题名

運動對冠狀動脈疾病患者的二級預防效果

并列篇名

Effect of Exercise on Secondary Prevention in Patients With Coronary Artery Disease

DOI

10.6162/SRR.202206_(161).0003

作者

陳粱友(Liang-You Chen);何承訓(Cheng-Shiun He)

关键词

等長握力訓練 ; 有氧訓練 ; 高強度間歇訓練 ; 脈波傳導速率 ; 漸進式動能訓練 ; isometric handgrip training ; aerobic training ; high intensity interval training ; pulse wave velocity ; progressive exercise of kinetic energy

期刊名称

大專體育

卷期/出版年月

161期(2022 / 06 / 30)

页次

25 - 38

内容语文

繁體中文

中文摘要

冠狀動脈疾病(coronary artery disease, CAD)影響了全球大約1.26億人。過去研究顯示等長握力訓練、有氧訓練和高強度間歇訓練,對血壓、血流介導擴張程度或脈波傳導速率對於肥胖的老年人、女性,以及坐式生活者等族群,分別有一些改善的效果,可能降低血管硬化和狹窄的程度,也建議CAD患者可以從事這些運動,有可能降低進行手術治療的機會。手術和藥物治療雖可以解決CAD立即性的問題,不過,仍有一些併發症的產生。本文目的為給予CAD患者在未手術、手術後隔天或是手術康復後等不同階段的運動選擇。回顧相關CAD患者運動介入文獻,再進行整理,提供臨床的運動介入建議。分析結果指出:CAD手術後的隔天,開始進行漸進式動能訓練(progressive exercise of kinetic energy, PEKE),例如:呼吸訓練、伸展運動、步行訓練、下樓梯訓練等,1年內可減少患者35%術後併發症機率,且能提高抗血栓能力,減少血管再次發生狹窄或阻塞的情況。接受過CAD手術的患者,完成PEKE,且心臟功能恢復後,可以開始從事每週2~3次的中等強度有氧運動,建議時間在30~45 min,有助於攝氧量峰值、心跳率峰值的提升,也可以提高生活品質,以及降低全因性死亡率。因此,運動介入將會是有效預防CAD的對策。

英文摘要

Coronary artery disease (CAD) affects 126 million people worldwide. Previous studies have shown that isometric handgrip training, aerobic training and high intensity interval training are effective in the attenuation of blood pressure flow, mediated dilation and pulse wave velocity in obese older adults, women and sedentary people, respectively. These exercises are also recommended for people with CAD, as they may reduce the likelihood of surgical intervention. Although surgery and medication are used to solve immediate problems of CAD, there are still inevitable postoperative complications which affect the patient's prognosis. The aim of this literature review is to survey clinical recommendations for exercise options for CAD patients at different stages of medical condition, including without surgery, the first day post-surgery, and post-recovery. Results show that when progressive exercise training (including breathing exercises, stretching, walking and stair climbing) is applied to patients with CAD the day after surgery, the patient's postoperative complications and total complication rate after 1 year are reduced by 35%. The progressive exercise of kinetic energy (PEKE) also increases the body's anti-thrombotic ability, accelerates vascular remodeling and reduces the chance of blood vessel restenosis or blockage. For patients who have undergone CAD surgery and are performing PEKE, it is recommended that they engage in moderate-intensity aerobic exercise for 30-45 minutes, 2-3 times per week, after their heart function has recovered. Moderate-intensity aerobic exercise has been shown to increase peak oxygen intake and peak heart rate, improve quality of life and reduce all-cause mortality for CAD patients. Therefore, exercise intervention would be an effective strategy for preventing CAD.

