TRAINING LEVEL VS. CARDIAC ADAPTATIONS--PATIENTS W/CHD

没有足够的信息可供选择最适当的 运动水平对冠心病的训练和康复作用 (CHD)不同严重程度的患者。 一些研究表明 剧烈运动可以安全地进行，这种训练可以 在选定的CHD患者中引起心血管适应。 我们建议 比较低水平和高水平定期监督培训的效果 在200名患者中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的CHD。 我们将测试 假设适当强度和持续时间的锻炼将 安全地影响心血管适应性。 征聘、培训和 评估将在两个附属临床中心进行， 心脏康复的经验。 符合条件的男性将进入一个预随机化程序， 并淘汰有坚持问题或动力不足的人。 参与者将被随机分配到高或低运动组， 将定期评估两个独立的运动技术- 仰卧功率计运动和气体直立最大运动试验 交换测量 这两项测试都将包括二维 运动前和运动后以及运动期间的超声心动图， 测力计 比较两种锻炼技术的价值， 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。 额外 反映心室功能、心肌氧输送的观察结果 将按治疗组列出随时间推移的容量和代谢变化 知道了 这项研究的结果将有助于更好地了解长期 心脏适应不同的体力活动水平， 二级预防的有效性。 对运动的影响 心脏康复计划中的处方和患者评估 将影响深远

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.