个体化运动处方对心血管疾病的康复效果研究进展
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摘要
个体化运动处方在慢性心血管疾病患者的心脏康复中发挥着至关重要的作用。心肺运动试验证明,个体化运动处方可降低心血管疾病患者的血压和血糖,改善心肺功能以及提高运动耐力和生活质量。同时,本文也综述了制定个体化运动处方需遵循的原则个体化运动处方在慢性心血管疾病患者的心脏康复中发挥的作用。心肺运动试验证明,个体化运动处方可降低心血管疾病患者的血压和血糖,改善心肺功能以及提高运动耐力和生活质量。同时,本文也综述了制定个体化运动处方需遵循的原则(个体性、有效性、安全性、专业性、全面性和终身性)、运动强度评估方法(由以往的心率、自我疲劳程度分级等方式转变为心肺运动试验)以及个体化运动处方的内容(重点是运动强度的制定)。
Currently, individualized exercise prescription plays a vital role in the cardiac rehabilitation of patients with chronic cardiovascular diseases. Many cardiopulmonary exercise tests proved that individualized exercise prescription can lower blood pressure and glucose of patients with cardiovascular diseases, improve cardiopulmonary function, and improve exercise endurance and quality of life. At the same time, this paper also summarized that the individualized exercise prescription should be formulated in compliance with the principle(individuality, effectiveness, safety, professionalization,comprehensiveness and permanence), exercise intensity evaluation method(from previous heart rate, fatigue grading methods into cardiopulmonary exercise test) and the contents of the individualized exercise prescription(with a focus on the exercise intensity formulation).
Currently, individualized exercise prescription plays a vital role in the cardiac rehabilitation of patients with chronic cardiovascular diseases. Many cardiopulmonary exercise tests proved that individualized exercise prescription can lower blood pressure and glucose of patients with cardiovascular diseases, improve cardiopulmonary function, and improve exercise endurance and quality of life. At the same time, this paper also summarized that the individualized exercise prescription should be formulated in compliance with the principle(individuality, effectiveness, safety, professionalization,comprehensiveness and permanence), exercise intensity evaluation method(from previous heart rate, fatigue grading methods into cardiopulmonary exercise test) and the contents of the individualized exercise prescription(with a focus on the exercise intensity formulation).
引文
[1]陈伟伟,高润霖,刘力生,等.?中国心血管病报告2017?概要[J].中国循环杂志,2018,33(1):1-8.
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[3]Sibilitz K L,Berg S K,Tang L H,et al.Exercise-based cardiac rehabili‐tation for adults after heart valve surgery[J].Cochrane Database Sys Rev,2016,3:D010876.
[4]Lewinter C,Doherty P,Gale C P,et al.Exercise-based cardiac rehabili‐tation in patients with heart failure:a meta-analysis of randomised con‐trolled trials between 1999 and 2013[J].Eur J Prev Cardiol,2015,22(12):1504-1512.
[5]Lane R,Harwood A,Watson L,et al.Exercise for intermittent claudica‐tion[J].Cochrane Database Syst Rev,2017,12:D990.
[6]Tu H,Wen C P,Tsai S P,et al.Cancer risk associated with chronic dis‐eases and disease markers:prospective cohort study[J].BMJ,2018360:k134.
[7]杨丽华,吴站蓉.实现综合性"现代心肺康复"[J].中国医药导报2014,11(29):165-168.
[8]Sandesara P B,Lambert C T,Gordon N F,et al.Cardiac rehabilitation and risk reduction:time to"rebrand and reinvigo-rate"[J].J Am Col Cardiol,2015,65(4):389.
[9]Clarke H H.Application of measurement to health and physical educa‐tion[M].2nd ed.New York:Prentice-Hall,1950.
[10]步斌,侯乐荣,周学兰,等.运动处方研究进展[J].中国循证医学杂志2010,10(12):1359-1366.
[11]刘洁.个体化理念在心脏运动康复健康教育中的应用[J].包头医学2016,40(2):104-105.
[12]Ingle L,Carroll S.Cardiac rehabilitation and exercise training[J]Heart,2013,99(17):1298.