主题分类 社會科學 > 體育學
参考文献
  1. Ahn, N.,Kim, K.(2016).High-density lipoprotein cholesterol (HDL-C) in cardiovascular disease: Effect of exercise training.Integrative Medicine Research,5(3),212-215.
  2. Akyuz, A.(2020).Exercise and coronary heart.Advances in Experimental Medicine and Biology,1228,169-179.
  3. Al-Lamee, R. K.,Nowbar, A. N.,Francis, D. P.(2019).Percutaneous coronary intervention for stable coronary artery disease.Heart,105(1),11-19.
  4. American Heart Association. (2016). Understand your risks to prevent a heart attack. Retrieved from https://www.heart.org/en/health-topics/heart-attack/understand-your-risks-to-prevent-a-heart-attack
  5. Andjic, M.,Spiroski, D.,Vidakovic, T.,Lazovic, M.,Babic, D.,Ristic, A.,Otasevic, P.(2016).Effect of short-term exercise training in patients following acute myocardial infarction treated with primary percutaneous coronary intervention.European Journal of Physical and Rehabilitation Medicine,52(3),364-369.
  6. Areas, G. P. T.,Mazzuco, A.,Caruso, F. R.,Jaenisch, R. B.,Cabiddu, R.,Phillips, S. A.,Borghi-Silva, A.(2019).Flow-mediated dilation and heart failure: A review with implications to physical rehabilitation.Heart Failure Reviews,24(1),69-80.
  7. Arnett, D. K.,Blumenthal, R. S.,Albert, M. A.,Buroker, A. B.,Goldberger, Z. D.,Hahn, E. J.,Ziaeian, B.(2019).2019 ACC/AHA guideline on the primary prevention of cardiovascular disease: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.Circulation,140(11),e596-e646.
  8. Bertagnoli, K.,Hanson, P.,Ward, A.(1990).Attenuation of exercise-induced ST depression during combined isometric and dynamic exercise in coronary artery disease.The American Journal of Cardiology,65(5),314-317.
  9. Brinkley, T. E.,Leng, I.,Bailey, M. J.,Houston, D. K.,Hugenschmidt, C. E.,Nicklas, B. J.,Hundley, W. G.(2021).Effects of exercise and weight loss on proximal aortic stiffness in older adults with obesity.Circulation,144(9),684-693.
  10. Cavalcante, J. L.,Lima, J. A. C.,Redheuil, A.,Al-Mallah, M. H.(2011).Aortic stiffness: Current understanding and future directions.Journal of the American College of Cardiology,57(14),1511-1522.
  11. Chen, Z.,Li, C.,Lin, K.,Zhang, Q.,Chen, Y.,Rao, L.(2018).MicroRNAs in acute myocardial infarction: Evident value as novel biomarkers.The Anatolian Journal of Cardiology,19,140-147.
  12. da Silva, M. R.,Waclawovsky, G.,Perin, L.,Camboim, I.,Eibel, B.,Lehnen, A. M.(2020).Effects of high-intensity interval training on endothelial function, lipid profile, body composition and physical fitness in normal-weight and overweight-obese adolescents: A clinical trial.Physiology & Behavior,213,112728.
  13. Dart, A. M.,Kingwell, B. A.(2001).Pulse pressure-A review of mechanisms and clinical relevance.Journal of the American College of Cardiology,37(4),975-984.
  14. Deng, B.,Shou, X.,Ren, A.,Liu, X.,Wang, Q.,Wang, B.,Zhu, L.(2020).Effect of aerobic training on exercise capacity and quality of life in patients older than 75 years with acute coronary syndrome undergoing percutaneous coronary intervention.Physiotherapy Theory and Practice,38(9),1135-1144.
  15. Dolecińska, D.,Przywarska, I.,Podgórski, T.,Dylewicz, P.(2020).Two early rehabilitation training models in male patients after coronary artery bypass surgery: Application of continuous walking training as an alternative to interval cycle ergometer training.Polish Journal of Cardio-Thoracic Surgery,17(2),87-93.
  16. Dos Santos, T. D.,Pereira, S. N.,Portela, L. O. C.,Cardoso, D. M.,Dal Lago, P.,Dos Santos Guarda, N.,de Albuquerque, I. M.(2019).Moderate-to-high intensity inspiratory muscle training improves the effects of combined training on exercise capacity in patients after coronary artery bypass graft surgery: A randomized clinical trial.International Journal of Cardiology,279,40-46.
  17. Farah, B. Q.,Germano-Soares, A. H.,Rodrigues, S. L. C.,Santos, C. X.,Barbosa, S. S.,Vianna, L. C.,Ritti-Dias, R. M.(2017).Acute and chronic effects of isometric handgrip exercise on cardiovascular variables in hypertensive patients: A systematic review.Sports,5(3),55.
