智能有氧踏车训练对不同病程脑梗死患者的效果

doi:10.3969/j.issn.1006-9771.2022.07.013

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (7): 822-827.doi: 10.3969/j.issn.1006-9771.2022.07.013

智能有氧踏车训练对不同病程脑梗死患者的效果

韩凯月^1,²,刘光亮^1,³,苏文龙^1,^2,⁴,唐芷晴^1,²,张皓^1,^2,^4,⁵()

1.首都医科大学康复医学院,北京市 100068
2.中国康复研究中心北京博爱医院,北京市100068
3.良乡医院,北京市 102401
4.康复大学,山东青岛市 266000
5.山东大学齐鲁医学院,山东济南市 250100

收稿日期:2022-05-24 修回日期:2022-06-16 出版日期:2022-07-25 发布日期:2022-08-08
通讯作者: 张皓 E-mail:zh1665@163.com
作者简介:韩凯月(1998-),女,汉族,山东淄博市人,硕士研究生,主要研究方向：神经康复。|张皓,女,博士,教授、主任医师、博士研究生导师。
基金资助:
首都临床特色应用研究项目(Z18110000178170)

Effects of intelligent aerobic bicycle training on ischemic stroke patients at different disease courses

HAN Kaiyue^1,²,LIU Guangliang^1,³,SU Wenlong^1,^2,⁴,TANG Zhiqing^1,²,ZHANG Hao^1,^2,^4,⁵()

1. Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China
2. Beijing Bo'ai Hospital, China Rehabilitation Research Centre, Beijing 100068, China
3. Liangxiang Hospital, Beijing 100068, China
4. University of Health and Rehabilitation Sciences, Qingdao, Shandong 266000, China
5. Cheeloo College of Medicine, Shandong University, Ji'nan, Shandong 250100, China

Received:2022-05-24 Revised:2022-06-16 Published:2022-07-25 Online:2022-08-08
Contact: ZHANG Hao E-mail:zh1665@163.com
Supported by:
Capital Clinical Research Project(Z18110000178170)

摘要/Abstract

摘要：

目的探讨智能有氧踏车训练对不同病程脑梗死患者下肢运动功能、心肺功能和日常生活活动能力(ADL)的影响。

方法 2019年11月至2021年11月,北京博爱医院收治的脑梗死患者138例,分层随机分为对照组和试验组各69例。所有患者均接受药物治疗和常规康复训练,试验组加智能有氧踏车训练,共8周。于治疗前、治疗4周和治疗8周后采用Fugl-Meyer评定量表下肢部分(FMA-LE)、峰值摄氧量(VO₂peak)、6分钟步行试验(6MWT)和改良Barthel指数(MBI)进行评价。

结果治疗后,两组FMA-LE评分、VO₂peak、6MWT、MBI评分均显著改善(|t| > 6.763, P < 0.001),试验组各项成绩均优于对照组(|t| > 2.439, P < 0.05)。其中,病程< 1个月的患者比较,试验组FMA-LE评分、VO₂peak和6MWT均优于对照组(|t| > 2.036, P < 0.05);病程1~3个月患者比较,试验组6MWT和MBI评分优于对照组(|t| > 2.005, P < 0.05);病程> 3~6个月患者比较,两组各项成绩均无显著性差异(|t| < 1.303,P > 0.05)。

结论智能有氧踏车训练能促进脑梗死患者下肢运动功能、心肺功能和ADL恢复,发病后早期干预效果最佳。

关键词: 脑梗死, 有氧踏车, 运动, 心肺功能, 日常生活活动能力

Abstract:

Objective To investigate the effects of an intelligent aerobic bicycle training on lower limb motor function, cardiopulmonary function and activities of daily living (ADL) in patients with ischemic stroke at different courses.

Methods From November, 2019 to November, 2021, 138 ischemic stroke patients were stratified-randomly divided into control group (n = 69) and experimental group (n = 69). All the patients received medication and routine rehabilitation training, and the experimental group additionally received intelligent aerobic bicycle training, for eight weeks. They were assessed with Fugl-Meyer Assessment-Lower Extremities (FMA-LE), peak oxygen uptake (VO₂peak), Six-minute Walk Test (6MWT) and modified Barthel Index (MBI) before, and four weeks and eight weeks after treatment.

