基于WHO-FICs架构有氧联合抗阻运动对老年冠心病并发高血压患者的效果

doi:10.3969/j.issn.1006-9771.2023.03.012

摘要/Abstract

摘要：

目的观察中等强度有氧联合低强度抗阻运动对老年冠心病并发高血压患者的综合效果。

方法 2021年11月至2022年5月，选取武汉市东湖医院冠心病并发高血压患者16例，分为对照组(n = 8)和试验组(n = 8)。基于WHO国际分类家族(WHO-FICs)构建运动干预方案，对照组行常规治疗，试验组在常规治疗基础上行中等强度有氧联合低强度抗阻运动，共8周。干预前后采用心肺运动测试系统测定患者肺功能、心脏功能，采用计时“起立-行走”测试、6分钟步行测试、2分钟踏步测试、30秒坐站测试和握力进行评定。

结果干预后，试验组肺活量、用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积占用力肺活量比值、呼气峰值流速、最大通气量均提高(|t| > 2.391, P < 0.05)，且肺活量、用力肺活量、最大通气量高于对照组(|t| > 2.207, P < 0.05)；试验组峰值摄氧量、无氧阈下摄氧量、代谢当量、氧脉搏、最大运动负荷、运动负荷时间均提高(|t| > 2.823, P < 0.05)，且各项指标均优于对照组(|t| > 2.295, P < 0.05)；两组收缩压均明显改善(|t| > 4.608, P < 0.01)，试验组舒张压明显改善(t = 5.964, P < 0.01)，试验组收缩压明显低于对照组(t = -3.654, P < 0.01)；干预后，试验组计时“起立-行走”测试时间、6分钟步行距离、2分钟踏步次数、30秒坐站次数、握力均改善(|t| > 2.996, P < 0.05)，试验组各项指标均优于对照组(|t| > 2.220, P < 0.05)。

结论基于WHO-FICs构建的运动方案可改善老年冠心病并发高血压患者的心、肺及运动功能。

关键词: 冠心病, 高血压, 有氧运动, 抗阻运动, 心功能, 肺功能, 运动功能

Abstract:

Objective To analyze the effect of moderate intensity aerobic combined with low intensity resistance exercise on old patients with coronary heart disease and hypertension.

Methods From November, 2021 to May, 2022, 16 patients with coronary heart disease and hypertension in Wuhan Donghu Hospital were divided into control group (n = 8) and experimental group (n = 8). Based on the World Health Organization Family of International Classification (WHO-FICs), the exercise intervention program was constructed. The control group accepted routine treatment, and the experimental group accepted moderate intensity aerobic combined with low intensity resistance exercise in addition, for eight weeks. They were measured lung function and cardiac function with cardiopulmonary exercise test system, and assessed with Timed 'Up and Go' Test, 6-Minute Walk Distance, 2-Minute Step Test, 30-Second Sit to Stand Test and grip strength before and after intervention.

Results The vital capacity, forced vital capacity, forced expiratory volume in the first second, forced expiratory volume in the one second as percentage of predicted volume, peak expiratory flow and maximal voluntary ventilation improved in the experimental after intervention (|t| > 2.391, P < 0.05), and the vital capacity, force vital capacity and maximal voluntary ventilation were more in the experimental group than in the control group (|t| > 2.207, P < 0.05). Peak oxygen uptake, anaerobic subthreshold oxygen uptake, metabolic equivalents, oxygen pulse, maximum work load and exercise load time improved in the experimental group after intervention (|t| > 2.823, P < 0.05), and they all were better in the experimental group than in the control group (|t| > 2.295, P < 0.05). Systolic blood pressure improved in both the groups (|t| > 4.608, P < 0.01), and diastolic blood pressure improved in the experimental group (t = 5.964, P < 0.01); while systolic blood pressure was less in the experimental group than in the control group (t = -3.654, P < 0.01). The performances of Timed 'Up and Go' Test, 6-Minute Walk Distance, 2-Minute Step Test, 30-Second Sit to Stand Test and grip strength improved in the experimental group after intervention (|t| > 2.996, P < 0.05), and all the performances were better in the experimental group than in the control group (|t| > 2.220, P < 0.05).