  18. Foote, R. S.,Pearlman, J. D.,Siegel, A. H.,Yeo, K.-T. J.(2004).Detection of exercise-induced ischemia by changes in B-type natriuretic peptides.Journal of the American College of Cardiology,44(10),1980-1987.
  19. Giannini, F.,Candilio, L.,Mitomo, S.,Ruparelia, N.,Chieffo, A.,Baldetti, L.,Colombo, A.(2018).A practical approach to the management of complications during percutaneous coronary intervention.JACC: Cardiovascular Interventions,11(18),1797-1810.
  20. Gould, K. L.,Lipscomb, K.(1974).Effects of coronary stenoses on coronary flow reserve and resistance.The American Journal of Cardiology,34(1),48-55.
  21. Hametner, B.,Wassertheurer, S.,Mayer, C. C.,Danninger, K.,Binder, R. K.,Weber, T.(2021).Aortic pulse wave velocity predicts cardiovascular events and mortality in patients undergoing coronary angiography: A comparison of invasive measurements and noninvasive estimates.Hypertension,77(2),571-581.
  22. Hohneck, A. L.,Fries, P.,Ströder, J.,Schneider, G.,Wagenpfeil, S.,Schirmer, S. H.,Custodis, F.(2019).Effects of heart rate reduction with ivabradine on vascular stiffness and endothelial function in chronic stable coronary artery disease.Journal of Hypertension,37(5),1023-1031.
  23. Hwang, I.-C.,Jin, K. N.,Kim, H.-L.,Kim, Y.-N.,Im, M.-S.,Lim, W.-H.,Kim, M.-A.(2018).Additional prognostic value of brachial-ankle pulse wave velocity to coronary computed tomography angiography in patients with suspected coronary artery disease.Atherosclerosis,268,127-137.
  24. Itier, R.,Roncalli, J.(2018).New therapies for acute myocardial infarction: Current state of research and future promise.Future Cardiology,14(4),329-342.
  25. Jia, S.,Liu, Y.,Yuan, J.(2020).Evidence in guidelines for treatment of coronary artery disease.Advances in Experimental Medicine and Biology,1177,37-73.
  26. Jiang, M.,Hua, M.,Zhang, X.,Qu, L.,Chen, L.(2021).Effect analysis of kinetic energy progressive exercise in patients with acute myocardial infarction after percutaneous coronary intervention: A randomized trial.Annals of Palliative Medicine,10(7),7823-7831.
  27. Joseph, P.,Swedberg, K.,Leong, D. P.,Yusuf, S.(2019).The evolution of β-blockers in coronary artery disease and heart failure (Part 1/5).Journal of the American College of Cardiology,74(5),672-682.
  28. Kaolawanich, Y.,Boonyasirinant, T.(2020).Incremental prognostic value of aortic stiffness in addition to myocardial ischemia by cardiac magnetic resonance imaging.BMC Cardiovasc Disorders,20(1),287.
  29. Kara, H.,Yasim, A.(2020).Effects of high-dose vitamin D supplementation on the occurrence of post-operative atrial fibrillation after coronary artery bypass grafting: Randomized controlled trial.General Thoracic and Cardiovascular Surgery,68(5),477-484.
  30. Katta, N.,Loethen, T.,Lavie, C. J.,Alpert, M. A.(2021).Obesity and coronary heart disease: Epidemiology, pathology, and coronary artery imaging.Current Problems in Cardiology,46(3),100655.
  31. Khan, M. A.,Hashim, M. J.,Mustafa, H.,Baniyas, M. Y.,Al Suwaidi, S. K. B. M.,AlKatheeri, R.,Lootah, S. N. A. H.(2020).Global epidemiology of ischemic heart disease: Results from the global burden of disease study.Cureus,12(7),e9349.
  32. Khera, A. V.,Kathiresan, S.(2017).Genetics of coronary artery disease: Discovery, biology and clinical translation.Nature Reviews Genetics,18(6),331-344.
  33. Khot, U. N.,Khot, M. B.,Bajzer, C. T.,Sapp, S. K.,Ohman, E. M.,Brener, S. J.,Topol, E. J.(2003).Prevalence of conventional risk factors in patients with coronary heart disease.The Journal of the American Medical Association,290(7),898-904.
  34. Kim, H.-L.,Seo, J.-B.,Chung, W.-Y.,Kim, S.-H.,Kim, M.-A.,Zo, J.-H.(2015).Association between invasively measured central aortic pressure and left ventricular diastolic function in patients undergoing coronary angiography.American Journal of Hypertension,28(3),393-400.
  35. Kim, H.-L.,Weber, T.(2021).Pulsatile hemodynamics and coronary artery disease.Korean Circulation Journal,51(11),881-898.
  36. Kim, S. T.,Ko, Y.,Beom, J.-W.,Boo, K. Y.,Lee, J.-G.,Choi, J.-H.,Joo, S.-J.(2021).Association of changes of pulse wave velocity and augmentation index after isometric handgrip exercise with coronary lesion extent and revascularization.Clinical Hypertension,27,5.
