Exercise Rehabilitation for Chronic Heart Failure Patients with Cardiac Device Implants

In the past decade a significant development in the management and rehabilitation of people with chronic heart failure (CHF) has been the utilization of cardiac devices. The use of biventricular pacemakers, referred to as Cardiac Resynchronization Therapy (CRT) can yield improvements in functional abilities for a select group of CHF patients and the inclusion of implantable cardiac defibrillators (ICDs) may reduce the risk of sudden death. This review provides physical therapists with a basic understanding of how to prescribe exercise for people with CHF who have these device implants.Key Words: heart failure, exercise, support devices     

血流限制训练促进人体健康体适能:历史、现状、争议

目的:为了探讨血流限制训练的历史脉络、研究现状以及存在的争议。方法:通过文献资料、逻辑分析、归纳总结等研究方法梳理血流限制训练的历史脉络,进一步分析、验证其对人体健康体适能的效果以及对其存在的争议进行剖析归因。结果与结论:血流限制训练可成为传统高强度力量训练的可行替代方式,对不同人群的健康都具有积极促进作用;负荷强度≤40%1RM的血流限制训练对肌肉适能具有正向效益,在特定条件下可提高肌肉的最大力量及横截面积;血流限制训练可通过增加机体VO2max、改善血管内皮功能和外周血循环、提高心脏代谢能力达到促进心肺耐力的目的;此外,血流限制训练结合小负荷运动能够有效改善人体身体成分、显著降低体脂肪量增加幅度。提示:加压压力取值与训练的安全性是紧密相连的,对不同人群的合理加压压力取值是需要进一步监控和评估的。     

抗阻训练运动处方研究进展

抗阻训练作为全面身体锻炼的一部分,可以显著增长肌肉力量和体积及发挥慢性病防治作用。抗阻训练运动处方的内容主要包括训练强度、组数、频率、方式、顺序、间歇时间、肌肉收缩速度和训练量等方面。根据运动人群和运动目的不同,其中每一方面都可以制定出多种不同处方方案。正确合理的处方制定和使用涉及到不同的运动效果,对于专业运动人群和普通大众合理科学地安排运动和锻炼十分有必要。     

Exercise training and impaired glucose tolerance in obese humans

Individuals with impaired glucose tolerance (IGT) are at greater risk of developing diabetes than in normoglycaemia. The aim of this study was to examine the effects of 12-weeks exercise training in obese humans with IGT. Eleven participants (6 males and 5 females; 49±9 years; mean Body Mass Index (BMI) 32.4 kg · m(-2)), completed a 12-week brisk walking intervention (30 min per day, five days a week (d · wk(-1)), at 65% of age-predicted maximal heart rate (HR(max)). Anthropometric measurements, dietary intake, pulse wave velocity (PWV, to determine arterial stiffness) and blood pressure (BP) were examined at baseline and post intervention. Fasting blood glucose, glycosylated haemoglobin, insulin, blood lipids, indices of oxidative stress and inflammation (lipid hydroperoxides; superoxide dismutase; multimeric adiponectin concentration and high-sensitivity C-reactive protein) were also determined. Post intervention, PWV (9.08±1.27 m · s(-1) vs. 8.39±1.21 m · s(-1)), systolic BP (145.4±14.5 vs. 135.8±14.9 mmHg), triglycerides (1.52±0.53 mmol · L(-1) vs. 1.31±0.54 mmol · L(-1)), lipid hydroperoxides (1.20±0.47 μM · L(-1) vs. 0.79±0.32 μM · L(-1)) and anthropometric measures decreased significantly (P < 0.05). Moderate intensity exercise training improves upper limb vascular function in obese humans with IGT, possibly by improving triglyceride metabolism, which may subsequently reduce oxidative stress. These changes were independent of multimeric adiponectin modification and alterations in other blood biomarkers.     

