運動對冠狀動脈疾病患者的二級預防效果

Effect of Exercise on Secondary Prevention in Patients With Coronary Artery Disease

陳粱友(Liang-You Chen) ； 何承訓(Cheng-Shiun He)

《大專體育》 161期 (2022/06) Pp. 25-38

https://doi.org/10.6162/SRR.202206_(161).0003

摘要

冠狀動脈疾病（coronary artery disease, CAD）影響了全球大約1.26億人。過去研究顯示等長握力訓練、有氧訓練和高強度間歇訓練，對血壓、血流介導擴張程度或脈波傳導速率對於肥胖的老年人、女性，以及坐式生活者等族群，分別有一些改善的效果，可能降低血管硬化和狹窄的程度，也建議CAD患者可以從事這些運動，有可能降低進行手術治療的機會。手術和藥物治療雖可以解決CAD立即性的問題，不過，仍有一些併發症的產生。本文目的為給予CAD患者在未手術、手術後隔天或是手術康復後等不同階段的運動選擇。回顧相關CAD患者運動介入文獻，再進行整理，提供臨床的運動介入建議。分析結果指出：CAD手術後的隔天，開始進行漸進式動能訓練（progressive exercise of kinetic energy, PEKE），例如：呼吸訓練、伸展運動、步行訓練、下樓梯訓練等，1年內可減少患者35%術後併發症機率，且能提高抗血栓能力，減少血管再次發生狹窄或阻塞的情況。接受過CAD手術的患者，完成PEKE，且心臟功能恢復後，可以開始從事每週2～3次的中等強度有氧運動，建議時間在30～45 min，有助於攝氧量峰值、心跳率峰值的提升，也可以提高生活品質，以及降低全因性死亡率。因此，運動介入將會是有效預防CAD的對策。

關鍵字

等長握力訓練 ； 有氧訓練 ； 高強度間歇訓練 ； 脈波傳導速率 ； 漸進式動能訓練

並列摘要

Coronary artery disease (CAD) affects 126 million people worldwide. Previous studies have shown that isometric handgrip training, aerobic training and high intensity interval training are effective in the attenuation of blood pressure flow, mediated dilation and pulse wave velocity in obese older adults, women and sedentary people, respectively. These exercises are also recommended for people with CAD, as they may reduce the likelihood of surgical intervention. Although surgery and medication are used to solve immediate problems of CAD, there are still inevitable postoperative complications which affect the patient's prognosis. The aim of this literature review is to survey clinical recommendations for exercise options for CAD patients at different stages of medical condition, including without surgery, the first day post-surgery, and post-recovery. Results show that when progressive exercise training (including breathing exercises, stretching, walking and stair climbing) is applied to patients with CAD the day after surgery, the patient's postoperative complications and total complication rate after 1 year are reduced by 35%. The progressive exercise of kinetic energy (PEKE) also increases the body's anti-thrombotic ability, accelerates vascular remodeling and reduces the chance of blood vessel restenosis or blockage. For patients who have undergone CAD surgery and are performing PEKE, it is recommended that they engage in moderate-intensity aerobic exercise for 30-45 minutes, 2-3 times per week, after their heart function has recovered. Moderate-intensity aerobic exercise has been shown to increase peak oxygen intake and peak heart rate, improve quality of life and reduce all-cause mortality for CAD patients. Therefore, exercise intervention would be an effective strategy for preventing CAD.

並列關鍵字

isometric handgrip training ； aerobic training ； high intensity interval training ； pulse wave velocity ； progressive exercise of kinetic energy

參考文獻

Ahn, N., & Kim, K. (2016). High-density lipoprotein cholesterol (HDL-C) in cardiovascular disease: Effect of exercise training. Integrative Medicine Research, 5(3), 212-215. doi:10.1016/j.imr.2016.07.001

Akyuz, A. (2020). Exercise and coronary heart. Advances in Experimental Medicine and Biology, 1228, 169-179. doi:10.1007/978-981-15-1792-1_11

Al-Lamee, R. K., Nowbar, A. N., & Francis, D. P. (2019). Percutaneous coronary intervention for stable coronary artery disease. Heart, 105(1), 11-19. doi:10.1136/heartjnl-2017-312755

Areas, G. P. T., Mazzuco, A., Caruso, F. R., Jaenisch, R. B., Cabiddu, R., Phillips, S. A., ... Borghi-Silva, A. (2019). Flow-mediated dilation and heart failure: A review with implications to physical rehabilitation. Heart Failure Reviews, 24(1), 69-80. doi:10.1007/s10741-018-9719-7

Arnett, D. K., Blumenthal, R. S., Albert, M. A., Buroker, A. B., Goldberger, Z. D., Hahn, E. J., ... Ziaeian, B. (2019). 2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation, 140(11), e596-e646. doi:10.1161/CIR.0000000000000678