Improvements in exercise tolerance with an exercise intensity above the anaerobic threshold in patients with acute myocardial infarction.
Improvements in exercise tolerance with an exercise intensity above the anaerobic threshold in patients with acute myocardial infarction.
复制标题
运动强度高于无氧阈值可改善急性心肌梗死患者的运动耐量。
DOI：
10.1007/s00380-020-01757-z
复制
发表时间：
2021
影响因子：
1.5
通讯作者：
Kimura Y
中科院分区：
文献类型：
--
作者：
Tagashira S;Kurose S;Kimura Y
在日本，心肺运动试验（CPX）的无氧阈（AT）是衡量心血管疾病患者运动强度的标准。然而，AT是否代表心血管疾病患者运动强度的安全限值仍存在争议。本研究的目的是在一项随机试验中研究运动强度高于AT和传统AT时心脏康复（CR）的有效性和安全性。参与者包括57名被诊断为急性心肌梗死的门诊CR单元的患者。参与者被随机分为以下两组：AT组25名患者，他们进行AT强度的有氧运动;“AT以上”组32名患者，他们进行高于AT强度的运动。测量了以下组成部分：最大摄氧量（峰值VO 2）、AT时的摄氧量（ATVO 2）、CPX期间运动时的摄氧量增加（Δ VO 2/ΔWR）、血管内皮功能试验（%FMD：血流介导的扩张百分比）和等长膝关节伸展强度。在运动疗法开始时以及2、3和4个月后获得测量结果。在组内和组间进行比较，并研究改善率之间的相关性。3个月后，两组的PeakVO 2、ATVO 2、Δ VO 2/ΔWR和%FMD均显著改善。2个月后，“超过AT”组的等长膝关节伸展强度有所改善。观察了与峰值VO 2、Δ VO 2/ΔWR和等长膝关节伸展强度的相互作用。然而，两组之间的%FMD无显著差异。在“超过AT”组中，峰值VO 2的改善率与等长伸膝肌力的改善呈正相关（r= 0.61，p < 0.001），但与%FMD无关。这些数据表明，高于AT的运动强度比AT更快地改善运动耐量，并且这种改善率与等长膝关节伸展强度的变化相关。
Anaerobic threshold (AT) from cardiopulmonary exercise tests (CPX) is the standard for measuring exercise intensity among patients with cardiovascular disease in Japan. However, it remains controversial whether AT represents the safety limit for exercise intensity in patients with cardiovascular disease. The purpose of this study was to investigate cardiac rehabilitation (CR) efficacy and safety with exercise intensities above the AT and at a traditional AT in a randomized trial. The participants included 57 patients who were admitted to the outpatient CR unit with a diagnosis of acute myocardial infarction. The participants were randomly divided as follows: 25 patients in the AT group, who performed aerobic exercises with an intensity at the AT; and 32 patients in the “Over AT” group, who performed exercises at an intensity higher than the AT. The following components were measured: maximum oxygen uptake (peakVO2), oxygen uptake at the AT (ATVO2), increase in oxygen uptake during exercise (ΔVO2/ΔWR) during the CPX, vascular endothelial function test (%FMD: the percentage of flow-mediated dilation), and isometric knee extension strength. The measurements were obtained at the start of the exercise therapy and after 2, 3, and 4 months. They were compared within and between groups, and the correlation between the rates of improvement was investigated. PeakVO2, ATVO2, ΔVO2/ΔWR, and %FMD had significantly improved after 3 months in both groups. The isometric knee extension strength had improved in the “Over AT” group after 2 months. Interactions were observed with peakVO2, ΔVO2/ΔWR, and isometric knee extension strength. However, %FMD was not significantly different between the groups. In the “Over AT” group, the rate of improvement in peakVO2was positively correlated with the improvement in the isometric knee extension strength (r= 0.61,p< 0.001), but not with %FMD. These data suggest that exercise at an intensity above the AT improved exercise tolerance faster than that at the AT, and this improvement rate was associated with changes in isometric knee extension strength.