低强度抗阻运动中不同程度的血流限制对血清生长激素和睾酮分泌量的影响

目的近些年来,加压训练因其显著的增肌效果而受到关注。但是,不同程度的血流限制对生长激素、睾酮等与增肌效果密切相关的合成类激素的影响目前还没有明确的研究结果。为此,观察了普通人在4种不同血流限制压力条件下,训练前后血清生长激素、睾酮等激素的变化,为今后进行加压训练时选择适宜压力提供实验依据。方法以10名健康成年男性为实验对象,在不同日期的同一时间点,分别在上肢0 mmHg、下肢0 mmHg(对照组),上肢100 mmHg、下肢140 mmHg(低压组),上肢140 mmHg、下肢180 mmHg(中压组),上肢180 mmHg、下肢220 mmHg(高压组)4种压力条件下,进行4组30%1RM的深蹲、屈臂、伸臂运动。每组均要求尽力完成30次(如完不成则做到力竭为止)。在运动前后测量上肢围度,并取肘静脉血测量生长激素和睾酮。而在运动后第2 min测指血血乳酸浓度,并记录主观疲劳度。结果1)3个加压组完成的总负荷均显著低于对照组(P<0.05),高压组显著低于低压组和中压组(P<0.05),而后二者之间无显著差异。2)各组间运动后血乳酸无显著差异,但3个加压组上肢放松围变化幅度和主观疲劳度均显著高于对照组(P<0.001)。其中,高压组的放松围变化显著低于低压组和中压组,高压组的主观疲劳度显著高于低压组和中压组P<0.05),而后二者之间无显著差异。3)运动后,4组的生长激素均显著增加(P<0.001)。其中,3个加压组的变化幅度显著大于对照组(P<0.05),低压组和中压组显著高于高压组(P<0.05),而低压组和中压组之间无显著性差异。4)对照组(的血睾酮)在运动前后无显著变化,而3个加压组均显著上升(P<0.05),但相互间均无显著差异。结论在以普通健康成年人为研究对象的低强度抗阻加压运动中,上肢压力为100~140 mmHg,下肢压力为140~180 mmHg的血流限制条件下,肌肉肿胀效应更加显著,生长激素、血睾酮等与增肌效果密切相关的合成类激素指标显著增加,同时疲劳感相对较小。     

自行车、划船及足球少年运动员心脏肥大影响因素的对比研究

目的:考察11岁左右少年运动员开始进行大运动量训练的3个项目(自行车、划船、足球)的动脉血压反应,并分析最大运动时动脉血压、VO_2max对受试者心脏体积增加的影响。方法:对受试者进行病史和体格检查,用M型二堆超声心动图、12导心电图检查心脏参数,逐级运动试验直接测定VO_2max。在安静和最大运动状态下检测收缩压和舒张压。用Devereux公式计算左心室体积指数(LVMI)。结果:自行车运动员的LVMI值明显高于其他运动员;划船运动员在最大运动时的动脉血压最高,而自行车运动员具有较高的VO_2max。LVMI与VO_2max和最大运动时的收缩压有较好的相关。结论:VO_2max对运动员心脏肥大的发生和发展起重要作用。较大的动脉血压反应有利于发展较大的LVMI。     

