方型人才培养的需要,亟待将运动处方纳入中医学临床课程体系并进行深入研究和探讨。将具有中医特色的运动处方有机融入课程案例,提高学生临床实践能力,促进学科知识体系的建设,拓展和完善慢性疾病的防治方案,以期为具有中医特色的体医融合课程建设提供参考,为新型人才的培养提供“摇篮”服务。

个性化运动处方对血液透析患者肌少症的作用和影响

肌少症是影响血液透析患者健康和生活质量的重要因素,运动可以有效改善血液透析患者的肌少症,但不同的运动类型、运动强度、运动时间和频率对肌少症有不同的影响。本文综述不同运动处方对血液透析患者肌少症的作用和影响,可帮助医护人员在临床中为血液透析患者制定个性化的运动处方,引导患者积极进行运动锻炼,为预防和治疗肌少症提供有效策略。

为何·如何:2型糖尿病“精准”运动干预的2个基本问题

运动干预作为2型糖尿病(T2DM)关键防治策略在世界范围内已被普遍接受。遗憾的是,各种身体活动指南推荐的“一刀切”干预方案,并不能让所有患者获得相同收益。究其原因:(1)T2DM的病因、发病机制和临床表现具有高度异质性;(2)T2DM患者对运动干预的应答反应存在异质性。这两个异质性影响了T2DM运动干预治疗的有效性,而要提高有效性,需要对糖尿病进行精确分型和精准干预。因此,有必要了解精准运动干预的原理和实施过程。总结T2DM的分子遗传基础、运动干预的分子机制和患者对运动应答的异质性,并对当前T2DM的精准分型、诊断、治疗、监测的研究进展进行评述,重点关注T2DM患者对运动应答反应个体差异的原因和机制,提出将运动处方各参数作为T2DM精准治疗关键变量的建议。

中医文化视域下运动处方的理念演变及局限

中医文化中的运动防治疾病理念自原始社会便已经开始萌芽,随着中医学理论实践的不断完善而逐步系统化,逐渐形成了以中医文化为基石的“辨体施动”特色运动医学概念。萌芽时期的中医“运动”以治疗为主,随着中医运动疗法的不断发展,目前已经形成了从“治疗、预防、健身、康复”多方位维护人体身体健康的医疗方式。与此同时,源于古籍的“法于阴阳”“形与神俱”“动以养身”等等中医运动处方原则也在不断完善中医运动疗法体系。而随着现代运动理念的融入,体医融合的趋势更加明显,中医运动处方也开始融入现代运动医学的运动要素概念,使其更加趋于系统性、规范性、合理性。然而,目前中医运动处方依旧还存在理法体系验证不完善、处方要素界定模糊、定量研究限制较多以及特色优势不明显等局限性,但是随着其不断完善,它将会成为现代运动处方体系的重要组成部分,并且具有更为广泛而有效的实际应用价值。