[13]于潇涵,毕颖斐,毛静远,等.心肺运动试验在心血管疾病中应用的研究进展[J].中西医结合心脑血管病杂志,2017,15(2):176-179.
[14]Budts W,Borjesson M,Chessa M,et al.Physical activity in adoles‐cents and adults with congenital heart defects:individualized exercise prescription[J].Eur Heart J,2013,34(47):3669-3674.
[15]孙兴国,胡大一.心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J].中华心血管病杂志,2014,42(10):817-821.
[16]Wasserman K,Hansen J,Sue D,et al.Principles of exercise testing and interpretation[M].5th ed.Philadelphia:Lippincott Williams&Wilkins,2011.
[17]Sun X G,Hansen J E,Beshai J F,et al.Oscillatory breathing and exer‐cise gas exchange abnormalities prognosticate early mortality and mor‐bidity in heart failure[J].J Am Coll Cardiol,2010,55(17):1814-1823.
[18]Fletcher G F,Ades P A,Kligfield P,et al.Exercise standards for testing and training:a scientific statement from the American Heart Associa‐tion[J].Circulation,2013,128(8):873-934.
[19]Malhotra R,Bakken K,D'Elia E,et al.Cardiopulmonary exercise test‐ing in heart failure[J].JACC Heart Fail,2016,4(8):607-616.
[20]郑秀峰,赵美红,陈艳红.高血压应用心肺运动试验精准制定个体化适度强度运动康复处方治疗的效果分析[J].中外医疗,2017,36(25)62-63,66.
[21]夏莉娟,张琳,罗慧琴,等.健步走对老年高血压患者血糖、血脂的干预作用[J].中国老年学杂志,2013,33(21):5233-5235.
[22]Chun-Qi Z.Analysis on the effect of individualized aerobic exercise intervention for teenagers with type 2 diabetes[J].Open Biomed Eng J,2015,9(1):262.
[23]郭娴.中年人运动中心血管风险预警及运动改善风险和心肺耐力的效果研究[D].北京:北京体育大学,2014.
[24]Stavropoulos-Kalinoglou A,Metsios G S,Veldhuijzen van Zanten J J,et al.Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis[J].Ann Rheum Dis,2013,72(11):1819-1825.
[25]Rissanen A E,Tikkanen H O,Koponen A S,et al.One-year unsuper‐vised individualized exercise training intervention enhances cardiore‐spiratory fitness but not muscle deoxygenation or glycemic control in adults with type 1 diabetes[J].Appl Physi-ol Nutr Metab,2018,43(4):387-396.
[26]张振英,孙兴国,席家宁,等.心肺运动试验制定运动强度对慢性心力衰竭患者心脏运动康复治疗效果影响的临床研究[J].中国全科医学,2016,19(35):4302-4309.
[27]陶贵周,张川海.心血管疾病患者心理评估及干预措施[J].医学与哲学(B),2017,38(3):16-18.
[28]杨献军,黄飞翔,时永超,等.健身操训练对慢性心力衰竭患者运动耐量的影响[J].中华护理杂志,2015,50(2):36-37.
[29]张振英,孙兴国,席家宁,等.心肺运动试验在慢性心力衰竭患者高强度个体化运动康复处方制定和运动康复效果评估中的作用研究[J].中国全科医学,2016,19(17):2061-2067.
[30]陈雪,樊秋明,霍婧婧,等.个体化可量化运动对2型糖尿病患者血糖控制、睡眠质量和生活质量的影响[J].中国疗养医学,2017,26(4):342-345.
[31]Tung H,Shen S,Shih C,et al.Effects of a preoperative individualized exercise program on selected recovery variables for cardiac surgery pa‐tients:a pilot study[J].J Saudi Heart Assoc,2012,24(3):153-161.
[32]渠泽普.长期传统健身运动对老年高血压患者干预效果的研究[D].扬州:扬州大学,2017.
[33]朱颖莹,陈晓亮.心肺运动试验在心血管疾病患者中的应用价值和前景[J].心电与循环,2017,36(4):271-274.