Results The performances of FMA-LE, VO₂peak, 6MWT and MBI improved in both groups after treatment (|t| > 6.763, P <0.001), and improved more in the experimental group than in the control group (|t| > 2.439, P <0.05). For the patients beginning training less than one month after stroke, the performances of FMA-LE, VO₂peak and 6MWT improved more in the experimental group than in the control group (|t| > 2.036, P <0.05); for those during one to three months, the performances of 6MWT and MBI improved more (|t| > 2.005, P <0.05); for those during three to six months, the performances of all the tests were not significantly different (|t| < 1.303, P >0.05).

Conclusion Intelligent aerobic bicycle training may improve the lower limb motor function, cardiopulmonary function and ADL for patients with ischemic stroke, especially intervening earlier.

Key words: ischemic stroke, aerobic cycling, motor, cardiopulmonary function, activities of daily living

中图分类号:

R743.32

韩凯月,刘光亮,苏文龙,唐芷晴,张皓. 智能有氧踏车训练对不同病程脑梗死患者的效果[J]. 《中国康复理论与实践》, 2022, 28(7): 822-827.

HAN Kaiyue,LIU Guangliang,SU Wenlong,TANG Zhiqing,ZHANG Hao. Effects of intelligent aerobic bicycle training on ischemic stroke patients at different disease courses[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(7): 822-827.

