High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction.
High-Intensity Interval Training in Patients With Heart Failure With Reduced Ejection Fraction.
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DOI：
10.1161/circulationaha.116.022924
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发表时间：
2017-02-28
期刊：
影响因子：
37.8
通讯作者：
SMARTEX Heart Failure Study (Study of Myocardial Recovery After Exercise Training in Heart Failure) Group
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文献类型：
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作者：
Ellingsen Ø;Halle M;Conraads V;Støylen A;Dalen H;Delagardelle C;Larsen AI;Hole T;Mezzani A;Van Craenenbroeck EM;Videm V;Beckers P;Christle JW;Winzer E;Mangner N;Woitek F;Höllriegel R;Pressler A;Monk-Hansen T;Snoer M;Feiereisen P;Valborgland T;Kjekshus J;Hambrecht R;Gielen S;Karlsen T;Prescott E;Linke A;SMARTEX Heart Failure Study (Study of Myocardial Recovery After Exercise Training in Heart Failure) Group
文本中提供了补充数字内容。小型研究表明，对于射血分数降低的心力衰竭患者，高强度间歇训练（HIIT）在逆转心脏重塑和增加有氧能力方面优于中度连续训练（MCT）。目前的多中心试验比较了 12 周的 HIIT、MCT 或定期运动建议 (RRE) 的监督干预措施。 261 名左心室射血分数≤35%、纽约心脏协会 II 级至 III 级患者被随机分配至最大心率 90% 至 95% 的 HIIT 组、最大心率 60% 至 70% 的 MCT 组或 RRE 组。此后，鼓励患者继续自行锻炼。在基线、干预后以及 52 周后的随访时进行临床评估。主要终点是左心室舒张末期内径从基线到 12 周的变化的组间比较。各组在年龄（中位数为 60 岁）、性别（19% 为女性）、缺血发病机制（59%）或药物治疗方面没有差异。 HIIT 和 MCT 之间左心室舒张末期内径从基线到 12 周的变化没有差异（P=0.45）；与 RRE 相比，HIIT 组左心室舒张末期直径变化为 -2.8 mm（-5.2 至 -0.4 mm；P=0.02），MCT 组为 -1.2 mm（-3.6 至 1.2 mm；P=0.34）。 HIIT和MCT的峰值摄氧量也没有差异（P=0.70），但均优于RRE。然而，这些变化在 52 周后的随访中均未维持。在监督干预期间或 52 周随访期间，严重不良事件没有统计学差异（HIIT，39%；MCT，25%；RRE，34%；P=0.16）。训练记录显示，51% 的患者在监督下 HIIT 期间的锻炼低于规定目标，80% 在 MCT 期间高于目标。 HIIT 在改变左心室重构或有氧能力方面并不优于 MCT，其在心力衰竭患者中的可行性尚未解决。网址：http://www.clinicaltrials.gov。唯一标识符：NCT00917046。
Supplemental Digital Content is available in the text. Small studies have suggested that high-intensity interval training (HIIT) is superior to moderate continuous training (MCT) in reversing cardiac remodeling and increasing aerobic capacity in patients with heart failure with reduced ejection fraction. The present multicenter trial compared 12 weeks of supervised interventions of HIIT, MCT, or a recommendation of regular exercise (RRE). Two hundred sixty-one patients with left ventricular ejection fraction ≤35% and New York Heart Association class II to III were randomly assigned to HIIT at 90% to 95% of maximal heart rate, MCT at 60% to 70% of maximal heart rate, or RRE. Thereafter, patients were encouraged to continue exercising on their own. Clinical assessments were performed at baseline, after the intervention, and at follow-up after 52 weeks. Primary end point was a between-group comparison of change in left ventricular end-diastolic diameter from baseline to 12 weeks. Groups did not differ in age (median, 60 years), sex (19% women), ischemic pathogenesis (59%), or medication. Change in left ventricular end-diastolic diameter from baseline to 12 weeks was not different between HIIT and MCT (P=0.45); left ventricular end-diastolic diameter changes compared with RRE were −2.8 mm (−5.2 to −0.4 mm; P=0.02) in HIIT and −1.2 mm (−3.6 to 1.2 mm; P=0.34) in MCT. There was also no difference between HIIT and MCT in peak oxygen uptake (P=0.70), but both were superior to RRE. However, none of these changes was maintained at follow-up after 52 weeks. Serious adverse events were not statistically different during supervised intervention or at follow-up at 52 weeks (HIIT, 39%; MCT, 25%; RRE, 34%; P=0.16). Training records showed that 51% of patients exercised below prescribed target during supervised HIIT and 80% above target in MCT. HIIT was not superior to MCT in changing left ventricular remodeling or aerobic capacity, and its feasibility remains unresolved in patients with heart failure. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00917046.