TRAINING LEVEL VS CARDIAC ADAPTATIONS IN PATIENTS W/CHD

没有足够的信息来选择最合适的 运动水平与冠心病的训练和康复 (CHD)严重程度不一的患者。多项研究表明 剧烈的运动可以安全地进行，这样的训练可以 在选定的CHD患者中诱导心血管适应。我们建议 比较常规监督训练的低水平和高水平的效果 对200名患者进行为期两年的心脏适应性治疗 动脉造影或心肌梗死证实有冠心病的患者。我们将测试 认为适当强度和持续时间的运动将 安全地影响心血管适应。招聘、培训和 评估将在Long的两个附属临床中心进行 有心脏康复的经验。 符合条件的男性将参加一项预随机计划，该计划旨在识别 并淘汰有坚持问题或动机不佳的人。 参与者将被随机分配到高或低运动组，并 将用两种独立的锻炼技巧定期进行评估- 仰卧位最大运动试验和直立最大运动试验 交换测量。这两项测试都将包括二维 运动前、运动后及运动中的超声心动图 测力计。比较这两种运动技巧的价值将会 产生重要的临床信息。评估的主要结果将是 一年后运动射血分数的变化。其他内容 反映心功能、心肌氧输送的观察 根据治疗组随时间推移的容量和代谢变化 注意到了。 这项研究的结果将有助于更好地理解长期 心脏对不同体力活动水平的适应性 二级预防的效果。对锻炼的影响 心脏康复计划中的处方和患者评价 影响将是深远的。

Insufficient information is available for selection of the most appropriate exercise levels for training and rehabilitation of coronary heart disease (CHD) patients with varying degrees of severity. Several studies indicate that vigorous exercise can be safely performed and that such training can elicit cardiovascular adaptations in selected CHD patients. We propose to compare the effects of low and high levels of regular supervised training over a two-year treatment period on cardiac adaptations among 200 patients with CHD documented by arteriogram or myocardial infarction. We will test the hypothesis that exercise of appropriate intensity and duration will safely effect cardiovascular adaptations. Recruitment, training and evaluation will take place at two affiliated clinical centers with long experience in cardiac rehabilitation. Eligible men will enter a pre-randomization program designed to identify and eliminate persons with adherence problems or poor motivation. Participants will be randomly assigned to high or low exercise groups and will be evaluated periodically with two independent exercise techniques - supine ergometer exercise and upright maximal exercise testing with gas exchange measurements. Both tests will include two-dimensional echocardiography pre- and post-exercise as well as during exercise with the ergometer. Comparison of the value of the two exercise techniques will yield important clinical information. The major outcome assessed will be the change in exercise ejection fraction at one year. Additional observations reflecting ventricular function, myocardial oxygen delivery capacity and metabolic alterations over time by treatment group will be noted. Results of this study will contribute to better understanding long-term cardiac adaptations with different physical activity levels and possibly the efficacy of secondary prevention. The implications for exercise prescriptions and patient evaluation in cardiac rehabilitation programs will be far reaching.