心肺运动试验精准制定个体化强度运动处方对代谢综合征患者心肺功能的影响
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摘要
目的:分析代谢综合征患者的心肺功能状况,探讨利用心肺运动试验(CPET)精准制定个体化运动强度处方对代谢综合征患者心肺功能的影响。方法:选取2017年3月至2018年3月于重庆医科大学附属康复医院就诊的代谢综合征患者32例和本院体检正常组30例,进行CPET测试。将代谢综合征患者随机分为运动组和对照组,运动组根据CPET结果制定个体化△50%W强度运动方案,在常规药物治疗的基础上进行5天/周、共12周的踏车训练,对照组只进行12周常规药物治疗,12周后再次进行CPET测试。结果:①与正常组相比,代谢综合征患者用力肺活量(FVC)、最大通气量(MVV)、无氧阈(AT)、峰值心率(HRpeak)、峰值摄氧量(PeakVO_2)、峰值负荷功率(PeakWR)、峰值氧脉搏(PeakVO_2/HR)、峰值心排量(PeakCO)、摄氧通气效率峰值平台(OUEP)均降低(P<0.05);静息收缩压(SBPrest)、峰值收缩压(SBPpeak)、二氧化碳排出通气效率最低值(Lowest VE/VCO_2)、二氧化碳排出通气斜率(VE/VCO2slope)均升高(P<0.05);心血管疾病危险指标中的代谢当量(METs)、峰值公斤摄氧量[PeakVO_2(ml·kg-1·min-1)]、运动后心率恢复(HRR)均降低(P<0.05);运动后收缩压恢复(SBPR)同正常组比无统计学差异(P>0.05)。②12周运动康复后,与对照组相比,运动组AT、HRpeak、SBPpeak、PeakVO_2、PeakWR、PeakVO_2/HR、PeakCO、OUEP升高(P<0.05);心血管疾病危险指标[METs、PeakVO_2(ml·kg~(-1)·min~(-1))、HRR]升高(P<0.05),SBPR降低(P<0.05)。③与治疗前比较,运动组治疗后的BMI、SBPrest、DBPrest降低(P<0.05),AT、PeakVO_2、PeakWR、PeakVO_2/HR、PeakCO、OUEP升高(P<0.05),METs、PeakVO_2(ml·kg~(-1)·min~(-1))、HRR升高(P<0.05);与治疗前比较,对照组治疗后的SBPrest、SBPpeak、DBPpeak、AT、PeakVO_2、PeakVO_2/HR、PeakCO降低(P<0.05),Lowest VE/VCO2升高(P<0.05),METs、PeakVO_2(ml·kg~(-1)·min~(-1))降低(P<0.05)。结论:代谢综合征患者整体心肺功能较正常人降低,患心血管疾病可能性较高;个体化强度运动可以有效改善代谢综合征患者的心肺功能,降低心血管疾病风险。
ObjectiveTo analyze the cardiopulmonary function of patients with the metabolic syndrome(MS) and to explore the effect of the cardiopulmonary exercise testing(CPET)-based precise individualized intensity exercise prescription.MethodsThirty-two MS patients treated between March 2017 andMarch 2018 were chosen and randomly divided into an exercise group and a control group,each of 16,while another 30 healthy counterparts were selected into a normal group. All subjects underwentCPET. All MS patients were treated with ordinary drugs,while those of the exercise group were additionally provided with an individualized intensity exercise prescription of △50% Watts treadmill training for 12 weeks,5 days/week based on their data of CPET. CPET was conducted again after the intervention.ResultsBefore the intervention,the force vital capacity(FVC),maximum voluntary ventilation(MVV),anaerobic threshold(AT),peak heart rate(HRpeak),peak oxygen uptake(PeakVO_2),peakload power(PeakWR),peak oxygen pulse(PeakVO_2/HR),peak cardiac output(PeakCO) and oxygen uptake efficiency plateau(OUEP) of the MS group were significantly lower than the normal group(P<0.05). However, the rest systolic blood pressure(SBPrest), peak systolic blood pressure(SBPpeak),minimum ventilatory equivalent for carbon dioxide(Lowest VE/VCO2) and slope of ventilatory equivalentfor caobon dioxide(VE/VCO_2 slope) of the MS group were significantly higher than the normal group(P<0.05). The cardiovascular risk(CVR) factors, metabolic equivalent(METs), peak oxygen uptake[PeakVO_2(ml·kg~(-1)·min~(-1))],heart rate recovery(HRR) were significantly lower in the MS group thanthe non-MS group(P<0.05). There was no significant difference between the two groups in the systolic blood pressure recovery(SBPR). After the rehabilitation,the average AT,HRpeak,SBPpeak,PeakVO_2,PeakWR,PeakVO_2/HR,PeakCO and OUEP,as well as the average METs,[PeakVO_2(ml·kg~(-1)·min~(-1))]and HRR of the exercise group increased significantly compared with the control group(P<0.05),while the SBPR was significantly lower than the control group(P<0.05). In the exercise group,the average AT,PeakVO_2,PeakWR,PeakVO_2/HR,PeakCO,OUEP,METs,PeakVO_2(ml·kg~(-1)·min~(-1)) andHRR increased