[34]孙兴国.整体整合生理学医学新理论体系概论Ⅰ:呼吸调控新视野[J].中国应用生理学杂志,2015,31(4):295-301.
[35]孙兴国.整体整合生理学医学新理论体系概论Ⅱ:循环调控新视野[J].中国应用生理学杂志,2015,31(4):302-307.
[36]孙兴国.整体整合生理学医学新理论体系概论Ⅲ:呼吸循环代谢一体化调控环路中神经体液作用模式[J].中国应用生理学杂志,2015,31(4):308-315.
[37]刘艳玲,孙兴国,高华,等.心肺运动指导个体化心衰患者康复的初步总结报告[J].中国应用生理学杂志,2015,31(4):374-377.
[38]孙兴国.心肺运动试验的规范化操作要求和难点-数据分析图示与判读原则[J].中国应用生理学杂志,2015,31(4):361-365.
[2]Rauch B,Davos C H,Doherty P,et al.The prognostic effect of cardiac rehabilitation in the era of acute revascularisation and statin therapy:a systematic review and meta-analysis of randomized and non-random‐ized studies-The Cardiac Rehabilitation Outcome Study(CROS)[J]Eur J Prev Cardiol,2016,23(18):1914-1939.
[3]Sibilitz K L,Berg S K,Tang L H,et al.Exercise-based cardiac rehabili‐tation for adults after heart valve surgery[J].Cochrane Database Sys Rev,2016,3:D010876.
[4]Lewinter C,Doherty P,Gale C P,et al.Exercise-based cardiac rehabili‐tation in patients with heart failure:a meta-analysis of randomised con‐trolled trials between 1999 and 2013[J].Eur J Prev Cardiol,2015,22(12):1504-1512.
[5]Lane R,Harwood A,Watson L,et al.Exercise for intermittent claudica‐tion[J].Cochrane Database Syst Rev,2017,12:D990.
[6]Tu H,Wen C P,Tsai S P,et al.Cancer risk associated with chronic dis‐eases and disease markers:prospective cohort study[J].BMJ,2018360:k134.
[7]杨丽华,吴站蓉.实现综合性"现代心肺康复"[J].中国医药导报2014,11(29):165-168.
[8]Sandesara P B,Lambert C T,Gordon N F,et al.Cardiac rehabilitation and risk reduction:time to"rebrand and reinvigo-rate"[J].J Am Col Cardiol,2015,65(4):389.
[9]Clarke H H.Application of measurement to health and physical educa‐tion[M].2nd ed.New York:Prentice-Hall,1950.
[10]步斌,侯乐荣,周学兰,等.运动处方研究进展[J].中国循证医学杂志2010,10(12):1359-1366.
[11]刘洁.个体化理念在心脏运动康复健康教育中的应用[J].包头医学2016,40(2):104-105.
[12]Ingle L,Carroll S.Cardiac rehabilitation and exercise training[J]Heart,2013,99(17):1298.
[13]于潇涵,毕颖斐,毛静远,等.心肺运动试验在心血管疾病中应用的研究进展[J].中西医结合心脑血管病杂志,2017,15(2):176-179.
[14]Budts W,Borjesson M,Chessa M,et al.Physical activity in adoles‐cents and adults with congenital heart defects:individualized exercise prescription[J].Eur Heart J,2013,34(47):3669-3674.
[15]孙兴国,胡大一.心肺运动试验的实验室和设备要求及其临床实施难点的质量控制[J].中华心血管病杂志,2014,42(10):817-821.
[16]Wasserman K,Hansen J,Sue D,et al.Principles of exercise testing and interpretation[M].5th ed.Philadelphia:Lippincott Williams&Wilkins,2011.
[17]Sun X G,Hansen J E,Beshai J F,et al.Oscillatory breathing and exer‐cise gas exchange abnormalities prognosticate early mortality and mor‐bidity in heart failure[J].J Am Coll Cardiol,2010,55(17):1814-1823.
