Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure - A randomized trial
Effects of exercise training on left ventricular function and peripheral resistance in patients with chronic heart failure - A randomized trial
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DOI：
10.1001/jama.283.23.3095
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发表时间：
2000-06-21
影响因子：
120.7
通讯作者：
Schuler, G
中科院分区：
文献类型：
--
作者：
Hambrecht, R;Gielen, S;Schuler, G
慢性心力衰竭患者的运动训练通过增强内皮功能和骨骼肌有氧代谢来改善工作能力，目的评价运动训练对稳定型慢性心力衰竭患者左室功能和运动对血流动力学反应的影响。设计1994年进行的前瞻性随机试验，1999年，地点：德国大学心内科/门诊，患者：73例年龄在70岁或以下的慢性心力衰竭男性患者的对比样本（左心室射血分数约为0.27）。干预患者被随机分配到2周的院内测力计锻炼，每天4至6次，每次10分钟，随后进行为期6个月的基于家庭的测力计运动训练，每天20分钟，峰值摄氧量为70%（n=36）或无干预（对照组; n=37）。主要结果：通过热稀释法测定静息和运动时的中枢血流动力学;结果6个月后，与对照组相比，运动训练组患者在纽约心脏协会功能分级、最大通气量、运动时间和运动能力以及降低的静息心率和增加的静息心搏量。在运动训练组中，观察到平均（SD）静息LV射血分数从基线至6个月随访时增加（0.30 [0.08] vs 0.35 [0.09]; P= 0.003）。运动训练组在峰值运动期间的平均（SD）总外周阻力（TPR）降低了157（306）dyne/s/cm-5，而对照组增加了43（148）dyne/s/cm-5（P=.03），同时平均（SD）每搏输出量增加了14（22）mt，而对照组增加了1（19）mL（P=.03）。左室舒张末期内径平均值（SD）减少4（6）mm，对照组增加1（4）mm（P
Context Exercise training in patients with chronic heart failure improves work capacity by enhancing endothelial function and skeletal muscle aerobic metabolism, but effects on central hemodynamic function are not well established.Objective To evaluate the effects of exercise training on left ventricular (LV) function and hemodynamic response to exercise in patients with stable chronic heart failure.Design Prospective randomized trial conducted in 1994-1999.Setting University department of cardiology/outpatient clinic in Germany.Patients Consecutive sample of 73 men aged 70 years or younger with chronic heart failure (with LV ejection fraction of approximately 0.27).Intervention Patients were randomly assigned to 2 weeks of in-hospital ergometer exercise for 10 minutes 4 to 6 times per day, followed by 6 months of home-based ergometer exercise training for 20 minutes per day at 70% of peak oxygen uptake (n=36) or to no intervention (control group; n=37).Main Outcome Measures Ergospirometry with measurement of central hemodynamics by thermodilution at rest and during exercise; echocardiographic determination of LV diameters and volumes, at baseline and 6-month follow-up, for the exercise training vs control groups.Results After 6 months, patients in the exercise training group had statistically significant improvements compared with controls in New York Heart Association functional class, maximal ventilation, exercise time, and exercise capacity as well as decreased resting heart rate and increased stroke volume at rest. In the exercise training group, an increase from baseline to 6-month follow-up was observed in mean (SD) resting LV ejection fraction (0.30 [0.08] vs 0.35 [0.09]; P=.003). Mean (SD) total peripheral resistance (TPR) during peak exercise was reduced by 157 (306) dyne/s/cm(-5) in the exercise training group vs an increase of 43 (148) dyne/s/cm-5 in the control group (P=.03), with a concomitant increase in mean (SD) stroke volume of 14 (22) mt vs 1 (19) mL in the control group (P=.03). There was a small but significant reduction in mean (SD) LV end diastolic diameter of 4 (6) mm vs an increase of 1 (4) mm in the control group (P