significantly after the treatment(P<0.05),while the average BMI,SBPrest and DBPrest decreased significantly(P<0.05). In the control group, the average SBPrest, SBPpeak, DBPpeak,AT,PeakVO_2,PeakVO_2/HR,PeakCO,METs,PeakVO_2(ml·kg~(-1)·min~(-1)) decreased significantly,while the Lowest VE/VCO_2 increased significantly after the treatment(P<0.05).ConclusionThe cardiopulmonary function of MS patients is lower and of higher CVR than non-MS ones. The CPET-basedprecise individualized intensity exercise prescription can enhance the holistic cardiopulmonary functionand reduce the CVR.
ObjectiveTo analyze the cardiopulmonary function of patients with the metabolic syndrome(MS) and to explore the effect of the cardiopulmonary exercise testing(CPET)-based precise individualized intensity exercise prescription.MethodsThirty-two MS patients treated between March 2017 andMarch 2018 were chosen and randomly divided into an exercise group and a control group,each of 16,while another 30 healthy counterparts were selected into a normal group. All subjects underwentCPET. All MS patients were treated with ordinary drugs,while those of the exercise group were additionally provided with an individualized intensity exercise prescription of △50% Watts treadmill training for 12 weeks,5 days/week based on their data of CPET. CPET was conducted again after the intervention.ResultsBefore the intervention,the force vital capacity(FVC),maximum voluntary ventilation(MVV),anaerobic threshold(AT),peak heart rate(HRpeak),peak oxygen uptake(PeakVO_2),peakload power(PeakWR),peak oxygen pulse(PeakVO_2/HR),peak cardiac output(PeakCO) and oxygen uptake efficiency plateau(OUEP) of the MS group were significantly lower than the normal group(P<0.05). However, the rest systolic blood pressure(SBPrest), peak systolic blood pressure(SBPpeak),minimum ventilatory equivalent for carbon dioxide(Lowest VE/VCO2) and slope of ventilatory equivalentfor caobon dioxide(VE/VCO_2 slope) of the MS group were significantly higher than the normal group(P<0.05). The cardiovascular risk(CVR) factors, metabolic equivalent(METs), peak oxygen uptake[PeakVO_2(ml·kg~(-1)·min~(-1))],heart rate recovery(HRR) were significantly lower in the MS group thanthe non-MS group(P<0.05). There was no significant difference between the two groups in the systolic blood pressure recovery(SBPR). After the rehabilitation,the average AT,HRpeak,SBPpeak,PeakVO_2,PeakWR,PeakVO_2/HR,PeakCO and OUEP,as well as the average METs,[PeakVO_2(ml·kg~(-1)·min~(-1))]and HRR of the exercise group increased significantly compared with the control group(P<0.05),while the SBPR was significantly lower than the control group(P<0.05). In the exercise group,the average AT,PeakVO_2,PeakWR,PeakVO_2/HR,PeakCO,OUEP,METs,PeakVO_2(ml·kg~(-1)·min~(-1)) andHRR increased significantly after the treatment(P<0.05),while the average BMI,SBPrest and DBPrest decreased significantly(P<0.05). In the control group, the average SBPrest, SBPpeak, DBPpeak,AT,PeakVO_2,PeakVO_2/HR,PeakCO,METs,PeakVO_2(ml·kg~(-1)·min~(-1)) decreased significantly,while the Lowest VE/VCO_2 increased significantly after the treatment(P<0.05).ConclusionThe cardiopulmonary function of MS patients is lower and of higher CVR than non-MS ones. The CPET-basedprecise individualized intensity exercise prescription can enhance the holistic cardiopulmonary functionand reduce the CVR.
引文
[1]中国2型糖尿病防治指南(2013年版)[J].中国糖尿病杂志,2014,22(08):2-42.
