缓步行走3km对血压心率的影响及其辅助降压的β内啡肽机制
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摘要
目的比较正常血压年轻人低、中、高强度运动前后血压、心率的变化,观察缓步行走对高血压患者血压、心率的影响,探讨真实世界研究中低代谢当量(MET,<3 METs)的温和运动之辅助降压作用及其神经内分泌机制。方法本试验分两部分:第一部分共入选正常血压年轻人32名,分别进行低强度[缓步行走3km,耗时(49±4)min]、中等强度[快步行走3km,耗时(32±2)min]和高强度(健身房综合锻炼1h)运动,其中32人全部参加缓步行走,自我评估体力可耐受中等强度运动的24人参加快步行走,平素有健身房锻炼习惯的9人参加高强度运动,于运动前、运动后即刻,5及10min分别测静息血压、心率,并计算简易心肌耗氧量(收缩压×心率),检测尿常规、白蛋白、尿β内啡肽;第二部分共入选20～86岁高血压患者30例及年龄相似的正常血压对照24人,均进行缓步行走3km,步行前后测静息血压、心率、尿白蛋白、尿β内啡肽及生长激素。结果 (1)正常血压年轻人一次性缓步行走3km可显著降低运动后10min内的静息血压、心率与简易心肌耗氧量[运动后10min比运动前:收缩压(108±8)比(115±8)mm Hg,心率(70±11)比(76±12)次/min,简易心肌耗氧量(7225±1189)比(8690±1633)mm Hg·次/min,均P<0.01],而快步行走显著增加运动后即刻静息收缩压、心率与心肌耗氧量[运动后即刻比运动前:收缩压(115±11)比(110±10)mm Hg,心率(89±18)比(73±10)次/min,简易心肌耗氧量(9151±2374)比(7230±1368)mm Hg·次/min,均P<0.01];高强度运动1h显著增加运动后10min内的静息心率(P<0.01)及心肌耗氧(P<0.05),增加血尿和(或)尿白蛋白阳性率(P<0.05)。(2)高血压患者缓步行走3km可显著降低步行后10min内的静息收缩压、舒张压、心率与简易心肌耗氧量[运动后10min比运动前:收缩压(125±11)比(133±9)mm Hg,心率(73±10)比(78±12)次/min,简易心肌耗氧量(8469±2075)比(9523±2216)mm Hg·次/min,均P<0.01];缓步行走过程中立位心率及心肌耗氧量变化不显著。(3)缓步行走3km可显著增加正常血压人群及高血压患者运动开始后1h尿β内啡肽排出量(P<0.05),而尿生长激素及白蛋白排出量无显著变化。结论真实世界研究中高血压患者缓步行走3km,可在不显著增加心血管负荷的情况下,降低运动后短期内的静息血压及心率,其辅助降压机制可能部分与运动增加β内啡肽释放有关。
Objective To investigate the influence of low-speed walking on blood pressure and heart rate(HR)in normotensive and hypertensive subjects and its neuroendocrine mechanism in the real-world study.Methods The study included two parts. In the first part,32 normotensive young volunteers were recruited,in which 32 subjects took part in the low-intensity exercise[a 3-kilometer low-speed walk for(49±4)min],24 subjects took part in the medium-intensity exercise[a 3-kilometer high-speed walk for(32±2)min]and 9 subjects who have the gym exercise habits took part in high-intensity exercise(comprehensive exercise for 1 hin gymnasium).The resting blood pressure and HR were measured in sitting position before walking(pre-walk baseline values),immediate and 5-as well as 10-min after walking(post-walk).Estimated myocardial oxygen consumption was calculated as the HR timed by the systolic blood pressure.Urine samples were collected before and after walking for urine routine and determination ofβ-endorphin.In the second part,30 hypertensives and 24 age-matched(20-86 years)normotensive volunteers were enrolled and had a 3-kilometer low-speed walk.The pre-walk/post-walk resting pressure and HR taken as mentioned above.Urine samples were collected forβ-endorphin and growth hormone determination. Results After 3-kilometer low-speed walking,resting blood pressure,HR and estimated myocardial oxygen consumption reduced significantly within 10 min post-walk in normotensive young volunteers[10 min after walk vs pre-walk values:systolic blood pressure(108±8)vs(115±8)mm Hg,HR(70±11)vs(76±12)beats/min,estimated myocardial oxygen consumption(7225±1189)vs(8690±1633)mm Hg·beats/min,all P<0.01],but increased immediately after high-speed walking[immediately after walk vs pre-walk values:systolic blood pressure(115±11)vs(110±10)mm Hg,HR(89±18)vs(73±10)beats/min,estimated myocardial oxygen consumption(9151±2374)vs(7230±1368)mm Hg·beats/min,all P<0.01].Hypertensive subjects who had the 3-kilometer low-speed walking also showed reduced systolic and diastolic blood pressure as well as lowered resting HR and estimated myocardial oxygen consumption within 10 min post-walk[10 min after walk vs pre-walk values:systolic blood pressure(125±11)vs(133±9)mm