The role of exercise training in chronic heart failure
The role of exercise training in chronic heart failure
复制标题
运动训练在慢性心力衰竭中的作用
作者：
R. P. Wielenga;A. Coats;W. Mosterd;I. Huisveld
慢性心力衰竭是一种预后不佳的主要健康问题。它现在是65岁以上患者最常见的出院诊断，其发病率预计在未来几年可能会增加。衰竭心脏的特征是它不能维持足够的心输出量，首先是在运动期间，然后也是在休息时。慢性心力衰竭患者舒张末期容积大，收缩储备少。
因此，心力衰竭是继发于心室功能障碍的循环衰竭综合征。这种主要的心室功能障碍之后是各种神经体液、外周循环、骨骼肌和呼吸适应，这些适应决定了综合征的临床表现和预后，而不是主要的心室功能障碍本身。
因此，传统上提倡在所有形式和阶段的心力衰竭中避免运动。1然而，现在有证据表明，不活动会导致剩余功能能力的进一步恶化。几项关于心室功能障碍患者身体调节的研究表明，选定的患者可以安全地进行运动训练，从而改善功能等级。2 3
左心室功能不佳不一定与慢性心力衰竭同义，慢性心力衰竭的特征是组织氧供应减少。评估心脏受损患者疾病状态的最佳方法是心肺运动试验，即在运动期间测量氧消耗量（V steco 2，单位为ml/kg/min）。因此，近年来对慢性心力衰竭的研究集中在左心室功能障碍和低峰值耗氧量（小于20 ml/kg/min）的组合上。有氧能力的测定是必要的，以允许适当选择患者的心力衰竭研究。4在这次审查中，我们将重点放在训练研究（表1）进行慢性心力衰竭患者的功能分类…
Chronic heart failure is a major health problem with a gloomy prognosis. It is now the most common discharge diagnosis in patients over 65 years of age and its incidence may be expected to grow in coming years. Characteristic of the failing heart is its inability to maintain an adequate cardiac output, first during exercise and later also at rest. Patients with chronic heart failure have a large end diastolic volume and little contractile reserve.
Cardiac failure is thus a syndrome of circulatory failure, secondary to ventricular dysfunction. This primarily ventricular dysfunction is followed by a variety of neurohumoral, peripheral circulatory, skeletal muscle, and respiratory adaptations which determine the syndrome’s clinical presentation and prognosis more than the primary ventricular dysfunction itself.
Traditionally, avoidance of exercise was thus advocated in all forms and stages of heart failure.1 However, there is now evidence that inactivity leads to a further deterioration of remaining functional capacity. Several studies on physical conditioning in patients with ventricular dysfunction have shown that selected patients can safely undergo exercise training, resulting in an improvement in functional class.2 3
Poor left ventricular function is not necessarily synonymous with chronic heart failure, which is characterised by reduced tissue oxygen supply. The best method of evaluating the disease state of a patient with a compromised heart is cardiopulmonary exercise testing, that is, the measurement of oxygen consumption (V˙o 2 in ml/kg/min) during exercise. In recent years studies on chronic heart failure have therefore focused on the combination of left ventricular dysfunction and a low peak oxygen consumption (less than 20 ml/kg/min). Determination of aerobic capacity is necessary to allow proper selection of patients for heart failure studies.4In this review we shall focus on the training studies (table 1) performed with chronic heart failure patients in functional class …
骨骼肌对充血性心力衰竭运动训练的反应。
DOI：
10.1172/jci114771
发表时间：
1990
期刊：
The Journal of clinical investigation
影响因子：
--
作者：
Minotti,JR;Johnson,EC;Hudson,TL;Zuroske,G;Murata,G;Fukushima,E;Cagle,TG;Chick,TW;Massie,BM;Icenogle,MV
通讯作者：
Icenogle,MV
影响因子：
37.8
作者：
SULLIVAN, MJ;HIGGINBOTHAM, MB;COBB, FR
通讯作者：
COBB, FR