[2]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率[J].中华糖尿病杂志,2005,(03):181-186.
[3] Lee DC,Sui X,Artero EG, et al.Long-term effects ofchanges in cardiorespiratory fitness and body mass indexon all-cause and cardiovascular disease mortality inmen:the Aerobics Center Longitudinal Study[J].Circulation,2011,124:2483-2490.
[4] Lackland DT.Metabolic syndrome and hypertension:regular exercise as part of lifestyle management[J].Curr Hypertens Rep,2014,16(11):492.
[5]王姗,何敏学.不同时长有氧运动对代谢综合征患者生活质量、体脂参数及代谢水平的影响[J].中国糖尿病杂志,2016,24(04):313-316.
[6]张崇龙,赵刚.不同强度有氧运动对代谢综合征患者心血管危险因子的干预效果分析[J].沈阳体育学院学报,2016,35(05):68-74.
[7]葛万刚,孙兴国,刘艳玲,等.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高血压的疗效研究[J].中国全科医学,2016,19(35):4316-4322.
[8] Wasserman K,Hansen J,Sue D,et al.Principles of exercise testing and interpretation[M]. 5th edition. Philadelphia:Lippincott Williams&Wilkins,2011.
[9]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.
[10]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.
[11] Salas-Romero R,Sánchez-Mu?oz V,Franco-Sánchez JG,et al.Effectiveness of two aerobic exercise programs inthe treatment of metabolic syndrome:a preliminary study[J].Gac Med Mex,2014,150(6):490-498.
[12] Huang CL,Su TC,Chen WJ,et al.Usefulness of paradoxical systolic blood pressure increase after exercise as apredictor of cardiovascular mortality[J].Am J Cardiol,2008,102(5):518-523.
[13]宁亮,孙兴国.心肺运动试验在医学领域的临床应用[J].中国全科医学,2013,16(39):3898-3902.
[14]孙景权,苏浩,严翊,等.高强度间歇运动改善心肺耐力的线粒体合成机制[J].中国运动医学杂志,2015,34(10):1022-1027.
[15]许杰,谢敏豪,严翊,等.12周不同强度运动干预对大鼠心肺耐力的改善效果[J].中国运动医学杂志,2017,36(06):479-485.
[16]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.
[17] Said M,Lamya N,Olfa N.Effects of high-impact aerobicsvs low-impact aerobics and strength training in overweight and obese women[J].J Sports Med Phys Fitness,2017,57(3):278-288.
[18] Boutcher SH.High-intensity intermittent exercise and fatloss[J].J Obes,2011,2011:1-10.
[19] Lira VA,Okutsu M,Zhang M, et al. Autophagy is required for exercise training-induced skeletal muscle adaptation and improvement of physical performance[J].FASEB J,2013,27(10):4184-4193.
[20] Manfredini F,Malagoni AM,Mandini S,et al.Sport therapy for hypertension:why,how,and how much?[J].Angiology,2009,60(2):207-216.
[21] Carlsson L,Lind B,Laaksonen MS,et al.Enhanced systolic myocardial function in elite endurance athletes duringcombined arm-and-leg exercise[J].Eur J Appl Physiol,2011,111(6):905-913.
[22] Giallauria F,Acampa W,Ricci F,et al.Exercise trainingearly after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function[J].Eur J Nucl Med Mol Imaging,2013,40(3):315-324.
[23] Mottillo S,Filion KB,Genest J,et al.The metabolic syndrome and cardiovascular risk a systematic review andmeta-analysis[J].J Am Coll Cardiol,2010,56(14):1113-1132.
[24] Yamaoka K.Effects of lifestyle modification on metabolicsyndrome:a systematic review and meta-analysis[J].BMCMed,2012,10(1):138.
[25] Lyerly GW,Sui X,Lavie CJ, et al.The association between cardiorespiratory fitness and risk of all-cause mortality among women with impaired fasting glucose or undiagnosed diabetes mellitus[J].Mayo Clin Proc,2009,84(9):780-786.
[26] Michaelides AP,Liakos CI,Vyssoulis GP,et al.The interplay of exercise heart rate and blood pressure as a predictor of coronary artery disease and arterial hypertension[J].J Clin Hypertens(Greenwich),2013,15(3):162-170.
[27] Mora S,Redberg RF,Cui Y,et al.Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women:a 20-year follow-up of the lipid research clinics prevalence study[J].JAMA,2003,290(12):1600-1607.
