Zhongguo cuzhong zazhi (Jan 2025)
卒中恢复期患者心肺适能评估及中高强度有氧训练的可行性、安全性及有效性研究 Feasibility, Safety, and Efficacy of Cardiopulmonary Fitness Assessment and Moderate to High Intensity Aerobic Training for Patients Recovering from Stroke
Abstract
目的 探讨卒中后恢复期患者进行心肺适能评估及中高强度有氧训练的可行性、安全性及有效性。 方法 连续纳入2022年12月—2023年9月在复旦大学附属华山医院静安分院康复医学科住院的卒中恢复期（1个月≤病程≤12个月）患者进行心肺运动试验，并将完成心肺运动试验的患者随机分为对照组与干预组。两组患者均接受常规康复治疗（3 h/d、5日/周、持续4周）。同时干预组根据心肺适能结果增加按照运动处方制订的中高强度有氧训练（每周5次，40分钟/次），对照组增加同样时长的康复指导（康复宣教、柔韧性训练等）。比较两组患者在试验前及试验4周后日常生活能力指标[改良Barthel指数（modified Barthel index，mBI）]，运动功能指标[Fugl-Meyer运动功能评定量表（Fugl-Meyer assessment scale，FMA）]，以及平衡功能指标[Berg平衡量表（Berg balance scale，BBS）]，并通过心肺运动试验分别评估两组患者的峰值摄氧量（peak oxygen uptake，VO2peak）、峰值功率等，同时比较两组患者的不良反应发生率、依从性。 结果 本试验纳入68例卒中恢复期患者，其中13例（19.12%）没有完成心肺运动试验，5例（7.35%）患者在评估过程中出现下肢痛、心肌缺血、血压过高、心律失常等不良反应，6例（8.82%）患者拒绝后续试验。最终44例（64.71%）完成心肺运动试验的患者随机分为干预组和对照组，每组各22例，其中干预组3例（13.64%）患者、对照组2例（9.09%）患者在治疗过程中出现下肢痛、心慌、头晕等不良反应退出训练。两组患者均未发生与本研究相关的再发心脑血管事件、猝死等严重不良事件。所有患者的出勤率为86.25%（759/880），其中干预组为88.41%（389/440），对照组为84.09%（370次/440次）。康复治疗前，两组患者的FMA（上肢/下肢）、BBS、mBI、VO2peak、峰值功率差异无统计学意义。康复治疗后，干预组的ΔFMA下肢[3.86（2.00～5.25）分 vs. 2.27（1.00～3.25）分，P=0.016]、ΔmBI[15.23（5.00～25.00）分 vs. 9.36（5.00～11.25）分，P=0.025]、ΔVO2peak[（3.78±3.49）mL/（kg·min）vs.（1.15±2.10）mL/（kg·min），P=0.004]、Δ峰值功率[（15.68±10.50）W vs.（7.05±10.20）W，P=0.008]较对照组改善明显。且两组患者的FMA上肢（P＜0.001）、FMA下肢（P＜0.001）、BBS（P＜0.001）、mBI（P＜0.001）、VO2peak（P＜0.001）、峰值功率（P=0.006）等指标均较本组治疗前明显改善。 结论 对卒中恢复期患者进行心肺运动试验评估及有氧训练安全可行，且相比常规康复治疗，进行中高强度有氧训练在患者运动功能、心肺功能等方面，可以得到更大获益。 Abstract: Objective To investigate the feasibility, safety, and efficacy of cardiopulmonary fitness assessment and moderate to high intensity aerobic training for patients recovering from stroke. Methods Patients in the recovery phase of stroke (1 month≤duration≤12 months) who were admitted to the Department of Rehabilitation Medicine, Jing’an Branch of Huashan Hospital, Fudan University from December 2022 to September 2023, were consecutively included for cardiopulmonary exercise testing. Patients who completed the cardiopulmonary exercise testing were randomly divided into the control group and the intervention group. Both groups received conventional rehabilitation therapy (3 hours/day, 5 days/week for 4 weeks). At the same time, the intervention group was added with the moderate to high intensity aerobic training (40 minutes/time, 5 times/week) according to the cardiopulmonary fitness results in accordance with the exercise prescription, and the control group was added with the rehabilitation guidance (rehabilitation education, flexibility training, etc.) for the same duration. The daily living ability indicators [modified Barthel index (mBI)], motor function indicators [Fugl-Meyer assessment scale (FMA)], and balance function indicators[Berg balance scale (BBS)] between the two groups of patients before the experiment and four weeks after the experiment were compared. The peak oxygen uptake (VO2peak) and peak work rate of the two groups were evaluated separately through cardiopulmonary exercise testing. At the same time, the incidence of adverse reactions and compliance of the two groups were compared. Results In this study, 68 patients recovering from stroke were included. Among them, 13 cases (19.12%) did not complete the cardiopulmonary exercise testing, 5 cases (7.35%) experienced adverse reactions such as lower extremity pain, myocardial ischemia, hypertension, and arrhythmia during the evaluation, and 6 cases (8.82%) refused the follow-up trial. Finally, 44 cases (64.7%) who completed the cardiopulmonary exercise testing were randomly divided into the intervention group and the control group, with 22 cases in each group. Among them, 3 cases (13.64%) in the intervention group and 2 cases (9.09%) in the control group withdrew from the training due to adverse reactions such as lower extremity pain, palpitation, and dizziness during the treatment. No recurrence of cardiovascular and cerebrovascular events, sudden death and other serious adverse events related to this study occurred in both groups. The attendance rate for all patients was 86.25% (759/880), with the intervention group at 88.41% (389/440) and the control group at 84.09% (370/440). Before the rehabilitation treatment, there were no statistical differences between the two groups in FMA (upper limb/lower limb), BBS, mBI, VO2peak, and peak work rate. After the rehabilitation treatment, the intervention group showed a significant improvement in ΔFMAlower limb[3.86 (2.00-5.25) points vs. 2.27 (1.00-3.25) points, P=0.016], ΔmBI[15.23 (5.00-25.00) points vs. 9.36 (5.00-11.25) points, P=0.025], ΔVO2peak[(3.78±3.49)mL/(kg·min) vs. (1.15±2.10) mL/(kg·min), P=0.004], and Δpeak work rate [(15.68±10.50) W vs. (7.05±10.20) W, P=0.008] compared to the control group. In addition, indicators for both groups like FMAupper limb (P<0.001), FMAlower limb (P<0.001), BBS (P<0.001), mBI (P<0.001), VO2peak (P<0.001), and peak work rate (P=0.006) were significantly improved compared with those before treatment. Conclusions Conducting cardiopulmonary exercise testing and aerobic training for patients recovering from stroke is safe and feasible. Compared to conventional rehabilitation treatment, engaging in moderate to high intensity aerobic training can achieve greater benefits in terms of motor function and cardiopulmonary function of patients.
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