Conclusion The moderate intensity aerobic combined with low resistance exercise developed based on WHO-FICs can improve the cardiac function, lung function, cardiac load and motor function of old patients with coronary heart disease and hypertension.

Key words: coronary heart disease, hypertension, aerobic exercise, resistance exercise, cardiac function, lung function, motor function

中图分类号:

R541

李慕瑶, 王梅, 杜亮, 童露, 许三雄. 基于WHO-FICs架构有氧联合抗阻运动对老年冠心病并发高血压患者的效果[J]. 《中国康复理论与实践》, 2023, 29(3): 326-334.

LI Muyao, WANG Mei, DU Liang, TONG Lu, XU Sanxiong. Functional effect of aerobic combined with resistance exercise on old patients with coronary heart disease and hypertension using WHO-FICs framework[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2023, 29(3): 326-334.

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人群			干预方式	结局
健康状况	ICD-11编码	ICF编码	干预方式	结局
冠心病高血压	BA80 冠状动脉粥样硬化 L1-BA0高血压病	b身体功能 b4心血管、血液、免疫和呼吸系统功能 b7神经肌肉骨骼和运动有关的功能 d活动和参与 d4活动	方式：有氧运动/抗阻运动频率：每周3次强度：40%~50% VO_2peak； Borg疲劳评分13~14；目标心率=(最大心率-安静心率)×40%~50%+安静心率时间：每次50 min	b4心血管、血液、免疫和呼吸系统功能 b410心脏功能 b4100心率 b430血液系统功能 b4301血液传输氧气功能 b420血管功能 b4200血压升高 b4201血压降低 b440呼吸功能 b4450胸呼吸肌功能 b4451膈肌功能 b4452辅助呼吸肌功能 b455运动耐受功能 b730肌肉力量功能 b7302单侧身体肌肉力量 b7303下半身肌肉力量 b7305躯干肌肉力量 b760随意运动控制 d4活动 d410改变身体的基本姿势 d4154保持站姿 d4103坐下 d4104站起 d4106移动身体重心 d450步行 d4500短距离步行

项目	对照组(n = 8)	试验组(n = 8)	χ²/t值	P值
性别(男/女)/n	4/4	4/4	< 0.001	1.000
年龄/岁	84.12±12.11	80.75±7.92	-0.660	0.520
身高/cm	159.63±9.10	161.50±8.03	0.146	0.886
体质量/kg	57.25±12.20	60.12±4.61	0.623	0.549
体质量指数/(kg·m^-2)	22.26±2.91	23.07±1.64	0.687	0.503

运动阶段	运动类型	运动时间/min	运动强度
适应阶段(1~4周)	有氧运动	20	40% VO_2peak，Borg疲劳量表评分13~14分，目标心率 = (最大心率-安静心率)×40%+安静心率
适应阶段(1~4周)	抗阻运动	20	40% VO_2peak，Borg疲劳量表评分13~14分，目标心率 = (最大心率-安静心率)×40%+安静心率
强化阶段(5~8周)	有氧运动	20	50% VO_2peak，Borg疲劳量表评分13~14分，目标心率 = (最大心率-安静心率)×50%+安静心率
强化阶段(5~8周)	抗阻运动	20	50% VO_2peak，Borg疲劳量表评分13~14分，目标心率 = (最大心率-安静心率)×50%+安静心率

组别	n	干预前	干预后	t值	P值
对照组	8	833.251±192.530	824.252±208.978	0.331	0.751
试验组	8	813.125±205.434	1074.253±180.330	-3.282	0.013
t值		0.202	-2.562
P值		0.843	0.023

组别	n	干预前	干预后	t值	P值
对照组	8	625.875±142.277	620.000±128.699	0.258	0.804
试验组	8	608.875±104.992	784.375±97.220	-4.132	0.004
t值		-0.272	2.834
P值		0.790	0.013