本帖最後由 lsc0019 於 2009-4-4 00:36 編輯
作者：Laurie Barclay, MD
出處：WebMD醫學新聞
March 19, 2009 — 根據3月16日循環期刊線上發表的一篇隨機控制試驗，各類運動(有氧、耐力型、或混合型)對於最近發生心肌梗塞之後的病患，都是安全有效的內皮細胞機能失調校正策略。
瑞士Clinique Valmont-Genolier的M. Vona醫師等人寫道，在冠狀動脈疾病，運動訓練(exercise training，ET)與改善內皮細胞機能有關，但對不同運動類型的相關效果瞭解甚少。研究動機是前溯式評估不同類型運動訓練對內皮細胞機能的效果，研究對象是209名最近初次發生急性心肌梗塞的病患。
在各類型運動訓練之前與之後四週、停止訓練後一個月，分別使用血管舒張幅度以及von Willebrand氏因子來評估內皮細胞機能。病患分為：第一組為有氧訓練(n = 52)、第二組為耐力訓練(n = 54)、第三組為耐力加有氧訓練(n = 53)、第四組無訓練(n = 50)。所有運動每週進行四次、為期四週。有氧運動是以固定式腳踏車測力計進行40分鐘。耐力訓練包括四套各10分鐘的耐力運動。
各組於開始時的血管舒張幅度差異不顯著(第一組4.5% ± 2.6%、第二組4.01% ± 1.6%、第三組4.4% ± 4%、第四組4.3% ± 2.3%；P 值不顯著)。運動訓練之後，血管舒張幅度增加，第一組9.9% ± 2.5%、第二組10.1% ± 2.6%、第三組10.8% ± 3% (這三組與開始時相比，P<.01)。雖然第四組的血管舒張幅度也增加到5.1% ± 2.5%，但是程度相當有限(與其他三組運動組相比，P<.01)。
運動訓練之後，第一、二、三組的von Willebrand氏因子值減少達16% (P<.01)，第四組則沒有改變。血管舒張幅度於停止訓練之後回到開始時的程度(相較於訓練後，P<.01)。
研究作者寫道，最近發生急性心肌梗塞的病患中，不論何種類型的運動訓練都與改善內皮細胞機能有關，但是在停止訓練之後一個月，此效果消失。這些資料意味著，遵守良好的長期訓練計畫對於維持內皮細胞機能之血管助益是必要的。對於冠狀動脈疾病患者之內皮細胞機能校正尤其重要，有助於延緩粥狀動脈硬化惡化。
這些病患在運動期間或者運動後的恢復時間全都沒有任何併發症，確認了心肌梗塞病患進行耐力訓練的安全性。
研究作者結論表示，此篇研究顯示，各類運動(有氧、耐力型、或混合型)對於最近發生心肌梗塞之後的病患，都是安全有效的內皮細胞機能失調校正策略。這些發現有助於鼓勵各種運動處方，最終促成較佳的長期體能訓練遵守性。
作者宣告沒有相關財務關係。
All Types of Exercise May Be Safe, Effective After Recent Myocardial Infarction
By Laurie Barclay, MD
Medscape Medical News
March 19, 2009 — All types of exercise (aerobic, resistance, and their combination) are safe and effective strategies for correcting endothelial dysfunction in patients after a recent myocardial infarction, according to the results of a randomized controlled trial reported in the March 16 Online First issue of Circulation.
"In coronary artery disease, exercise training (ET) is associated with an improvement in endothelial function, but little is known about the relative effect of different types of training," write M. Vona, MD, from Clinique Valmont-Genolier, Glion-sur-Montreux in Switzerland, and colleagues. "The purpose of this study was to prospectively evaluate the effect of different types of ET on endothelial function in 209 patients after a first recent acute myocardial infarction."
Flow-mediated dilation and von Willebrand factor levels were used to assess endothelial function before and after 4 weeks of different types of exercise training and after 1 month of detraining. Patients were assigned to group 1 (aerobic training; n = 52), group 2 (resistance training; n = 54), group 3 (resistance plus aerobic training (n = 53), or group 4 (no training; n = 50). All exercise was performed 4 times a week for 4 weeks. Aerobic exercise was performed for 40 minutes on a cycle ergometer. Resistance training consisted of 4 sets of 10 resistance exercises.
Flow-mediated dilation at baseline was not significantly different between groups (4.5% ± 2.6% in group 1, 4.01% ± 1.6% in group 2, 4.4% ± 4% in group 3, and 4.3% ± 2.3% in group 4; P = not significant). Flow-mediated dilation increased after exercise training to 9.9% ± 2.5% in group 1, 10.1% ± 2.6% in group 2, and 10.8% ± 3% in group 3 (P?P?
After exercise training, von Willebrand factor level decreased by 16% (P?P?
"In patients with recent acute myocardial infarction, ET was associated with improved endothelial function independently of the type of training, but this effect disappeared after 1 month of detraining," the study authors write. "These data imply that good, long-term adherence to training programs is necessary to maintain vascular benefits on endothelial dysfunction. This aspect is probably particularly important in patients with coronary artery disease in whom the correction of endothelial anomalies could help to slow the progression of atherosclerosis."
None of the patients had any complications during either the exercise sessions or postexercise recovery, confirming the safety of resistance training in patients who have had a myocardial infarction.
"The present study demonstrates that all types of exercise (aerobic, resistance, and their combination) are safe and effective strategies for correcting endothelial dysfunction in patients after a recent myocardial infarction," the study authors conclude. "These findings could help to encourage variety in the prescription of exercise and ultimately to promote better adherence to long-term physical training."
The study authors have disclosed no relevant financial relationships.
Circulation. Published online March 16, 2009. |
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