  37. Kodama, S.,Saito, K.,Tanaka, S.,Maki, M.,Yachi, Y.,Asumi, M.,Sone, H.(2009).Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis.The Journal of the American Medical Association,301(19),2024-2035.
  38. Kollet, D. P.,Marenco, A. B.,Bellé, N. L.,Barbosa, E.,Boll, L.,Eibel, B.,Lehnen, A. M.(2021).Aerobic exercise, but not isometric handgrip exercise, improves endothelial function and arterial stiffness in patients with myocardial infarction undergoing coronary intervention: A randomized pilot study.BMC Cardiovascular Disorders,21,101.
  39. Lavie, C. J.,Milani, R. V.(2011).Cardiac rehabilitation and exercise training in secondary coronary heart disease prevention.Progress in Cardiovascular Diseases,53(6),397-403.
  40. Lavie, C. J.,Milani, R. V.(1994).Effects of cardiac rehabilitation and exercise training on low-density lipoprotein cholesterol in patients with hypertriglyceridemia and coronary artery disease.The American Journal of Cardiology,74(12),1192-1195.
  41. Lewington, S.,Clarke, R.,Qizilbash, N.,Peto, R.,Collins, R.(2002).Age-specific relevance of usual blood pressure to vascular mortality: A meta-analysis of individual data for one million adults in 61 prospective studies.The Lancet,360(9349),1903-1913.
  42. Lucini, D.,Milani, R. V.,Costantino, G.,Lavie, C. J.,Porta, A.,Pagani, M.(2002).Effects of cardiac rehabilitation and exercise training on autonomic regulation in patients with coronary artery disease.American Heart Journal,143(6),977-983.
  43. Malakar, A. K.,Choudhury, D.,Halder, B.,Paul, P.,Uddin, A.,Chakraborty, S.(2019).A review on coronary artery disease, its risk factors, and therapeutics.Journal of Cellular Physiology,234(10),16812-16823.
  44. Maruhashi, T.,Soga, J.,Fujimura, N.,Idei, N.,Mikami, S.,Iwamoto, Y.,Higashi, Y.(2018).Endothelial dysfunction, increased arterial stiffness, and cardiovascular risk prediction in patients with coronary artery disease: FMD-J (Flow-Mediated Dilation Japan) Study A.Journal of the American Heart Association,7(14),e008588.
  45. Milani, R. V.,Lavie, C. J.,Spiva, H.(1995).Limitations of estimating metabolic equivalents in exercise assessment in patients with coronary artery disease.The American Journal of Cardiology,75(14),940-942.
  46. Montrief, T.,Koyfman, A.,Long, B.(2018).Coronary artery bypass graft surgery complications: A review for emergency clinicians.The American Journal of Emergency Medicine,36(12),2289-2297.
  47. Niessner, A.,Richter, B.,Penka, M.,Steiner, S.,Strasser, B.,Ziegler, S.,Niessner, C.(2006).Endurance training reduces circulating inflammatory markers in persons at risk of coronary events: Impact on plaque stabilization?.Atherosclerosis,186(1),160-165.
  48. O’Rourke, M. F.,Nichols, W. W.(2005).Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension.Hypertension,45(4),652-658.
  49. Ohkuma, T.,Ninomiya, T.,Tomiyama, H.,Kario, K.,Hoshide, S.,Kita, Y.,Yamashita, T.(2017).Brachial-ankle pulse wave velocity and the risk prediction of cardiovascular disease: An individual participant data meta-analysis.Hypertension,69(6),1045-1052.
  50. Palmefors, H.,DuttaRoy, S.,Rundqvist, B.,Börjesson, M.(2014).The effect of physical activity or exercise on key biomarkers in atherosclerosis-A systematic review.Atherosclerosis,235(1),150-161.
  51. Quindry, J. C.,Franklin, B. A.,Chapman, M.,Humphrey, R.,Mathis, S.(2019).Benefits and risks of high-intensity interval training in patients with coronary artery disease.The American Journal of Cardiology,123(8),1370-1377.
  52. Ramírez-Vélez, R.,Hernández-Quiñones, P. A.,Tordecilla-Sanders, A.,Álvarez, C.,Ramírez-Campillo, R.,Izquierdo, M.,Garcia, R. G.(2019).Effectiveness of HIIT compared to moderate continuous training in improving vascular parameters in inactive adults.Lipids in Health and Disease,18,42.
  53. Ramos, J. S.,Dalleck, L. C.,Tjonna, A. E.,Beetham, K. S.,Coombes, J. S.(2015).The impact of high-intensity interval training versus moderate-intensity continuous training on vascular function: A systematic review and meta-analysis.Sports Medicine,45(5),679-692.
