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Áhrif hjartaendurhæfingar á hjartabilaða

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Authors
Karl Andersen
Sólrún Jónsdóttir
Axel F. Sigurðsson
Stefán B. Sigurðsson
Issue Date
2006-11-01

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The effect of physical training in chronic heart failure
Citation
Læknablaðið 2006, 92(11):759-64
Abstract
OBJECTIVE: Supervised cardiac rehabilitation programs have been offered to patients following myocardial infarct (MI), coronary artery bypass graft surgery (CABG) and percutaneous coronary intervention (PCI) for many years. However, limited information is available on the usefulness of rehabilitation programs in chronic heart failure (CHF). The aim of our study was to evaluate the outcome of supervised physical training on CHF patients by measuring both central and peripheral factors. MATERIAL AND METHODS: This was a prospective randomized study, including 43 patients with CHF, New York Heart Association (NYHA) class II or III, mean age 68 years. After initial measurements of V02peak, 6 minute walk distance, muscle strength, plasma levels of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), echocardiogram, measurements of pulmonary function and quality of life questionnaire, patients were randomized to either a training group (n=21) or a control group (n=22). The training group had supervised aerobic and resistance training program twice a week for five months. After the training program was completed, all measurements were repeated in both groups. RESULTS: No training related adverse events were reported. Significant improvement was found between groups in the six minute walk test (+37.1 m vs. +5.3 m, p=0.01), work load on the bicycle exercise test (+6.1W vs. +2.1 W, p=0.03), time on the bicycle exercise test (+41 s vs +0 s, p=0.02) and quadriceps muscle strength test (+2.8 kg vs +0.2 kg, 0.003). Quality of life factors that reflect exercise tolerance and general health, improved significantly in the training group compared to the control group. No other significant changes were found between the two groups. CONCLUSION: Supervised physical training as used in this study appears safe for CHF patients in NYHA class II or III. The improvement in functional capacity observed in the training group seems to be related more to increased muscle performance rather than central cardiovascular conditioning.
Tilgangur: Hjartaendurhæfing hefur um langt skeið verið boðin sjúklingum eftir kransæðastíflu, kransæðahjáveituaðgerð og kransæðavíkkun. Hins vegar er minna vitað um gagnsemi endurhæfingar hjá hjartabiluðum sjúklingum enda var þeim um tíma ráðið frá líkamlegri áreynslu. Tilgangur þessarar rannsóknar var að meta áhrif hjartaendurhæfingar hjá sjúklingum með hjartabilun. Efniviður og aðferðir: Fjörutíu og þrír sjúklingar með hjartabilun af flokki II eða III samkvæmt New York Heart Association (NYHA) voru rannsakaðir. Upphafsmælingar voru þrekpróf með hámarkssúrefnisupptöku, sex mínútna göngupróf, vöðvastyrksmælingar, blóðmælingar á atrial natriuretic peptide (ANP) og brain natriuretic peptide (BNP), útfallsbrot mælt með hjartaómskoðun, öndunarpróf (spirometria) og spurninga-listi um heilsutengd lífsgæði. Hópnum var síðan slembiraðað í tvo hópa, þjálfunarhóp (n=21) og viðmiðunarhóp (n=22). Þjálfunarhópurinn fékk hjartaendurhæfingu undir umsjá sjúkraþjálfara tvisvar í viku í 5 mánuði. Eftir að þjálfunartímabilinu lauk voru allar mælingar endurteknar í báðum hópunum. Niðurstöður: Engir fylgikvillar tengdir þjálfuninni komu fram. Þjálfunarhópurinn bætti sig meira í 6 mínútna gönguprófi (+37,1 m vs +5,3 m, p=0,01), hámarksálagi á þrekhjóli (+6,1 W vs +2,1 W, p=0,03), tímalengd á þrekhjóli (+41 s vs +0 s, p=0,02) og vöðvastyrk í quadriceps vöðva (+2,8 kg vs 0,2 kg, p=0,003) en viðmiðunarhópurinn. Þeir þættir heilsutengdra lífsgæða sem mældu áreynsluþol og almennt heilsufar bötnuðu marktækt meira í þjálfunarhópnum en viðmiðunarhópnum. Að öðru leyti var ekki munur á milli hópanna í mældum gildum. Ályktun: Hjartaendurhæfingin sem notuð var í þessari rannsókn virðist þolast vel hjá hjartabiluðum sjúklingum í NYHA flokki II og III. Ávinningurinn í áreynsluþoli sem mældist í þjálfunarhópnum virðist skýrast af auknum vöðvastyrk fremur en bættri starfsgetu hjarta og lungna.
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