Hg,HR(73±10)vs(78±12)beats/min,estimated myocardial oxygen consumption(8469±2075)vs(9523±2216)mm Hg·beats/min,all P<0.01],while the upright HR and estimated myocardial oxygen consumption during low-speed walking remained relatively unchanged.In both normotensive and hypertensive subjects,the low-speed walking for 3-kilometer increased 1-hour urineβ-endorphin output(P<0.05 as compared with baseline values)but not growth hormone. Conclusion Low-speed walking with sufficient distance revealed pressure-lowering and HR-lowering effects that might be related partly to enhancedβ-endorphin release.
Objective To investigate the influence of low-speed walking on blood pressure and heart rate(HR)in normotensive and hypertensive subjects and its neuroendocrine mechanism in the real-world study.Methods The study included two parts. In the first part,32 normotensive young volunteers were recruited,in which 32 subjects took part in the low-intensity exercise[a 3-kilometer low-speed walk for(49±4)min],24 subjects took part in the medium-intensity exercise[a 3-kilometer high-speed walk for(32±2)min]and 9 subjects who have the gym exercise habits took part in high-intensity exercise(comprehensive exercise for 1 hin gymnasium).The resting blood pressure and HR were measured in sitting position before walking(pre-walk baseline values),immediate and 5-as well as 10-min after walking(post-walk).Estimated myocardial oxygen consumption was calculated as the HR timed by the systolic blood pressure.Urine samples were collected before and after walking for urine routine and determination ofβ-endorphin.In the second part,30 hypertensives and 24 age-matched(20-86 years)normotensive volunteers were enrolled and had a 3-kilometer low-speed walk.The pre-walk/post-walk resting pressure and HR taken as mentioned above.Urine samples were collected forβ-endorphin and growth hormone determination. Results After 3-kilometer low-speed walking,resting blood pressure,HR and estimated myocardial oxygen consumption reduced significantly within 10 min post-walk in normotensive young volunteers[10 min after walk vs pre-walk values:systolic blood pressure(108±8)vs(115±8)mm Hg,HR(70±11)vs(76±12)beats/min,estimated myocardial oxygen consumption(7225±1189)vs(8690±1633)mm Hg·beats/min,all P<0.01],but increased immediately after high-speed walking[immediately after walk vs pre-walk values:systolic blood pressure(115±11)vs(110±10)mm Hg,HR(89±18)vs(73±10)beats/min,estimated myocardial oxygen consumption(9151±2374)vs(7230±1368)mm Hg·beats/min,all P<0.01].Hypertensive subjects who had the 3-kilometer low-speed walking also showed reduced systolic and diastolic blood pressure as well as lowered resting HR and estimated myocardial oxygen consumption within 10 min post-walk[10 min after walk vs pre-walk values:systolic blood pressure(125±11)vs(133±9)mm Hg,HR(73±10)vs(78±12)beats/min,estimated myocardial oxygen consumption(8469±2075)vs(9523±2216)mm Hg·beats/min,all P<0.01],while the upright HR and estimated myocardial oxygen consumption during low-speed walking remained relatively unchanged.In both normotensive and hypertensive subjects,the low-speed walking for 3-kilometer increased 1-hour urineβ-endorphin output(P<0.05 as compared with baseline values)but not growth hormone. Conclusion Low-speed walking with sufficient distance revealed pressure-lowering and HR-lowering effects that might be related partly to enhancedβ-endorphin release.