[18]Fletcher G F,Ades P A,Kligfield P,et al.Exercise standards for testing and training:a scientific statement from the American Heart Associa‐tion[J].Circulation,2013,128(8):873-934.
[19]Malhotra R,Bakken K,D'Elia E,et al.Cardiopulmonary exercise test‐ing in heart failure[J].JACC Heart Fail,2016,4(8):607-616.
[20]郑秀峰,赵美红,陈艳红.高血压应用心肺运动试验精准制定个体化适度强度运动康复处方治疗的效果分析[J].中外医疗,2017,36(25)62-63,66.
[21]夏莉娟,张琳,罗慧琴,等.健步走对老年高血压患者血糖、血脂的干预作用[J].中国老年学杂志,2013,33(21):5233-5235.
[22]Chun-Qi Z.Analysis on the effect of individualized aerobic exercise intervention for teenagers with type 2 diabetes[J].Open Biomed Eng J,2015,9(1):262.
[23]郭娴.中年人运动中心血管风险预警及运动改善风险和心肺耐力的效果研究[D].北京:北京体育大学,2014.
[24]Stavropoulos-Kalinoglou A,Metsios G S,Veldhuijzen van Zanten J J,et al.Individualised aerobic and resistance exercise training improves cardiorespiratory fitness and reduces cardiovascular risk in patients with rheumatoid arthritis[J].Ann Rheum Dis,2013,72(11):1819-1825.
[25]Rissanen A E,Tikkanen H O,Koponen A S,et al.One-year unsuper‐vised individualized exercise training intervention enhances cardiore‐spiratory fitness but not muscle deoxygenation or glycemic control in adults with type 1 diabetes[J].Appl Physi-ol Nutr Metab,2018,43(4):387-396.
[26]张振英,孙兴国,席家宁,等.心肺运动试验制定运动强度对慢性心力衰竭患者心脏运动康复治疗效果影响的临床研究[J].中国全科医学,2016,19(35):4302-4309.
[27]陶贵周,张川海.心血管疾病患者心理评估及干预措施[J].医学与哲学(B),2017,38(3):16-18.
[28]杨献军,黄飞翔,时永超,等.健身操训练对慢性心力衰竭患者运动耐量的影响[J].中华护理杂志,2015,50(2):36-37.
[29]张振英,孙兴国,席家宁,等.心肺运动试验在慢性心力衰竭患者高强度个体化运动康复处方制定和运动康复效果评估中的作用研究[J].中国全科医学,2016,19(17):2061-2067.
[30]陈雪,樊秋明,霍婧婧,等.个体化可量化运动对2型糖尿病患者血糖控制、睡眠质量和生活质量的影响[J].中国疗养医学,2017,26(4):342-345.
[31]Tung H,Shen S,Shih C,et al.Effects of a preoperative individualized exercise program on selected recovery variables for cardiac surgery pa‐tients:a pilot study[J].J Saudi Heart Assoc,2012,24(3):153-161.
[32]渠泽普.长期传统健身运动对老年高血压患者干预效果的研究[D].扬州:扬州大学,2017.
[33]朱颖莹,陈晓亮.心肺运动试验在心血管疾病患者中的应用价值和前景[J].心电与循环,2017,36(4):271-274.
[34]孙兴国.整体整合生理学医学新理论体系概论Ⅰ:呼吸调控新视野[J].中国应用生理学杂志,2015,31(4):295-301.
[35]孙兴国.整体整合生理学医学新理论体系概论Ⅱ:循环调控新视野[J].中国应用生理学杂志,2015,31(4):302-307.
[36]孙兴国.整体整合生理学医学新理论体系概论Ⅲ:呼吸循环代谢一体化调控环路中神经体液作用模式[J].中国应用生理学杂志,2015,31(4):308-315.
[37]刘艳玲,孙兴国,高华,等.心肺运动指导个体化心衰患者康复的初步总结报告[J].中国应用生理学杂志,2015,31(4):374-377.
[38]孙兴国.心肺运动试验的规范化操作要求和难点-数据分析图示与判读原则[J].中国应用生理学杂志,2015,31(4):361-365.