图/表 9

表1

表2

表3

表4

表5

表6

表7

表8

表9

参考文献 34

[1]	WU S, WU B O, LIU M, et al. Stroke in China: advances and challenges in epidemiology, prevention, and management[J]. Lancet Neurol, 2019, 18(4): 394-405. doi: 10.1016/S1474-4422(18)30500-3
[2]	FESKE S K. Ischemic stroke[J]. Am J Med, 2021, 134(12): 1457-1464. doi: 10.1016/j.amjmed.2021.07.027
[3]	XING Y, BAI Y. A Review of exercise-induced neuroplasticity in ischemic stroke: pathology and mechanisms[J]. Mol Neurobiol, 2020, 57(10): 4218-4231. doi: 10.1007/s12035-020-02021-1
[4]	KRAMER S F, HUNG S H, BRODTMANN A. The impact of physical activity before and after stroke on stroke risk and recovery: a narrative review[J]. Curr Neurol Neurosci Rep, 2019, 19(6): 1-9. doi: 10.1007/s11910-019-0917-z
[5]	范星月. 踏车有氧训练对缺血性脑卒中患者心血管适应性影响的研究[D]. 哈尔滨: 黑龙江中医药大学, 2018.
	FAN X Y. The research of treadmill aerobic exercise's effectiveness on cardiovascular fitness in ischemic stroke patients[D]. Harbin: Heilongjiang University of Traditional Chinese Medicine, 2018.
[6]	中华医学会神经病学分会, 中华医学会神经病学分会脑血管病学组. 中国脑血管疾病分类2015[J]. 中华神经科杂志, 2017, 50(3): 168-171.
	Cerebrovascular Disease Study Group; Chinese Society of Neurology. Chinese Medical Association. Chin J Neurol, 2017, 50(3): 168-171.
[7]	BILLINGER S A, ARENA R, BERNHARDT J, et al. Physical activity and exercise recommendations for stroke survivors: a statement for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2014, 45(8): 2532-2553. doi: 10.1161/STR.0000000000000022
[8]	THOMPSON P D, ARENA R, RIEBE D, et al. ACSM's new preparticipation health screening recommendations from ACSM's guidelines for exercise testing and prescription[J]. Curr Sports Med Rep, 2013, 12(4): 215-217. doi: 10.1249/JSR.0b013e31829a68cf
[9]	LIN J, WU W, GAO L, et al. Global myocardial work combined with treadmill exercise stress to detect significant coronary artery disease[J]. J Am Soc Echocardiogr, 2022, 35(3): 247-257. doi: 10.1016/j.echo.2021.10.009
[10]	徐泉, 马迪, 潘钰, 等. 功能性电刺激下踏车训练对亚急性期脑卒中患者运动功能和心肺适能的效果[J]. 中国康复理论与实践, 2020, 26(9): 1005-1009.
	XU Q, MA D, PAN Y, et al. Effects of functional electrical stimulation-assisted cycling on motor function and cardiopulmonary fitness in subacute stroke patients[J]. Chin J Rehabil Theory Pract, 2020, 26(9): 1005-1009.
[11]	LOUIE D R, LIM S B, ENG J J. The efficacy of lower extremity mirror therapy for improving balance, gait, and motor function poststroke: a systematic review and meta-analysis[J]. J Stroke Cerebrovasc Dis, 2019, 28(1): 107-120. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.017
[12]	HERDY A H, RITT L E F, STEIN R, et al. Cardiopulmonary exercise test: background, applicability and interpretation[J]. Arq Bras Cardiol, 2016, 107: 467-481.
[13]	MACCHIAVELLI A, GIFFONE A, FERRARELLO F, et al. Reliability of the six-minute walk test in individuals with stroke: systematic review and meta-analysis[J]. Neurol Sci, 2021, 42(1): 81-87. doi: 10.1007/s10072-020-04829-0
[14]	YANG C M, WANG Y C, LEE C H, et al. A comparison of test-retest reliability and random measurement error of the Barthel Index and modified Barthel Index in patients with chronic stroke[J]. Disabil Rehabil, 2022, 44(10): 2099-2103. doi: 10.1080/09638288.2020.1814429
[15]	KUZNETSOVA A, BROCKHOFF P B, CHRISTENSEN R H B. lmerTest package: tests in linear mixed effects models[J]. J Stat Softw, 2017, 82: 1-26.
[16]	POWERS W J. Acute ischemic stroke[J]. N Engl J Med, 2020, 383(3): 252-260. doi: 10.1056/NEJMcp1917030
[17]	KRAWCYK R S, VINTHER A, PETERSEN N C, et al. "Graded cycling test with talk test" is a reliable test to monitor cardiovascular fitness in patients with minor stroke[J]. J Stroke Cerebrovasc Dis, 2017, 26(3): 494-499. doi: 10.1016/j.jstrokecerebrovasdis.2016.12.004
[18]	GEZER H, KARAAHMET O Z, GURCAY E, et al. The effect of aerobic exercise on stroke rehabilitation[J]. Ir J Med Sci, 2019, 188(2): 469-473. doi: 10.1007/s11845-018-1848-4
[19]	LINDER S M, DAVIDSON S, ROSENFELDT A, et al. Forced and voluntary aerobic cycling interventions improve walking capacity in individuals with chronic stroke[J]. Arch Phys Med Rehabil, 2020, 102(1): 1-8. doi: 10.1016/j.apmr.2020.08.006
[20]	DA SILVA R S, DA SILVA S T, DE SOUZA J M, et al. Effects of inclined treadmill training on functional and cardiovascular parameters of stroke patients: study protocol for a randomized controlled trial[J]. Trials, 2019, 20(1): 1-9. doi: 10.1186/s13063-018-3101-x
[21]	KERR A, CUMMINGS J, BARBER M, et al. Community cycling exercise for stroke survivors is feasible and acceptable[J]. Top Stroke Rehabil, 2019, 26(7): 485-490. doi: 10.1080/10749357.2019.1642653
[22]	DA ROSA PINHEIRO D R, CABELEIRA M E P, DA CAMPO L A, et al. Effects of aerobic cycling training on mobility and functionality of acute stroke subjects: a randomized clinical trial[J]. NeuroRehabilitation, 2021, 48(1): 39-47. doi: 10.3233/NRE-201585
[23]	DAN B. Intensive repetitive motor training: how does it work in children with cerebral palsy?[J]. Dev Med Child Neurol, 2021, 63(9): 1008-1008. doi: 10.1111/dmcn.14970
[24]	LINDER S M, ROSENFELDT A B, DAVIDSON S, et al. Forced, not voluntary, aerobic exercise enhances motor recovery in persons with chronic stroke[J]. Neurorehabil Neural Repair, 2019, 33(8): 681-690. doi: 10.1177/1545968319862557
[25]	RAIMUNDO R D, DE ABREU L C, ADAMI F, et al. Heart rate variability in stroke patients submitted to an acute bout of aerobic exercise[J]. Transl Stroke Res, 2013, 4(5): 488-499. doi: 10.1007/s12975-013-0263-4
[26]	袁建容, 龚泽辉, 何明川, 等. 上、下肢踏车训练对早期偏瘫患者肢体功能及生活质量的影响[J]. 心血管康复医学杂志, 2020, 29(2): 142-145.
	YUAN J R, GONG Z H, HE M C, et al. Effects of upper and lower limb treadmill training on limb function and quality of life in early hemiplegia patients[J]. Chin J Cardiovasc Rehabil Med, 2020, 29(2): 142-145.
[27]	AGUIAR L T, NADEAU S, BRITTO R R, et al. Effects of aerobic training on physical activity in people with stroke: a randomized controlled trial[J]. NeuroRehabilitation, 2020, 46(3): 391-401. doi: 10.3233/NRE-193013
[28]	JIN H, JIANG Y, WEI Q, et al. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke[J]. NeuroRehabilitation, 2013, 32(2): 327-335. doi: 10.3233/NRE-130852
[29]	钱贞, 陈伟, 李瑾, 等. 四肢联动在健康青年人心肺适能评估中应用的可行性分析[J]. 中国全科医学, 2018, 21(35): 4340-4345. doi: 10.12114/j.issn.1007-9572.2018.00.067
	QIAN Z, CHEN W, LI J, et al. Feasibility analysis of the use of limb linkage equipment to assess cardiorespiratory fitness in healthy youths[J]. Chin Gen Prac, 2018, 21(35): 4340-4345. doi: 10.12114/j.issn.1007-9572.2018.00.067
[30]	景会锋. 运动、高血压与血管内皮细胞生长因子研究进展[J]. 延安大学学报(自然科学版), 2015, 34(3): 109-112.
	JING H F. Research progress on exercise, hypertension and vascular endothelial growth factor[J]. J Yan'an Univ (Nat Sci), 2015, 34(3): 109-112.
[31]	TANG A, SIBLEY K M, THOMAS S G, et al. Effects of an aerobic exercise program on aerobic capacity, spatiotemporal gait parameters, and functional capacity in subacute stroke[J]. Neurorehabil Neural Repair, 2009, 23(4): 398-406. doi: 10.1177/1545968308326426
[32]	VANROY C, FEYS H, SWINNEN A, et al. Effectiveness of active cycling in subacute stroke rehabilitation: a randomized controlled trial[J]. Arch Phys Med Rehabil, 2017, 98(8): 1576-1585, e5. doi: 10.1016/j.apmr.2017.02.004
[33]	ROTHROCK J F, CLARK W M, LYDEN P D. Spontaneous early improvement following ischemic stroke[J]. Stroke, 1995, 26(8): 1358-1360. doi: 10.1161/01.STR.26.8.1358
[34]	CRAMER S C. Repairing the human brain after stroke: I. Mechanisms of spontaneous recovery[J]. Ann Neurol, 2008, 63(3): 272-287. doi: 10.1002/ana.21393