引文
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[14]郑林,王建,陶韬,等.大鼠耐力训练增加血红素加氧酶1诱导的血管舒张[J].中华高血压杂志,2007,15(11):904-907.
[15]Sun MW,Zhong MF,Gu JZ,et al.Effects of different levels of exercise volume on endothelium-dependent vasodilation:roles of nitric oxide synthase and heme oxygenase[J].Hypertens Res,2008,31(4):805-816.
[16]Sun MW,Qian FL,Wang J,et al.Low-intensity voluntary running lowers blood pressure with simultaneous improvement in endothelium-dependent vasodilatation and insulin sensitivity in aged spontaneously hypertensive rats[J].Hypertens Res,2008,31(3):543-552.
[17]钟梅芳,吴国忠,杨文君,等.低强度自愿运动与强迫运动对自发性高血压大鼠血管内皮功能及炎症损伤的影响[J].中华高血压杂志,2009,17(9):825-829.
[18]Pepe S,Xiao RP,Hohl C,et al.‘Cross talk’between opioid peptide and adrenergic receptor signaling in isolated rat heart[J].Circulation,1997,95(8):2122-2129.
[19]Di Luigi L,Guidetti L,Baldari C,et al.Heredity and pituitary response to exercise-related stress in trained men[J].Int J Sports Med,2003,24(8):551-558.
[20]Fournier PE,Stalder J,Mermillod B,et al.Effects of a 110kilometers ultra-marathon race on plasma hormone levels[J].Int J Sports Med,1997,18(4):252-256.
[21]Petraglia F,Bacchi Modena A,Comitini G,et al.Plasma betaendorphin and beta-lipotropin levels increase in well trained athletes after competition and noncompetitive exercise[J].J Endocrinol Invest,1990,13(1):19-23.
[22]下光輝一,岩根久夫.超持久運動後における血血漿β濃度の変化と感情·気分との関係[J].東京医科大学雑誌,1993,52(2):116-124.
[23]林昱,洪新如.原发性高血压患者血压水平与血浆β内啡肽、亮啡肽含量的关系[J].放射免疫学杂志,1994,7(6):327-328
[24]Guasti L,Cattaneo R,Daneri A,et al.Endogenous beta-endorphins in hypertension:correlation with 24-hour ambulatory blood pressure[J].J Am Coll Cardiol,1996,28(5):1243-1248.
[25]Boluyt MO,Younes A,Caffrey JL,et al.Age-associated increase in rat cardiac opioid production[J].Am J Physiol,1993,265(1Pt 2):H212-218.
[26]World Health Organization:Global recommendations on physical activities for health[DB/OL].http://www.who.int/dietphysicalactivity/publications/9789241599979/en/.
[27]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.
[2]Hanson S,Jones A.Is there evidence that walking groups have health benefits?A systematic review and meta-analysis[J].Br J Sports Med,2015,49(11):710-715.
[3]Ghadieh AS,Saab B.Evidence for exercise training in the management of hypertension in adults[J].Can Fam Physician,2015,61(3):233-239.
[4]《中国高血压基层管理指南》修订委员会,中国高血压基层管理指南(2014年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[5]Leung AA,Daskalopoulou SS,Dasgupta K,et al.Hypertension Canada’s 2017guidelines for diagnosis,risk assessment,prevention,and treatment of hypertension in adults[J].Can J Cardiol,2017,33(5):557-576.
[6]Schultz MG,Otahal P,Cleland VJ,et al.Exercise-induced hypertension,cardiovascular events,and mortality in patients undergoing exercise stress testing:a systematic review and meta-analysis[J].Am J Hypertens,2013,26(3):357-366.
