Exercise as a nonpharmacologic intervention in patients with heart failure.
Exercise as a nonpharmacologic intervention in patients with heart failure.
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DOI：
10.3810/psm.2011.11.1937
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发表时间：
2011-11
期刊：
影响因子：
--
通讯作者：
Schulze PC
中科院分区：
文献类型：
--
作者：
Chung CJ;Schulze PC
对于心力衰竭患者，导致运动耐量降低的呼吸困难和疲劳是导致社会和身体功能以及生活质量下降的主要因素。长期以来有证据表明，心脏功能的测量，如射血分数和心输出量与患者的运动能力相关性很差，这表明除了影响中央循环的因素外，还有其他因素的参与。中枢血流动力学和运动耐量之间缺乏密切的相关性，导致了对外周改变的研究，如血管内皮功能异常、交感神经系统过度激活以及骨骼肌结构和氧化能力的变化，这些在心力衰竭患者中常见。在过去的二十年里，许多临床研究已经证明了运动训练对骨骼肌能量代谢、血管功能和舒张能力的有益影响，这些影响与心力衰竭患者的运动耐量、住院率和生活质量的改善相关。根据美国和欧洲领先的心脏病学会制定的最新指南，敦促医生强调使用个性化方案对所有临床稳定的心力衰竭患者进行运动训练，这些方案的特点是在疾病急性加重后进行早期动员并逐渐增加强度。
For the patient with heart failure, dyspnea and fatigue resulting in diminished exercise tolerance are among the main factors contributing to decreased social and physical functioning and quality of life. There has long been evidence that measures of cardiac function such as ejection fraction and cardiac output only poorly correlate with a patient’s capacity to exercise, suggesting the involvement of factors other than those impacting the central circulation. The lack of a close correlation between central hemodynamics and exercise tolerance has led to investigations into alterations in the periphery, such as abnormalities in vascular endothelial function, hyperactivation of the sympathetic nervous system, and changes in structure and oxidative capacity of skeletal muscle, which are commonly seen in patients with heart failure. Over the past two decades, numerous clinical studies have demonstrated the beneficial impact of exercise training on skeletal muscle energy metabolism, vascular function, and ventilatory capacity, which correlate with measures of exercise tolerance, improvements in hospitalization rates and quality of life of patients with heart failure. In accordance with recent guidelines set forth by the leading cardiology societies in the United States and Europe, physicians are urged to emphasize exercise training for all clinically stable patients with heart failure using individualized protocols that feature early mobilization after acute exacerbations of disease and gradual increases in intensity.
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DOI：
10.1097/hcr.0b013e3181b4ca4e
发表时间：
2009-11-01
影响因子：
3.8
作者：
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