项目	病程< 1个月		病程1~3个月		病程> 3~6个月		t/χ²值^a	P值^a	t/χ²值^b	P值^b	t/χ²值^c	P值^c
项目	对照组 (n = 23)	试验组 (n = 23)	对照组 (n = 23)	试验组 (n = 23)	对照组 (n = 23)	试验组 (n = 23)	t/χ²值^a	P值^a	t/χ²值^b	P值^b	t/χ²值^c	P值^c
性别(男/女)/n	12/11	13/10	16/7	19/4	19/4	17/6	0.880	0.767	1.075	0.300	0.511	0.475
年龄/岁	64.96±8.68	65.78±7.98	60.43±6.36	58.65±10.61	64.17±10.60	64±7.78	0.334	0.740	-0.690	0.494	-0.062	0.951
病灶侧(左/右)/n	8/15	6/17	7/16	9/14	7/16	6/17	0.411	0.522	0.383	0.536	0.107	0.743
高血压/n	14	15	19	14	20	19	0.093	0.760	2.681	0.102	0.168	0.681
糖尿病/n	10	8	9	5	4	8	0.365	0.546	1.643	0.200	1.804	0.179
NHISS	6.78±2.00	6.00±1.81	5.04±1.58	5.35±1.77	5.00±1.20	5.52±1.34	-1.387	0.172	0.627	0.534	1.386	0.173
左室射血分数/%	61.74±5.44	61.43±4.24	61.13±3.99	61.96±5.82	63.35±5.38	61.65±4.37	-0.212	0.833	0.561	0.577	-1.174	0.247

