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首页> 外文期刊>The Internet Journal of Academic Physician Assistants >Does Aerobic Exercise have a Role in the Treatment Plan of a Patient with Heart Failure
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Does Aerobic Exercise have a Role in the Treatment Plan of a Patient with Heart Failure

机译：有氧运动在心力衰竭患者的治疗计划中是否起作用

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Heart failure (HF) prevention is an urgent public health need with coronary artery disease, hypertension, dilated cardiomyopathy, and a growing elderly population increasing the prevalence of HF. Management of HF involves multiple medications, lifestyle modification, and control of risk factors. Aerobic exercise (AE) has become more accepted in HF treatment as information regarding its safety and benefits has emerged. AE enhances peak VO2, improves muscle oxygen utilization, increases exercise duration, reduces sympathetic and increases vagal tone at rest, improves endothelial function, reduces plasma levels of proinflammatory cytokines, improves symptoms of dyspnea and fatigue, and improves quality of life in persons with HF. As a universal exercise prescription for HF patients does not exist, an individualized approach is recommended allowing for adjustments in the exercise program as necessary. Though there is need for further study, AE is more accepted and utilized in the treatment of persons with HF and should be viewed as a complement to rather than replacement of the lifestyle modification, pharmacological therapy, and physician follow-up. Introduction The prevention of heart failure (HF) has emerged as an urgent public health need with national and global implications with an estimated 550,000 new cases diagnosed each year and over 5 million Americans with HF (1). HF is a lethal condition that has emerged as a leading cause of hospitalizations with 6.5 million hospital days each year, over $33 billion spent on its treatment in 2007, and an estimated annual mortality of 21% in men and 17% in women (1,2). One factor increasing the prevalence and incidence of HF is the growth in the elderly population (>65 years of age) which is expected to grow to 70.3 million in 2030 (1). The management of HF typically involves multiple medications, lifestyle modification, and control of risk factors that increase the prevalence or worsen the course of HF. In the past, patients with HF were advised to avoid physical exertion in the belief that resting would minimize symptoms and exertion would accelerate the progression of left ventricular dysfunction (2). As information has become available regarding the safety and benefits of aerobic exercise (AE) in persons with HF, AE has become more widely accepted as a valuable component in the treatment of persons with HF (2,3). AE has been shown to enhance peak VO2, improve muscle oxygen utilization, increase exercise duration, reduce sympathetic and increase vagal tone at rest, improve endothelial function, reduce plasma levels of proinflammatory cytokines, improve symptoms of dyspnea and fatigue, and improve quality of life (QOL) in persons with HF (2,3). This EBM paper will evaluate if aerobic exercise has a role in the treatment of a patient with heart failure. Background HF is a complex syndrome that may result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood with the cardinal symptoms being fatigue and shortness of breath. HF can also manifest as limited exercise capacity or fluid retention that may lead to pulmonary congestion, peripheral edema, and shortened life expectancy. HF was thought to arise as a result of depressed left ventricular ejection fraction (EF); however, studies have shown that up to half of patients with HF have a normal or preserved EF (4). Therefore, patients with HF may be categorized as having either systolic heart failure (a depressed ejection fraction) or diastolic heart failure (a preserved ejection fraction). Left ventricular dysfunction is a progressive process that begins with an injury or stress to the myocardium resulting in a change in the geometry and structure of the left ventricle causing the chamber to dilate and/or hypertrophy and become more spherical. Patients with left ventricular dysfunction may remain asymptomatic for months or years due to several compensatory mechanisms bei
机译：预防心力衰竭（HF）是冠心病，高血压，扩张型心肌病以及日益增加的HF患病率的老年人口的紧急公共卫生需求。 HF的管理涉及多种药物，改变生活方式和控制危险因素。随着有氧运动的安全性和益处方面的信息不断涌现，有氧运动（AE）在HF治疗中已被越来越多地接受。 AE可提高VO2峰值，改善肌肉氧气利用率，延长运动时间，减少交感神经并增加静止时的迷走神经张力，改善内皮功能，降低促炎细胞因子的血浆水平，改善呼吸困难和疲劳症状并改善HF患者的生活质量。由于不存在针对HF患者的通用运动处方，因此建议采用个性化方法，以便根据需要调整运动程序。尽管有必要进行进一步的研究，但AE在心力衰竭患者的治疗中得到了更多的接受和利用，应被视为补充，而不是替代生活方式的改变，药物治疗和医生的随访。引言预防心力衰竭（HF）已成为一项紧迫的公共卫生需求，涉及国家和全球范围，每年估计诊断出55万新病例，超过500万美国人患有HF（1）。 HF是致死性疾病，已成为住院的主要原因，每年有650万住院日，在2007年用于治疗的费用超过330亿美元，估计每年的男性死亡率为21％，女性为17％（1， 2）。增加HF的患病率和发病率的一个因素是老年人口（> 65岁）的增长，预计到2030年将增长到7030万（1）。 HF的管理通常涉及多种药物治疗，生活方式的改变以及对增加HF患病率或加重HF病程的危险因素的控制。过去，建议HF患者避免体力活动，因为他们认为休息会减少症状，而运动会加速左心功能不全的发展（2）。随着有氧运动对心衰患者的安全性和益处的可用信息的普及，AE已被更广泛地接受为治疗心衰患者的有价值的成分（2,3）。已证明AE可增强VO2峰值，改善肌肉氧气利用率，延长运动时间，减少交感神经并增加静止时的迷走神经张力，改善内皮功能，降低血浆中促炎细胞因子的水平，改善呼吸困难和疲劳症状并改善生活质量HF（2,3）患者的（QOL）。这份EBM论文将评估有氧运动在治疗心力衰竭患者中是否起作用。背景HF是一种复杂的综合症，可能由任何结构性或功能性心脏疾病引起，这种疾病会损害心室充盈或排出血液的能力，而主要症状是疲劳和呼吸急促。 HF还可表现为有限的运动能力或体液retention留，这可能导致肺部充血，外周水肿和预期寿命缩短。 HF被认为是由于左心室射血分数（EF）降低而引起的;但是，研究表明，多达一半的HF患者的EF正常或保持不变（4）。因此，HF患者可分为收缩性心力衰竭（射血分数降低）或舒张性心力衰竭（射血分数保留）。左心功能不全是一种进行性过程，其始于心肌的损伤或应力，导致左心室的几何形状和结构发生变化，从而导致腔室扩张和/或肥大并变得更加球形。左心功能不全的患者可能由于多种补偿机制而在数月或数年内无症状。

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