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

• 批准号: 7114977
• 负责人: JOEL D POSNER
• 金额: $ 34.11万
• 依托单位: FEINSTEIN INSTITUTE FOR MEDICAL RESEARCH
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-30 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7114977
• 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

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]维持身体机能的能力的主要独立预测指标是他们能够保留的功能骨骼肌肉的量（10）。 CHF的老年患者（组成绝大多数CHF患者）是至少能够做到这一点的。该疾病的特征是有氧肌肉纤维的损失（3-5），而衰老的标志是糖酵解肌纤维的损失（6-9）。确实，由于老年CHF患者两种肌肉类型的损失，这种疾病在生理上可能与年轻患者不同，需要不同的治疗方法。旨在通过收缩失败患者的抵抗力量训练来增加肌肉质量的策略的测试很少见，很小，而且 - 所有人 - 通常都缺乏较旧的受试者。在年轻的CHF患者中进行的研究表明，有氧和组合有氧运动和力量训练都可以提高工作能力，氧化肌肉活性和糖酵解肌肉强度（18-22），而联合训练可以改善包括左心室屈服分数在内的心脏测量（20）。拟议研究的主要目的是检验以下假设：与纯粹有氧运动的计划相比，与纽约心脏协会II和III类长期交通交通衰竭[CHF]相比，耐力和耐药力强度训练的计划将增加65岁及以上的患者的身体能力[CHF]。我们将通过招募200名65岁及以上的受试者，其中II级和III CHF和LVEF 20％-40％，并在循环测量计运动压力测试中测量其工作能力[时间1]。我们将通过性别，种族和疾病的严重程度将它们随机分为两个运动组：RA =抵抗和有氧训练以及A =有氧训练。两组将每周运动3次，共4个月。在4个月训练结束时，我们将重复循环测得应力测试[时间2]。通过比较每组从时间1到时间2的最大瓦特的变化，我们可以比较每个锻炼程序在提高工作能力方面的有效性。其次，我们将执行并比较时间1和时间2时的心肌重塑，腿部强度和腿部肌肉氧化能力。我们相信，这项研究的结果可以具有重要的理论和实际意义，并具有新的启示，从而为老年患者的残疾机制提供了新的启示。