[2]顾东风,Reynolds K,杨文杰,等.中国成年人代谢综合征的患病率[J].中华糖尿病杂志,2005,(03):181-186.
[3] Lee DC,Sui X,Artero EG, et al.Long-term effects ofchanges in cardiorespiratory fitness and body mass indexon all-cause and cardiovascular disease mortality inmen:the Aerobics Center Longitudinal Study[J].Circulation,2011,124:2483-2490.
[4] Lackland DT.Metabolic syndrome and hypertension:regular exercise as part of lifestyle management[J].Curr Hypertens Rep,2014,16(11):492.
[5]王姗,何敏学.不同时长有氧运动对代谢综合征患者生活质量、体脂参数及代谢水平的影响[J].中国糖尿病杂志,2016,24(04):313-316.
[6]张崇龙,赵刚.不同强度有氧运动对代谢综合征患者心血管危险因子的干预效果分析[J].沈阳体育学院学报,2016,35(05):68-74.
[7]葛万刚,孙兴国,刘艳玲,等.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高血压的疗效研究[J].中国全科医学,2016,19(35):4316-4322.
[8] Wasserman K,Hansen J,Sue D,et al.Principles of exercise testing and interpretation[M]. 5th edition. Philadelphia:Lippincott Williams&Wilkins,2011.
[9]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.
[10]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.
[11] Salas-Romero R,Sánchez-Mu?oz V,Franco-Sánchez JG,et al.Effectiveness of two aerobic exercise programs inthe treatment of metabolic syndrome:a preliminary study[J].Gac Med Mex,2014,150(6):490-498.
[12] Huang CL,Su TC,Chen WJ,et al.Usefulness of paradoxical systolic blood pressure increase after exercise as apredictor of cardiovascular mortality[J].Am J Cardiol,2008,102(5):518-523.
[13]宁亮,孙兴国.心肺运动试验在医学领域的临床应用[J].中国全科医学,2013,16(39):3898-3902.
[14]孙景权,苏浩,严翊,等.高强度间歇运动改善心肺耐力的线粒体合成机制[J].中国运动医学杂志,2015,34(10):1022-1027.
[15]许杰,谢敏豪,严翊,等.12周不同强度运动干预对大鼠心肺耐力的改善效果[J].中国运动医学杂志,2017,36(06):479-485.
[16]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.
[17] Said M,Lamya N,Olfa N.Effects of high-impact aerobicsvs low-impact aerobics and strength training in overweight and obese women[J].J Sports Med Phys Fitness,2017,57(3):278-288.
[18] Boutcher SH.High-intensity intermittent exercise and fatloss[J].J Obes,2011,2011:1-10.
[19] Lira VA,Okutsu M,Zhang M, et al. Autophagy is required for exercise training-induced skeletal muscle adaptation and improvement of physical performance[J].FASEB J,2013,27(10):4184-4193.
[20] Manfredini F,Malagoni AM,Mandini S,et al.Sport therapy for hypertension:why,how,and how much?[J].Angiology,2009,60(2):207-216.
[21] Carlsson L,Lind B,Laaksonen MS,et al.Enhanced systolic myocardial function in elite endurance athletes duringcombined arm-and-leg exercise[J].Eur J Appl Physiol,2011,111(6):905-913.
[22] Giallauria F,Acampa W,Ricci F,et al.Exercise trainingearly after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function[J].Eur J Nucl Med Mol Imaging,2013,40(3):315-324.
[23] Mottillo S,Filion KB,Genest J,et al.The metabolic syndrome and cardiovascular risk a systematic review andmeta-analysis[J].J Am Coll Cardiol,2010,56(14):1113-1132.
[24] Yamaoka K.Effects of lifestyle modification on metabolicsyndrome:a systematic review and meta-analysis[J].BMCMed,2012,10(1):138.
[25] Lyerly GW,Sui X,Lavie CJ, et al.The association between cardiorespiratory fitness and risk of all-cause mortality among women with impaired fasting glucose or undiagnosed diabetes mellitus[J].Mayo Clin Proc,2009,84(9):780-786.
[26] Michaelides AP,Liakos CI,Vyssoulis GP,et al.The interplay of exercise heart rate and blood pressure as a predictor of coronary artery disease and arterial hypertension[J].J Clin Hypertens(Greenwich),2013,15(3):162-170.
[27] Mora S,Redberg RF,Cui Y,et al.Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women:a 20-year follow-up of the lipid research clinics prevalence study[J].JAMA,2003,290(12):1600-1607.