運動訓練對永久性心房震顫患者於內皮功能、運動能力、心率變異度與生活品質的效果

Abstract

研究背景和目標：心房震顫是一種常見的心律不整，易造成心衰竭、心血管疾病、和中風等共病症，整體死亡率比一般人高。心房震顫患者運動功能、內皮功能、生活品質顯著較一般人低。運動訓練可有效改善心房震顫患者的運動能力和生活品質，但是過去研究少有內皮功能和心率變異度方面的實證。故本研究目的是有氧合併阻力運動訓練對於心房震顫患者在內皮功能、運動能力、心率變異度以及生活品質的探討。 研究方法與受試者：33位永久性心房震顫患者（平均年齡62.90±8.39歲，身體質量指數為24.96±4.14 kg/m2，66.7%男性）隨機分配至運動組或是控制組。運動組進行12週有氧合併阻力運動訓練，運動強度是50-80％最大攝氧量，持續40分鐘，每週3次為期12週。受試者在12週前和後接受：（1）血流介導的血管擴張反應（flow mediated-dilatation）；（2）最大運動測試；（3）傾斜測試（head-up tilt test）時心率、血壓與心率變異度的改變量之量測，以及心房震顫的症狀評量表、臺灣版36題簡短生活品質量表與七日回憶活動量問卷的調查。 結果：相較於控制組，運動組顯著改善最大攝氧量（16.18±4.93 ml/kg/min進步至20.80±6.44 ml/kg/min）、通氣量（49.32±19.64 L/min進步至61.31±24.62 L/min）、潮氣量（1.59±0.62 L進步至1.82±0.62 L）、運動功率（95.00±36.91 watts進步至117.69±44.34 watts）。在內皮功能方面，運動組顯著改善肱動脈擴張最大直徑（4.87±0.52 mm進步至5.33±0.61 mm）以及血管反應性（8.40±5.19%進步至15.45±6.34%）。運動訓練後運動組在60°傾斜時有較高的rMSSD，且運動組顯著減少從平躺休息至傾斜時心率上升量（4.86±4.95 bpm進步至2.74±5.96 bpm）。在心房震顫相關之症狀方面，運動組顯著改善「呼吸短促」之頻率（1.17±1.06分進步至0.70±0.80分）和嚴重度（0.87±0.74分進步至0.53±0.55分）。本研究全體受試者的血管反應性改變量與最大攝氧量、攝氧量百分比改變量皆具有顯著的中度相關（分別為r=0.445和r=0.376），攝氧量百分比的改變量也與由平躺休息至傾斜的rMSSD下降量之改變量呈現中度正相關（r=0.421）。在運動組中，血管反應性改變量則與從平躺休息至傾斜時SDRR和rMSSD下降量之改變量分別具有顯著的中度相關性（分別為r=0.546和r=0.593）。 結論：永久性心房震顫患者在12週有氧合併阻力運動訓練後可顯著改善血管內皮功能、增加心率變異度、提高運動能力以及減少心房震顫相關症狀。

Background and Purpose: Atrial fibrillation (AF) is a common arrhythmia seen in clinics. Patients with AF usually have higher mortality and morbidity of heart failure, cardiovascular disease, and stroke than those without AF. They were noted to have poor exercise capacity, impaired endothelial function, and decreased quality of life compared with healthy subjects. Some reseraches found that exercise training could improve exercise capacity and quality of life, whereas few studies reported effect of exercise on endothelial function and heart rate variability in AF. The purpose of this study was to investigate the effect of exercise training on endothelial function, exercise capacity, heart rate variability and quality of life in patients with AF. Methods: Thrity-three patients with permanent AF (mean age: 62.90±8.39 years old; BMI: 24.96±4.14 kg/m2, 66.7% male) were recruited and randomizedly assigned to exercise or control group. Exercise group underwent 12-week aerobic combined with resistance training with 50-80% peak VO2 for 40 minutes, 3 sessions per week. All subjects underwent evaluation of flow-mediated dilatation, maximal cardiopulmonary exercise test, tilting test with measurements of heart rate, blood pressure, and heart rate variability during the test, and filled in symptom checklist, short form-36 health survey, and 7-day recall physical activity questionnaire. Results: Compared wth the control group, subjects in exercise group had siginifcant improvement in peak VO2 (from 16.18±4.93 ml/kg/min to 20.80±6.44 ml/kg/min), maximal ventilation (from 49.32±19.64 L/min to 61.31±24.62 L/min), tidal volume (from 1.59±0.62 L to 1.82±0.62 L) and maximal workrate (from 95.00±36.91 watts to 117.69±44.34 watts). Exercise training significantly increased post-occlusion brachial diameter (from 4.87±0.52 mm to 5.33±0.61 mm) and, %FMD (from 8.40±5.19% to 15.45±6.34%), rMSSD at 60°tilt-up, and decreased the change of HR while tilting up (from 4.86±4.95 bpm to 2.74±5.96 bpm). In AF related symptoms exercise training improved the frequency and severity of “short of breath” (frequency: from 1.17±1.06 points to 0.70±0.80 point; severity: from 0.87±0.74 point to 0.53±0.55 point).The change of peak VO2 and %predicted VO2 were associated with %FMD (r=0.445 and r=0.376, respectively) and the change of %predicted VO2 was related to the change of the decrement of rMSSD during tilting-up (r=0.421). In exercise group, the change of %FMD was correlated with the change of decrement of SDRR (r=0.546) and rMSSD (r=0.593). Conclusion: Tweleve-week aerobic combined with resistance training improved endothelial function, heart rate variability, exercise capacity, and the AF related symptom in patients with permanent AF.