中老年2型糖尿病有氧运动干预的Meta分析

目的:检验间歇和持续有氧运动对中老年2型糖尿病患者的干预效果,从而提供较为科学合理的运动处方。方法:通过Web of science、PubMed/MEDLINE、Cochrane Library、EMBASE、SportDiscus、中国知网(CNKI)、万方等中外文数据库,检索有关间歇与持续有氧运动干预中老年2型糖尿病患者的随机对照试验研究,利用Review Manager 5.3统计软件进行计量分析,包括偏倚风险评估、异质性分析、合并效应与效应大小检验和敏感性分析。结果:1)共纳入9项研究,包括297名被试;2)间歇训练与持续训练能有效改善中老年2型糖尿病患者胰岛素抵抗、BMI、有氧适能和疲劳、幸福感等身心健康指标;3)两者在改善HbA1c%(P=0.04)、总胆固醇(P=0.00)、收缩压(P=0.00)和有氧适能(P=0.00)方面存在显著差异;4)15~30 min/次、3~5次/周,持续8~12周的中至高等强度间歇训练对糖化血红蛋白、收缩压和有氧适能的干预效应更优,而长于12周、5次/周、大于30 min/次的中等强度间歇训练对总胆固醇可以产生较好的干预效应。结论:间歇训练与持续训练能一定程度改善中老年2型糖尿病患者的身心健康,相较于持续训练,间歇训练能更有效降低HbA1c%、总胆固醇、收缩压、提高有氧适能,15~30 min/次、3~5次/周、持续8~12周的中等强度间歇训练是干预中老年2型糖尿病较为有效的运动处方。     

不同运动方式对绝经后女性IL-6、TNF-α和hs-CRP的影响

目的比较12周有氧运动或抗阻训练对绝经后女性白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)和高敏C-反应蛋白(hs-CRP)影响的差异,为制定特异性的运动处方提供依据。方法将符合标准的受试者随机分为有氧运动组(18人),抗阻训练组(17人)和对照组(20人)。有氧运动组和抗阻训练组进行每周3次、共12周的运动干预,对照组保持日常生活习惯不变。实验前后分别测定血清IL-6、TNF-α、hs-CRP等指标。结果 12周运动干预后,有氧运动组血清IL-6较运动前下降了13%(P<0.01),血清TNF-α(P>0.05)和hs-CRP(P>0.05)无显著性变化;抗阻训练组血清IL-6较运动前无显著性变化(P>0.05),但血清TNF-α和hs-CRP分别下降了11%(P<0.05)和26%(P<0.05)。对照组所有指标的变化不明显。相关分析显示,实验前hs-CRP基础值与BMI(r=0.36,P<0.01)、空腹血糖(r=0.23,P<0.05)和IL-6(r=0.22,P<0.01)正相关,与VO2max(r=-0.29,P<0.05)负相关;实验后hs-CRP的变化值与BMI的变化值(r=0.21,P<0.05)正相关。结论 绝经妇女慢性全身性炎症状态与其BMI、血糖水平和体内炎症因子的水平有关;12周有氧运动或抗阻训练均能有效改善绝经后女性慢性全身性炎症状态,但抗阻训练的效果优于有氧运动,其原因与BMI的改善有关。     

Physical exercise in the prevention and treatment of Alzheimer's disease

Dementia is one of the greatest global challenges for health and social care in the 21st century. Alzheimer's disease (AD), the most common type of dementia, is by no means an inevitable consequence of growing old. Several lifestyle factors may increase, or reduce, an individual's risk of developing AD. Much has been written over the ages about the benefits of exercise and physical activity. Among the risk factors associated with AD is a low level of physical activity. The relationship between physical and mental health was established several years ago. In this review, we discuss the role of exercise (aerobic and resistance) training as a therapeutic strategy for the treatment and prevention of AD. Older adults who exercise are more likely to maintain cognition. We address the main protective mechanism on brain function modulated by physical exercise by examining both human and animal studies. We will pay especial attention to the potential role of exercise in the modulation of amyloid β turnover, inflammation, synthesis and release of neurotrophins, and improvements in cerebral blood flow. Promoting changes in lifestyle in presymptomatic and predementia disease stages may have the potential for delaying one-third of dementias worldwide. Multimodal interventions that include the adoption of an active lifestyle should be recommended for older populations.     