组别	n	治疗前	治疗4周	治疗8周	t值^a	P值^a	t值^b	P值^b
对照组	69	24.00(23.34~24.66)	26.83(26.17~27.48)	28.39(27.73~29.05)	-16.846	< 0.001	-8.079	< 0.001
试验组	69	24.09(23.43~24.75)	27.99(27.33~28.64)	29.86(29.20~30.51)	-12.212	< 0.001	-6.763	< 0.001
t值		0.183	2.439	3.079
P值		0.855	0.016	0.002

组别	n	治疗前	治疗4周	治疗8周	t值^a	P值^a	t值^b	P值^b
对照组	69	15.59(15.14~16.05)	16.32(15.86~16.78)	16.91(16.45~17.37)	-19.124	< 0.001	-9.171	< 0.001
试验组	69	15.58(15.12~16.03)	17.16(16.70~17.61)	18.31(17.85~18.76)	-13.863	< 0.001	-7.678	< 0.001
t值		-0.051	2.533	4.239
P值		0.959	0.012	< 0.001

组别	n	治疗前	治疗4周	治疗8周	t值^a	P值^a	t值^b	P值^b
对照组	69	171.16(158.62~183.70)	244.06(231.51~256.60)	332.46(319.92~345.01)	-24.939	< 0.001	-21.556	< 0.001
试验组	69	171.88(159.34~184.43)	284.06(271.51~296.60)	381.01(368.47~393.56)	-16.207	< 0.001	-19.655	< 0.001
t值		0.080	4.418	5.363
P值		0.936	< 0.001	< 0.001

组别	n	治疗前	治疗4周后	治疗8周后	t值^a	P值^a	t值^b	P值^b
对照组	69	63.41(60.66~66.15)	71.38(68.63~74.12)	77.03(74.28~79.77)	-19.586	< 0.001	-9.306	< 0.001
试验组	69	65.07(62.33~67.82)	78.19(75.44~80.93)	84.42(81.68~87.16)	-11.903	< 0.001	-8.440	< 0.001
t值		0.843	3.447	3.740
P值		0.400	< 0.001	< 0.001

智能有氧踏车训练对不同病程脑梗死患者的效果

Effects of intelligent aerobic bicycle training on ischemic stroke patients at different disease courses

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

图/表 9

参考文献 34

相关文章 15

Metrics

本文评价

推荐阅读 0

组别	n	< 1个月	1~3个月	> 3~6个月
对照组	23	25.07(24.00~26.14)	26.64(25.57~27.71)	27.51(26.44~28.58)
试验组	23	26.71(25.64~27.78)	27.41(26.34~28.47)	27.81(26.74~28.88)
t值		2.123	0.996	0.395
P值		0.036	0.321	0.694

组别	n	< 1个月	1~3个月	> 3~6个月
对照组	23	15.53(14.75~16.31)	16.23(15.45~17.01)	17.07(16.29~17.85)
试验组	23	16.67(15.89~17.45)	17.01(16.23~17.79)	17.36(16.58~18.14)
t值		2.036	1.389	0.513
P值		0.044	0.167	0.609

组别	n	< 1个月	1~3个月	> 3~6个月
对照组	23	219.71(199.91~239.51)	244.06(231.51~256.60)	332.46(319.92~345.01)
试验组	23	261.16(241.36~280.96)	284.06(271.51~296.60)	381.01(368.47~393.56)
t值		2.890	2.031	1.303
P值		0.005	0.044	0.195