[7]Pepe S,Van dB,Lakatta EG,et al.Cross-talk of opioid peptide receptor andβ-adrenergic receptor signalling in the heart[J].Cardiovasc Res,2004,63(3):414-422.
[8]Allen M.Activity-generated endorphins:a review of their role in sports science[J].Can J Appl Sport Sci,1983,8(3):115-133.
[9]Farrell PA,Gates WK,Maksud MG,et al.Increases in plasma beta-endorphin/beta-lipotropin immunoreactivity after treadmill running in humans[J].J Appl Physiol,1982,52(52):1245-1249.
[10]Ainsworth BE,Haskell WL,Whitt MC,et al.Compendium of physical activities:an update of activity codes and MET intensities[J].Med Sci Sports Exerc,2000,32(9suppl):S498-516.
[11]中华人民共和国卫生部疾病预防控制局.中国成人身体活动指南:试行[M].北京:人民卫生出版社,2011:49-50.
[12]Whelton PK,Carey RM,Aronow WS,et al.2017ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention,detection,evaluation,and management of high blood pressure in adults:a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines[J].J Am Coll Cardiol,2018,71(19):e127-248.
[13]Hayashi T,Tsumura K,Suematsu C,et al.Walking to work and the risk for hypertension in men:the Osaka health survey[J].Ann Intern Med,1999,131(1):21-26.
[14]郑林,王建,陶韬,等.大鼠耐力训练增加血红素加氧酶1诱导的血管舒张[J].中华高血压杂志,2007,15(11):904-907.
[15]Sun MW,Zhong MF,Gu JZ,et al.Effects of different levels of exercise volume on endothelium-dependent vasodilation:roles of nitric oxide synthase and heme oxygenase[J].Hypertens Res,2008,31(4):805-816.
[16]Sun MW,Qian FL,Wang J,et al.Low-intensity voluntary running lowers blood pressure with simultaneous improvement in endothelium-dependent vasodilatation and insulin sensitivity in aged spontaneously hypertensive rats[J].Hypertens Res,2008,31(3):543-552.
[17]钟梅芳,吴国忠,杨文君,等.低强度自愿运动与强迫运动对自发性高血压大鼠血管内皮功能及炎症损伤的影响[J].中华高血压杂志,2009,17(9):825-829.
[18]Pepe S,Xiao RP,Hohl C,et al.‘Cross talk’between opioid peptide and adrenergic receptor signaling in isolated rat heart[J].Circulation,1997,95(8):2122-2129.
[19]Di Luigi L,Guidetti L,Baldari C,et al.Heredity and pituitary response to exercise-related stress in trained men[J].Int J Sports Med,2003,24(8):551-558.
[20]Fournier PE,Stalder J,Mermillod B,et al.Effects of a 110kilometers ultra-marathon race on plasma hormone levels[J].Int J Sports Med,1997,18(4):252-256.
[21]Petraglia F,Bacchi Modena A,Comitini G,et al.Plasma betaendorphin and beta-lipotropin levels increase in well trained athletes after competition and noncompetitive exercise[J].J Endocrinol Invest,1990,13(1):19-23.
[22]下光輝一,岩根久夫.超持久運動後における血血漿β濃度の変化と感情·気分との関係[J].東京医科大学雑誌,1993,52(2):116-124.
[23]林昱,洪新如.原发性高血压患者血压水平与血浆β内啡肽、亮啡肽含量的关系[J].放射免疫学杂志,1994,7(6):327-328
[24]Guasti L,Cattaneo R,Daneri A,et al.Endogenous beta-endorphins in hypertension:correlation with 24-hour ambulatory blood pressure[J].J Am Coll Cardiol,1996,28(5):1243-1248.
[25]Boluyt MO,Younes A,Caffrey JL,et al.Age-associated increase in rat cardiac opioid production[J].Am J Physiol,1993,265(1Pt 2):H212-218.
[26]World Health Organization:Global recommendations on physical activities for health[DB/OL].http://www.who.int/dietphysicalactivity/publications/9789241599979/en/.
[27]中国高血压防治指南修订委员会.中国高血压防治指南2010[J].中华高血压杂志,2011,19(8):701-743.