骨骼肌衰减症与运动干预研究进展

肌肉衰减症是指具有渐进性、全身性的骨骼肌质量和力量丢失为特征的综合症状,该综合征状伴有身体活动能力丧失,生活质量下降甚至死亡等严重后果的风险。骨骼肌质量和功能降低（肌肉力量下降和/或身体活动能力下降）是评判骨骼肌衰减症的临床诊断标准。有氧运动、尤其是抗阻训练和快速力量训练是改善老年人骨骼肌力量和身体活动能力的有效方法。本文综述了骨骼肌衰减的定义和临床诊断标准,以及运动干预的研究成果,以期为国内骨骼肌衰减症的基础研究和临床应用研究提供借鉴和参考。     

Influence of cold-water immersion on limb blood flow after resistance exercise*

This study determined the influence of cold (8°C) and cool (22°C) water immersion on lower limb and cutaneous blood flow following resistance exercise. Twelve males completed 4 sets of 10-repetition maximum squat exercise and were then immersed, semi-reclined, into 8°C or 22°C water for 10-min, or rested in a seated position (control) in a randomized order on different days. Rectal and thigh skin temperature, muscle temperature, thigh and calf skin blood flow and superficial femoral artery blood flow were measured before and after immersion. Indices of vascular conductance were calculated (flux and blood flow/mean arterial pressure). The colder water reduced thigh skin temperature and deep muscle temperature to the greatest extent (P?<?.001). Reductions in rectal temperature were similar (0.2–0.4°C) in all three trials (P?=?.69). Femoral artery conductance was similar after immersion in both cooling conditions, with both conditions significantly lower (55%) than the control post-immersion (P?<?.01). Similarly, there was greater thigh and calf cutaneous vasoconstriction (40–50%) after immersion in both cooling conditions, relative to the control (P?<?.01), with no difference between cooling conditions. These findings suggest that cold and cool water similarly reduce femoral artery and cutaneous blood flow responses but not muscle temperature following resistance exercise.     

肥胖症与动脉粥样硬化的关系研究进展

运用文献资料法,分析肥胖症与动脉粥样硬化的关系。肥胖引起脂肪组织分泌的细胞因子,如C反应蛋白、脂联素、瘦素、血管内皮生长因子、肿瘤坏死因子-α、白细胞介素-6等水平异常,可加速血管内皮炎性反应,与肥胖密切相关的脂代谢紊乱、血液流变性异常、胰岛素抵抗,亦可诱发血管内皮功能障碍,从多个环节加速动脉粥样硬化的进程。对肥胖症患者早期进行运动干预,有望阻止动脉粥样硬化病灶的进一步发展,降低动脉粥样硬化发生的危险性。     

运动干预对老年糖尿病-Ⅱ型患者生命质量的影响

目的:评价运动干预对老年糖尿病-Ⅱ型患者生命质量的影响。方法:将30例老年糖尿病-Ⅱ型患者随机分为运动干预组和对照组,采用规律运动对干预组进行12周干预实验,对照组则不进行任何规律运动,两组均检测血糖等指标、测量体质状况、SF-36量表。结果:实验后干预组与对照组在血糖等指标、体质状况、生命质量各维度得分等方面,差异具有统计学意义。结论:规律性运动干预对老年糖尿病-Ⅱ型患者血糖降低、体质增强有积极的影响,可有效提升患者生命质量。     

Submaximal and Peak Cardiorespiratory Response After Moderate-High Intensity Exercise Training in Subacute Stroke

Purpose

Reduced cardiovascular fitness post-stroke may negatively impact recovery. There is little information regarding exercise testing performance and cardiorespiratory response to an aerobic exercise intervention in subacute stroke. The purpose of this study was to examine cardiorespiratory response in subacute stroke after an 8-week aerobic exercise intervention using a total body recumbent stepper (TBRS).

Methods

Nine individuals with mean age 61.2 (SD 4.7) years and mean 66.7 (SD 41.5) days post-stroke completed the exercise intervention. Participants had a mean Fugl-Meyer score of 100.3 (SD 29.3). Outcome measures were obtained at baseline and postintervention. A peak exercise test using a TBRS assessed oxygen consumption, heart rate, and minute ventilation. Participants completed an 8-week exercise intervention on a recumbent stepper 3 times per week at a prescribed heart rate intensity.

