结合耐力和阻力运动训练在心力衰竭中与保存的喷射分数:一个随机对照试验
Frank Edelmann1,2,3, Rolf Wachter4,5,6, André Duvinage7
1Department of Cardiology, Angiology and Intensive Care Medicine, Campus Virchow Klinikum, Deutsches Herzzentrum der Charité, Berlin, Germany. frank.edelmann@dhzc-charite.de.
Nature medicine
|January 3, 2025
概括
结合耐力和阻力运动训练 (ET) 在心力衰竭中与保存的喷射分数 (HFpEF) 并没有显著改善主要结果. 然而,ET与常规护理相比,在峰值氧气消耗和NYHA类中显示出临床相关的改善.
科学领域:
- 心脏病学 心脏病学
- 运动生理学 运动生理学
- 临床医学 临床医学
背景情况:
- 心力衰竭与保留喷射分数 (HFpEF) 的管理通常涉及运动.
- 耐力训练 (ET) 已为HFpEF建立,但结合耐力和抵抗训练的影响不太了解.
研究的目的:
- 评估HFpEF患者联合耐力和抵抗运动训练的12个月疗效.
- 为了评估对修改后的Packer分数,峰值氧气消耗,透气功能,NYHA类和全球自我评估的影响.
主要方法:
- 一个多中心的随机试验,涉及322名HFpEF患者.
- 患者随机分配到12个月的联合ET或常规护理 (UC).
- 主要终点:修改的Packer分数;次要终点:峰值氧气消耗,E/e',NYHA类,GSA,住院,死亡率.
主要成果:
- 修改后的Packer分数在ET和UC组之间没有显著差异 (P=0.17).
- 在ET组观察到峰值氧气消耗 (平均差异1.3毫升/千克/分钟) 和NYHA类 (OR 7.77) 的临床相关改善.
- 对于E/e,GSA,心血管住院病例或全因死亡率没有发现显著差异.
结论:
- 在HFpEF中,一年的综合耐力和耐力ET没有达到主要终点.
- 然而,ET在关键临床参数上显著改善,如峰值氧气消耗和NYHA类.
- 组合ET可能为HFpEF患者提供好处,需要进一步调查.
相关概念视频
01:20Exercise and Cardiovascular Response
727
Exercise significantly impacts cardiovascular response, which is crucial for understanding patient health and designing effective treatment plans.
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...
727
01:27Exercise and Muscle Performance
1.3K
Exercise induces a range of adaptations in muscle tissue, depending on the type and duration of activity. Such physical training can be broadly categorized into two types: endurance exercises and resistance exercises.
Endurance exercises
Endurance exercises involve running, swimming, or cycling, which require repetitive movements with low force output. When a person engages in endurance exercise, a few noticeable changes occur in their skeletal muscles. For instance, the number of capillaries...
Endurance exercises
Endurance exercises involve running, swimming, or cycling, which require repetitive movements with low force output. When a person engages in endurance exercise, a few noticeable changes occur in their skeletal muscles. For instance, the number of capillaries...
1.3K
01:17Exercise and Cardiac Output
908
Regular physical activity is essential for maintaining cardiovascular health, with aerobic exercises being particularly effective. According to the American Heart Association, 150 minutes of moderate to intense aerobic exercise per week is recommended for a healthy heart. Aerobic activities may include brisk walking, running, bicycling, cross-country skiing, and swimming, ideally performed three to five times per week.
Sustained exercise increases the muscles' oxygen demand, which can be...
Sustained exercise increases the muscles' oxygen demand, which can be...
908
01:17Pathophysiology of Heart Failure
1.5K
Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...
1.5K
01:26Heart Failure Drugs: Inotropic Agents
515
Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
515
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
381
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
381