  54. Rosenbaum, D.,Giral, P.,Chapman, J.,Rached, F. H.,Kahn, J. F.,Bruckert, E.,Girerd, X.(2013).Radial augmentation index is a surrogate marker of atherosclerotic burden in a primary prevention cohort.Atherosclerosis,231(2),436-441.
  55. Rybicki, J. R.,Leszczyńska-Bolewska, B. M.,Grochulska, W. E.,Malina, T. F.,Jaros, A. J.,Samek, K. D.,Kapko, W. S.(2015).Oxygen uptake during Nordic walking training in patients rehabilitated after coronary events.Kardiologia Polska (Polish Heart Journal),73(1),17-23.
  56. Safar, M. E.,Levy, B. I.,Struijker-Boudier, H.(2003).Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases.Circulation,107(22),2864-2869.
  57. Scardovi, A. B.,De Maria, R.,Colettat, C.,Aspromonte, N.,Perna, S.,Infusino, T.,Cec, V.(2006).Brain natriuretic peptide is a reliable indicator of ventilatory abnormalities during cardiopulmonary exercise test in heart failure patients.Medical Science Monitor: International Medical Journal of Experimental and Clinical Research,12(5),CR191-CR195.
  58. Schultz, M. G.,La Gerche, A.,Sharman, J. E.(2017).Blood pressure response to exercise and cardiovascular disease.Current Hypertension Reports,19(11),89.
  59. Shao, C.,Wang, J.,Tian, J.,Tang, Y.-D.(2020).Coronary artery disease: From mechanism to clinical practice.Coronary Artery Disease: Therapeutics and Drug Discovery,1177,1-36.
  60. Sierra-Johnson, J.,Romero-Corral, A.,Somers, V. K.,Lopez-Jimenez, F.,Thomas, R. J.,Squires, R. W.,Allison, T. G.(2008).Prognostic importance of weight loss in patients with coronary heart disease regardless of initial body mass index.European Journal of Cardiovascular Prevention & Rehabilitation,15(3),336-340.
  61. Smith, S. C.,Benjamin, E. J.,Bonow, R. O.,Braun, L. T.,Creager, M. A.,Franklin, B. A.,Taubert, K. A.(2011).AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: A guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association.Journal of the American College of Cardiology,58(23),2432-2446.
  62. Spiroski, D.,Andjić, M.,Stojanović, O. I.,Lazović, M.,Dikić, A. D.,Ostojić, M.,Lović, D.(2017).Very short/short‐term benefit of inpatient/outpatient cardiac rehabilitation programs after coronary artery bypass grafting surgery.Clinical Cardiology,40(5),281-286.
  63. Sud, K.,Haddadin, F.,Tsutsui, R. S.,Parashar, A.,Bandyopadhyay, D.,Ellis, S. G.,Kapadia, S.(2019).Readmissions in ST-elevation myocardial infarction and cardiogenic shock (from Nationwide readmission database).The American Journal of Cardiology,124(12),1841-1850.
  64. Suzuki, Y.,Ito, K.,Yamamoto, K.,Fukui, N.,Yanagi, H.,Kitagaki, K.,Goto, Y.(2018).Predictors of improvements in exercise capacity during cardiac rehabilitation in the recovery phase after coronary artery bypass graft surgery versus acute myocardial infarction.Heart and Vessels,33(4),358-366.
  65. Takehana, K.,Sugiura, T.,Nagahama, Y.,Hatada, K.,Okugawa, S.,Iwasaka, T.(2000).Cardiovascular response to combined static-Dynamic exercise of patients with myocardial infarction.Coronary Artery Disease,11(1),35-40.
  66. Weber, T.,O’Rourke, M. F.,Lassnig, E.,Porodko, M.,Ammer, M.,Rammer, M.,Eber, B.(2010).Pulse waveform characteristics predict cardiovascular events and mortality in patients undergoing coronary angiography.Journal of Hypertension,28(4),797-805.
  67. Xiao, M.,Li, Y.,Guan, X.(2021).Community-based physical rehabilitation after percutaneous coronary intervention for acute myocardial infarction.Texas Heart Institute Journal,48(2),e197103.
  68. Yamagata, T.,Sako, T.(2020).High cardiovascular reactivity and muscle strength attenuate hypotensive effects of isometric handgrip training in young women: A randomized controlled trial.Clinical and Experimental Hypertension,42(7),595-600.
  69. Yang, Y.,Sun, L.,Feng, W.,Sun, D.(2021).Observation of the effect of a 7-day gradual early functional exercise program in middle-aged and young patients with acute myocardial infarction after percutaneous coronary intervention.Annals of Palliative Medicine,10(1),258-265.
  70. Zhang, Y.,Cao, H.,Jiang, P.,Tang, H.(2018).Cardiac rehabilitation in acute myocardial infarction patients after percutaneous coronary intervention: A community-based study.Medicine,97(8),e9785.