Results

Submaximal VO₂ was significantly lower from baseline to postintervention with a main effect of Study Visit (F_1,8 = 8.5, p = 0.02). Heart rate was not significantly different pre- to postintervention. Minute ventilation exhibited no main effect of Study Visit or Test Minute.

Conclusion

Moderate-high intensity aerobic exercise in subacute stroke appears to be beneficial for improving cardiovascular outcomes during submaximal performance of an exercise test.Key Words: oxygen uptake, cerebrovascular accident, cardiovascular fitness, submaximal exercise     

Exercise training and impaired glucose tolerance in obese humans

Abstract

Individuals with impaired glucose tolerance (IGT) are at greater risk of developing diabetes than in normoglycaemia. The aim of this study was to examine the effects of 12-weeks exercise training in obese humans with IGT. Eleven participants (6 males and 5 females; 49±9 years; mean Body Mass Index (BMI) 32.4 kg · m^?2), completed a 12-week brisk walking intervention (30 min per day, five days a week (d · wk^?1), at 65% of age-predicted maximal heart rate (HR_max). Anthropometric measurements, dietary intake, pulse wave velocity (PWV, to determine arterial stiffness) and blood pressure (BP) were examined at baseline and post intervention. Fasting blood glucose, glycosylated haemoglobin, insulin, blood lipids, indices of oxidative stress and inflammation (lipid hydroperoxides; superoxide dismutase; multimeric adiponectin concentration and high-sensitivity C-reactive protein) were also determined. Post intervention, PWV (9.08±1.27 m · s^?1 vs. 8.39±1.21 m · s^?1), systolic BP (145.4±14.5 vs. 135.8±14.9 mmHg), triglycerides (1.52±0.53 mmol ^. L^?1 vs. 1.31±0.54 mmol ^. L^?1), lipid hydroperoxides (1.20±0.47 μM · L^?1 vs. 0.79±0.32 μM · L^?1) and anthropometric measures decreased significantly (P < 0.05). Moderate intensity exercise training improves upper limb vascular function in obese humans with IGT, possibly by improving triglyceride metabolism, which may subsequently reduce oxidative stress. These changes were independent of multimeric adiponectin modification and alterations in other blood biomarkers.     

心血管机能评定与运动处方门诊操作常规

结合临床运用实际,论述了康复医师在门诊中如何评定体育锻炼者(康复病人)心血管机能的方法,注意事项,以及运动处方的操作常规。     

低负荷加压训练改善自发性高血压大鼠的血压效果及机制研究

目的:探究低负荷加压训练对自发性高血压大鼠的降压效果及其作用机制。方法:选取4周龄雄性自发性高血压大鼠,随机分为对照组(高血压安静组)、低负荷训练组、低负荷加压训练组和高负荷训练组。低负荷训练组进行35%~55%1RM递进式低负荷爬梯训练,低负荷加压训练组进行30%~40%血流受限结合35%~55%1RM递进式低负荷爬梯训练,高负荷训练组进行55%~75%1RM递进式高负荷爬梯训练,训练后测定血压、血液中内皮素-1、血管内皮生长因子、一氧化氮合成酶的表达和心肌组织中内皮型一氧化氮合成酶的表达。结果:1)与对照组、高负荷训练组相比,低负荷加压训练组收缩压、舒张压显著下降(P<0.05);与低负荷训练组相比,低负荷加压训练组舒张压显著下降(P<0.05)。2)与对照组相比,低负荷加压训练组血液中内皮素-1表达显著下调(P<0.05),血管内皮生长因子和一氧化氮合成酶表达显著上调(P<0.05);3)与对照组相比,低负荷加压训练组心肌中内皮型一氧化氮合成酶表达显著上调(P<0.05);4)在低负荷加压训练组中,收缩压与内皮素-1呈正相关,相关性分析具有统计学意义(P<0.05);收缩压与一氧化氮合成酶、血管内皮生长因子、内皮型一氧化氮合成酶均呈负相关,相关性分析具有统计学意义(P<0.05)。结论:1)低负荷加压训练降压效果优于高负荷训练;2)低负荷加压训练能够通过下调血液中内皮素-1的表达,上调血液中血管内皮生长因子和一氧化氮合成酶的表达,同时上调心肌中内皮型一氧化氮合成酶表达,改善内皮细胞功能,达到降压的效果。     

