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| 6周线上监督运动干预对不同类型冠心病患者的效果 |
| 王政1,李佳佳1,焦昆立2,严健华2,张婷婷2,俞莞琦3,陈楠4,高玙4,韩甲5*,孟舒2* |
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(1. 上海体育学院运动健康学院, 上海 200438;
2. 上海交通大学医学院附属新华医院心血管内科, 上海 200092;
3. 上海交通大学医学院附属第六人民医院康复医学科, 上海 200233;
4. 上海交通大学医学院附属新华医院康复医学科, 上海 200092;
5. 上海健康医学院康复学院, 上海 201318
*通信作者) |
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| 摘要: |
| 目的 探究6周线上监督运动干预对不同类型冠心病（CAD）患者的效果与安全性。方法 入选两组共22例经皮冠状动脉介入术（PCI）后的CAD患者，其中非心肌梗死组11例、陈旧性心肌梗死组11例。所有入选患者均填写心脏康复问卷或量表，并行血液生物化学检测、运动功能测试和心肺运动试验（CPET）。在心血管内科医师的指导下，由治疗师每日定时线上监督患者进行运动。运动方案包含下肢抗阻训练与有氧运动。抗阻训练为坐站运动，每天2次，每次2～3组，每组20～30个；有氧训练为快步走，每天1次，每次30～60 min，按需间断休息。训练强度均为达到无氧阈对应的心率或自我疲劳感觉分级量表得分为13分。6周线上监督运动干预后，复测各指标并分析组内变化差异。结果 全部患者均按时间节点完成复测，未发生严重不良心血管事件。6周线上监督运动干预后，非心肌梗死组和陈旧性心肌梗死组的冠心病自我管理行为量表、冠心病教育问卷、体力活动阻碍量表得分均较干预前改善，陈旧性心肌梗死组的班杜拉运动自我效能量表得分较干预前提高（P均<0.05）；非心肌梗死组和陈旧性心肌梗死组的6 min步行试验、坐站起立走测试、5次坐站测试、30 s坐站测试、1 min坐站测试均较干预前改善（P均≤0.05）；非心肌梗死组和陈旧性心肌梗死组的低密度脂蛋白、甘油三酯均较干预前下降（P均<0.01）。CPET结果显示，与干预前相比，陈旧性心肌梗死组6周线上监督运动干预后的摄氧量与功率比值［（8.44±0.93）mL/（min·W） vs （9.05±0.77 mL/（min·W），P<0.01］、每搏摄氧量［（9.85±1.91）mL vs （10.65±1.83）mL，P=0.01］、最大代谢当量（MET）值［（4.92±0.74）MET vs （5.22±0.76）MET，P=0.05］均提高，而非心肌梗死组上述指标在干预前后无明显变化。结论 6周线上监督运动是一种安全有效的干预方式，不仅能显著增强非心肌梗死组和陈旧性心肌梗死组患者的疾病认知与自我健康管理能力，也能改善两组患者的运动功能与血脂水平，且该干预方式能够显著改善陈旧性心肌梗死组患者的心肺功能。 |
| 关键词: 冠心病 线上干预 坐站运动 心肺功能 |
| DOI：10.16781/j.CN31-2187/R.20211126 |
| 投稿时间：2021-11-06修订日期：2022-02-25 |
| 基金项目:国家自然科学基金面上项目（31870936）. |
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| Effect of 6-week online supervised exercise intervention on patients with different types of coronary artery disease |
| WANG Zheng1,LI Jia-jia1,JIAO Kun-li2,YAN Jian-hua2,ZHANG Ting-ting2,YU Wan-qi3,CHEN Nan4,GAO Yu4,HAN Jia5*,MENG Shu2* |
(1. School of Exercise and Health, Shanghai University of Sport, Shanghai 200438, China;
2. Department of Cardiovasology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
3. Department of Rehabilitation Medicine, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200233, China;
4. Department of Rehabilitation Medicine, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China;
5. College of Rehabilitation Sciences, Shanghai University of Medicine & Health Sciences, Shanghai 201318, China
*Corresponding authors) |
| Abstract: |
| Objective To investigate the efficacy and safety of 6-week online supervised exercise intervention on patients with different types of coronary artery disease (CAD). Methods A total of 22 patients with CAD after percutaneous coronary intervention (PCI) were enrolled in 2 groups, including 11 in non-myocardial infarction (non-MI) group and 11 in post-MI group. All enrolled patients were required to fill in the cardiac rehabilitation questionnaires or scales and underwent blood biochemical detection, motor function test and cardiopulmonary exercise test (CPET). Under the guidance of cardiovascular physicians, the patients were asked for daily exercise by their therapists online. The exercise program consisted of resistance training of lower extremities and aerobic exercise. Resistance training was sit-to-stand training, twice a day for 2-3 sets per time, 20-30 in each set. Aerobic exercise was brisk walking, once a day for 30-60 min, and intermittent rest was permitted. Exercise intensity was either to reach the heart rate reflecting the anaerobic threshold or to score 13 on rating of perceived exertion scale. After 6-week online supervised exercise intervention, the indicators were re-tested, and the differences of intra-group changes were analyzed. Results All patients completed retests according to the timeline without any serious adverse cardiovascular events. After 6-week online supervised exercise intervention, the scores of CAD self-management scale, CAD education scale and barriers to physical activity scale were improved in the non-MI and post-PCI groups, and the scores of Bandura's exercise self-efficacy scale were improved in the post-MI group (all P<0.05). The results of 6-min walk test, sit to stand test, 5 times sit to stand test, 30-s sit-to-stand test (STS) and 1-min STS were all improved in the non-MI and post-MI groups after the intervention (all P ≤ 0.05). Both groups had significant decreases in low-density lipoprotein and triglycerides (all P<0.01). CPET results showed that the oxygen uptake to work rate ratio ([8.44±0.93] mL/[min·W] vs[9.05±0.77] mL/[min·W], P<0.01), oxygen uptake/heart rate ([9.85±1.91] mL vs[10.65±1.83] mL, P=0.01) and maximal metabolic equivalent[MET] ([4.92±0.74] MET vs[5.22±0.76] MET, P=0.05) were all increased in the post-MI group after the intervention, while the above indicators had no significant change in the non-MI group. Conclusion The 6-week online supervised exercise is a safe and effective intervention. It can not only significantly enhance the disease knowledge and self-health management ability of patients in non-MI and post-MI groups, but also can remarkably improve their motor function and blood lipid level, and this intervention can significantly improve the cardiopulmonary function of patients in post-MI group. |
| Key words: coronary artery disease online intervention sit to stand exercise cardiopulmonary function |