组别	n	< 1个月	1~3个月	> 3~6个月
对照组	23	68.77(64.20~73.33)	69.49(64.93~74.06)	73.55(68.98~78.12)
试验组	23	74.86(70.29~79.42)	76.09(71.52~80.65)	76.74(72.17~82.31)
t值		1.851	2.005	0.969
P值		0.067	0.047	0.334

[1]	周治宁, 周容, 肖燕文, 王博文, 吕娇娇, 刘宇. 多靶区经颅直流电刺激对健康成年人工作记忆-姿势控制双任务表现的影响[J]. 《中国康复理论与实践》, 2024, 30(1): 21-28.
[2]	王昊懿, 史亚伟, 鲁俊, 许光旭. 主观垂直感知障碍对脑卒中患者功能影响的回顾性研究[J]. 《中国康复理论与实践》, 2024, 30(1): 68-73.
[3]	陈珺雯, 陈谦, 陈程, 李淑月, 刘玲玲, 吴存书, 龚翔, 鲁俊, 许光旭. 改良八段锦身体活动对脑卒中患者心肺功能、运动功能和日常生活活动能力的效果[J]. 《中国康复理论与实践》, 2024, 30(1): 74-80.
[4]	魏梦力, 钟亚平, 周易文, 桂辉贤, 关烨明, 于婷婷. 单侧前交叉韧带重建患者步行双侧下肢肌肉协同模式差异[J]. 《中国康复理论与实践》, 2024, 30(1): 95-104.
[5]	张冠聪, 黄秋晨, 顾蕊, 刘四海, 胡春英, 刘克敏. 不同神经肌肉训练方法对早期膝骨关节炎患者疼痛和运动功能效果的比较[J]. 《中国康复理论与实践》, 2023, 29(9): 1090-1097.
[6]	孙藤方, 任梦婷, 杨琳, 王耀霆, 王红雨, 闫兴洲. 高压氧治疗联合重复外周磁刺激干预脑卒中患者踝运动功能和平衡能力的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 875-881.
[7]	王亚楠, 刘西花. 脑卒中偏瘫患者主观和客观平衡功能测量的相关性及预测效能[J]. 《中国康复理论与实践》, 2023, 29(8): 890-895.
[8]	魏晓微, 杨剑, 魏春艳, 贺启令. 学校环境下适应性体育课程促进智力与发展性残疾儿童心理运动发展的系统综述[J]. 《中国康复理论与实践》, 2023, 29(8): 910-918.
[9]	王海云, 王寅, 周信杰, 何爱群. 基于“中枢-外周-中枢”理论的经颅直流电刺激结合针刺干预脑卒中患者中枢及上肢功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 919-925.
[10]	陈怡婷, 王倩, 崔慎红, 李映彩, 张思鈺, 魏衍旭, 任慧, 冷军, 陈斌. 双侧序贯重复经颅磁刺激干预脑卒中患者上肢运动功能的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 926-932.
[11]	武广艳, 张冉, 王璐, 于歌, 陈亚平. 核心肌群运动控制训练对产后腹直肌分离的效果[J]. 《中国康复理论与实践》, 2023, 29(8): 948-953.
[12]	陈渔, 郭峰, 郭建瑞, 董彤彤, 夏雪莲. 镜像视觉反馈训练中大脑运动皮质激活的脑电特征研究[J]. 《中国康复理论与实践》, 2023, 29(8): 967-976.
[13]	李子怡, 宋为群, 杜巨豹, 曹光磊, 张艳明, 李冉. 运动表象训练对膝关节单髁置换术后膝关节功能的效果[J]. 《中国康复理论与实践》, 2023, 29(7): 745-749.
[14]	唐流泉, 彭兴云. 血流限制下运动对绝经后慢性阻塞性肺疾病患者脆性骨折部分危险因素的疗效[J]. 《中国康复理论与实践》, 2023, 29(7): 761-769.
[15]	韩亚兵, 刘少青, 李新通, 梁馨文, 罗敬, 李婷, 潘玮敏. 髋部神经肌肉训练对女子足球运动员前交叉韧带损伤风险的影响[J]. 《中国康复理论与实践》, 2023, 29(7): 770-776.