不同运动干预训练促进脑瘫患者体质健康研究进展

采用文献资料法查阅国内外文献,选定与研究相符具有代表性的文章,选取国内实证类文献10篇,国外实证类文献6篇,共计16篇。了解治疗脑瘫患者的运动干预康复手段,分析其干预方法及结果。研究结果表明:当前国内一般采用核心稳定运动干预、抗阻训练、悬吊运动训练以及柔韧训练为主;国外采用向后行走训练,机器人辅助训练,平衡训练等多种训练干预方式。国内外在对其进行运动干预之后,显示对脑瘫患者粗大功能、痉挛状况、步态步速行走能力以及肌肉肌张力、平衡等方面均有显著性差异。提示:针对脑瘫患者特殊的体质情况,借鉴先进干预手段以及多种运动方式相结合的治疗康复手段,促进患者临床康复。并进一步探究其作用机理,设计更科学有效的训练方式刺激肌肉的康复,改善脑瘫患者身体素质。     

Impacts of exercise interventions on different diseases and organ functions in mice

BackgroundIn recent years, much evidence has emerged to indicate that exercise can benefit people when performed properly. This review summarizes the exercise interventions used in studies involving mice as they are related to special diseases or physiological status. To further understand the effects of exercise interventions in treating or preventing diseases, it is important to establish a template for exercise interventions that can be used in future exercise-related studies.MethodsPubMed was used as the data resource for articles. To identify studies related to the effectiveness of exercise interventions for treating various diseases and organ functions in mice, we used the following search language: (exercise [Title] OR training [Title] OR physical activity [Title]) AND (mice [title/abstract] OR mouse [title/abstract] OR mus [title/abstract]). To limit the range of search results, we included 2 filters: one that limited publication dates to “in 10 years” and one that sorted the results as “best match”. Then we grouped the commonly used exercise methods according to their similarities and differences. We then evaluated the effectiveness of the exercise interventions for their impact on diseases and organ functions in 8 different systems.ResultsA total of 331 articles were included in the analysis procedure. The articles were then segmented into 8 systems for which the exercise interventions were used in targeting and treating disorders: motor system (60 studies), metabolic system (45 studies), cardio-cerebral vascular system (58 studies), nervous system (74 studies), immune system (32 studies), respiratory system (7 studies), digestive system (1 study), and the system related to the development of cancer (54 studies). The methods of exercise interventions mainly involved the use of treadmills, voluntary wheel-running, forced wheel-running, swimming, and resistance training. It was found that regardless of the specific exercise method used, most of them demonstrated positive effects on various systemic diseases and organ functions. Most diseases were remitted with exercise regardless of the exercise method used, although some diseases showed the best remission effects when a specific method was used.ConclusionOur review strongly suggests that exercise intervention is a cornerstone in disease prevention and treatment in mice. Because exercise interventions in humans typically focus on chronic diseases, national fitness, and body weight loss, and typically have low intervention compliance rates, it is important to use mice models to investigate the molecular mechanisms underlying the health benefits from exercise interventions in humans.     

体育锻炼对大学生单纯性肥胖干预效果评价

采用中等强度的体育活动进行训练，对实验对象身体各指标变化进行实验前后的比较与分析。发现训练12周后，男生平均体重降低8．38kg，女生平均体重降低8．11kg，男女生的脉搏、血压也都呈现下降趋势，肺括量指标有所提高。表明中等强度的体育活动具有明显的控制体重作用，不仅可以增加过剩的热量的消耗，还可以改善血管功能，对单纯性肥胖症的治疗具有方法简单、奴果明显等优越性。