有氧運動訓練對左心室心衰竭患者心肺耐力及左心室功能之成效：前驅試驗

Effects of Exercise Training on Cardiorespiratory Fitness and Cardiac Function among Heart Failure Patients with Decreased Left Ventricular Function: A Pilot Study

林佳慧(Chia-Huei Lin) ； 曾炳憲(Bing-Hsiean Tzeng) ； 蔣立琦(Li-Chi Chiang) ； 曾雯琦(Wen-Chii Tzeng) ； 陳良城(Liang-Cheng Chen) ； 蔣尚霖(Shang-Lin Chiang)

《台灣復健醫學雜誌》 41卷4期 (2013/12) Pp. 251-262

https://doi.org/10.6315/2013.41(4)06

摘要

背景：運動不僅有益身心健康，對病程不可逆的心衰竭患者而言，更有助改善心臟收縮能力、提升功能狀態。然而，探討中強度運動訓練對心衰竭患者的心肺耐力及左心室功能之本土性研究卻仍少數。目的：本研究目的主要探討中強度運動訓練對心衰竭患者的心肺耐力及左心室功能之成效。方法：本研究乃一前驅試驗，為單一組別類實驗式研究設計，以立意取樣選取北市某醫學中心之心衰竭患者作為研究對象，共計七位心衰竭患者完成12週的中強度（60%尖峰攝氧量）運動訓練。運動訓練前後分別收集體位測量值、心肺耐力（尖峰攝氧量）、運動測試時間、運動能力及最大心跳率、左心室功能（左心室射出率）等資料。透過配對t檢定分析運動訓練前後各項成效指標之差異。結果：研究結果發現，在12週中強度運動訓練後，不僅未對心衰竭患者造成不良反應，參加者的體重、身體質量指數與腰臀比分別下降1.64公斤（2.1%，p = .023）、0.95Kg/m^2（3.3%，p = .006）、0.03（3.2%，p = .004）；心肺耐力亦呈現顯著改善，包含：尖峰攝氧量（VO_(2peak)）增加2.18ml/kg/min（10.7%，p = .002）、運動測試時間增加2.04分鐘（25.9%，p = .002）、運動能力增加0.61 METs（10.6%，p = .006）；最大心跳率增加至135.9 bpm，平均增加11.7 bpm（9.4%，p = .016）。此外，十二週運動訓練後，患者的左心室射出率顯著上升9.29%，提升比例達34.8%（p ＜ .001）。結論：本研究不僅證實中強度運動訓練對心衰竭患者的安全性，更可改善健康體位、提升心肺耐力，亦能有效改善患者的左心室功能。建議臨床上應更積極協助心衰竭患者轉介，介入運動測試與量身訂作運動處方，讓國內更多心衰竭患者受惠，確實從事運動訓練，進而改善其身體功能。

關鍵字

心衰竭（heart failure） ； 運動訓練（exercise training） ； 心肺耐力（cardiorespiratory fitness） ； 左心室功能（left ventricular function）

並列摘要

Background: Exercise is not only beneficial for physical and psychological health but can also improve cardiac contractility; thus, exercise can result in the improvement of the functional status of patients who suffer from irreversible damage from heart failure. However, there are limited local data on the effects of moderate-intensity exercise training on cardiorespiratory fitness and left ventricular function among patients with heart failure. Purpose: The aim of our study was to investigate the effects of moderate-intensity exercise training on cardiorespiratory fitness and left ventricular function among patients with heart failure. Methods: This is a pilot study with a single group and quasi-experimental research design. Purposive sampling was applied to recruit target patients with heart failure at a medical center in northern Taiwan. Seven participants completed a 12-week moderate-intensity (60% peak oxygen uptake, VO_(2peak)) exercise training program. The anthropometric measurements, cardiorespiratory fitness (VO_(2peak)), duration of exercise testing, exercise capacity, maximum heart rate, and left ventricular function (ejection fraction, EF) were collected before and after the exercise training program. A paired t-test was applied to appraise the differences of all outcome indicators before and after the exercise training program. Results: The results showed that after a 12-week moderate-intensity exercise training program, there was no adverse event occurred and that body weight, BMI, and waist-to-hip ratio decreased by 1.64 kg (2.1%, p = .023), 0.95 kg/m^2 (3.3%, p = .006), and 0.03 (3.2%, p = .004), respectively. Cardiorespiratory fitness was significantly improved; the VO_(2peak) increased by 2.18 ml/kg/min (10.7%, p = .002). The duration of the exercise testing increased by 2.04 minutes (25.9%, p = .002); the exercise capacity increased by 0.61 MET (10.6%, p = .006); the maximum heart rate increased by 11.7 bpm (9.4%, p = .016) to 135.9 bpm. With regards to left ventricular function, a significant increase in the ejection fraction of 9.29% (34.8%, p ＜ .001) was observed among patients with heart failure after completing the 12-week exercise training program. Conclusions: We confirm that a moderate-intensity exercise training program is safe for patients with heart failure. Exercise training not only improves anthropometric data and increases cardiorespiratory fitness in general but also improves the left ventricular function of patients with heart failure. The results of this study confirm that exercise has a beneficial impact on cardiac function. We recommend that clinicians aggressively refer heart failure patients to exercise training programs that are individualized based on the results of exercise testing; this will greatly improve the physical function of heart failure patients.