More effective exercise modalities in older CHF patients

老年慢性心力衰竭患者更有效的运动方式

基本信息

批准号：
7155403
负责人：
JOEL D POSNER
金额：
$ 74.25万
依托单位：
FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
依托单位国家：
美国
项目类别：
财政年份：
2004
资助国家：
美国
起止时间：
2004-09-30 至 2008-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7155403
关键词：
aerobic exercise cardiovascular disorder therapy cardiovascular stress test clinical research combination therapy congestive heart failure echocardiography functional ability human old age (65+)human subject human therapy evaluation infrared spectrometry muscle strength myocardium patient oriented research therapy compliance three dimensional imaging /topography

项目摘要

DESCRIPTION (provided by applicant): A major independent predictor of the ability of congestive heart failure [CHF] patients to maintain physical function is the amount of functional skeletal muscle they have been able to preserve (10). Older patients with CHF--who make up the vast majority of CHF patients--are least able to do this. The disease is marked by a loss of aerobic muscle fibers (3-5), while aging is marked by a loss of glycolyic muscle fibers (6-9). Indeed, because of the loss of both muscle types in older CHF patients, the disease may be physiologically different in them than in younger ones, needing different therapeutic approaches. Tests of strategies aimed at increasing muscle mass by resistance strength training in systolic failure patients have been rare, small, and --above all-- generally lacking older subjects. The studies done among younger CHF patients have shown that both aerobic and combination aerobic and strength training can increase work capacity, oxidative muscle activity, and glycolytic muscle strength (18-22) while combination training can improve cardiac measures including left ventricular ejection fraction (20). The primary purpose of the proposed study is to test the hypotheses that: A program of exercise combining endurance and resistance strength training will increase the physical capacity of patients 65 and older with New York Heart Association Class II and Class III chronic congestive failure [CHF] more effectively than a program of purely aerobic exercise. We will do this by recruiting 200 subjects age 65 and older with Class II and III CHF and LVEF 20%-40% and measuring their work capacity in watts on a cycle ergometer exercise stress test [Time 1]. We will randomize them by gender, race, and disease severity into two exercise groups: RA = resistance and aerobic training, and A = aerobic training. Both groups will exercise 3 times a week for 4 months. At the end of the 4 months training, we will repeat the cycle ergometer stress test [Time 2.]. By comparing changes in maximum watts achieved from Time 1 to Time 2 in each group, we can compare the effectiveness of each program of exercise at improving work capacity. Secondarily, we will perform and compare measures of myocardial remodeling, leg strength, and leg muscle oxidative capacity at Time 1 and Time 2. We believe the results of this study can have important theoretical as well as practical implications shedding new light on the mechanisms of the disability of CHF in older patients and aiding in their rehabilitation.

描述（由申请人提供）：充血性心力衰竭 [CHF] 患者维持身体功能的能力的一个主要独立预测因素是他们能够保留的功能性骨骼肌的数量 (10)。老年充血性心力衰竭患者占充血性心力衰竭患者的绝大多数，他们最没有能力做到这一点。该疾病的特点是有氧肌纤维的丧失 (3-5)，而衰老的特点是糖酵解肌纤维的丧失 (6-9)。事实上，由于老年慢性心力衰竭患者两种肌肉类型的丧失，他们的疾病在生理上可能与年轻患者不同，需要不同的治疗方法。针对收缩衰竭患者通过阻力力量训练来增加肌肉质量的策略测试很少、规模较小，而且最重要的是，通常缺乏老年受试者。在年轻 CHF 患者中进行的研究表明，有氧运动以及有氧运动和力量训练相结合，可以提高工作能力、氧化性肌肉活动和糖酵解肌力量 (18-22)，而组合训练可以改善心脏指标，包括左心室射血分数 (20) ）。拟议研究的主要目的是检验以下假设：结合耐力和阻力力量训练的运动计划将提高 65 岁及以上纽约心脏协会 II 级和 III 级慢性充血性衰竭 [CHF] 患者的身体能力比纯粹的有氧运动计划更有效。为此，我们将招募 200 名 65 岁及以上、CHF 为 II 级和 III 级且 LVEF 为 20%-40% 的受试者，并在自行车测力计运动压力测试中测量他们的工作能力（以瓦特为单位）[时间 1]。我们将根据性别、种族和疾病严重程度将他们随机分为两个运动组：RA = 阻力和有氧训练，A = 有氧训练。两组均每周锻炼 3 次，持续 4 个月。在 4 个月的训练结束时，我们将重复自行车测力计压力测试 [时间 2.]。通过比较每组从时间 1 到时间 2 所达到的最大瓦数的变化，我们可以比较每个锻炼计划在提高工作能力方面的有效性。其次，我们将在时间 1 和时间 2 进行并比较心肌重塑、腿部力量和腿部肌肉氧化能力的测量。我们相信这项研究的结果具有重要的理论和实践意义，为揭示心肌重塑的机制提供新的线索。老年患者因慢性心力衰竭造成的残疾并帮助他们康复。