不同强度有氧踏车训练对不同病程缺血性卒中患者运动和心肺适能的影响

doi:10.3969/j.issn.1673-5765.2022.11.008

摘要/Abstract

摘要： 目的探讨不同强度有氧踏车训练对不同病程的缺血性卒中患者肢体运动功能、步行能力和心肺适能的影响。
方法本研究为前瞻性研究，于2019年9月-2020年9月分别连续入组病程＜1个月、1～3个月、4～6个月的缺血性卒中患者各60例，每个病程的患者随机分为试验组和对照组。2组均在常规康复干预的基础上进行有氧踏车训练，试验组为50%～80%最大心率的高强度训练，对照组为<50%最大心率的低强度训练。于训练前、训练2周后、4周后和8周后采用Fugl-Meyer评定量表下肢部分（Fugl-Meyer assessment lower extremity，FMA-LE）、6分钟步行试验（6 minute walking test，6MWT）和左心室射血分数（left ventricular ejection fraction，LVEF）进行评价。
结果最终纳入患者180例，男127例，女53例，平均年龄63.2±8.3岁。各病程内的2组患者训练前评分差异无统计学意义。卒中病程<1个月的试验组在训练4周时6MWT（279.7±67.5 m vs. 221.0±48.2 m，P＜0.001）、LVEF（63.8%±0.8% vs. 61.9%±0.8%，P=0.036）以及训练8周时的6MWT（355.6±74.8 m vs. 307.6±69.0 m，P=0.012）、LVEF（66.4%±0.8% vs. 62.3%±0.8%，P=0.001）均优于对照组；病程1～3个月的试验组在训练4周时的6MWT（297.7±46.5 m vs. 254.0±43.3 m，P＜0.001）、LVEF（63.3%±0.8% vs. 60.8%±0.8%，P=0.031）以及在训练8周时6MWT（412.3±64.4 m vs. 349.3±54.2 m，P＜0.001）、LVEF（65.8%±0.8% vs. 61.7%±0.8%，P＜0.001）也均优于对照组。卒中病程>3个月的2组在所有评定时间的各项评分差异均无统计学意义。
结论高强度有氧踏车训练较低强度训练能够有效改善病程≤3个月的缺血性卒中患者的步行能力和心肺适能，并且具有剂量累积效应。

文章导读： 在卒中后运动功能和心肺功能恢复的康复训练中，医师可以根据患者不同程度的功能障碍选择具有针对性、个体化的有氧训练。功率康复踏车有氧训练可以作为一种有效的、安全的辅助手段，供康复医师和治疗师选择。

关键词: 缺血性卒中; 有氧踏车训练; 运动功能; 步行能力; 心肺适能

Abstract: Objective To investigate the effects of aerobic cycling training intensity on limb motor function, walking ability and cardiopulmonary fitness in patients with ischemic stroke.
Methods This prospective study enrolled the consecutive ischemic stroke patients with disease course <1 month, 1-3 months and 4-6 months (60 cases in each course) from September 2019 to September 2020. The subjects in each course were randomly divided into experimental group and control group. Both groups underwent aerobic cycling training on the basis of routine rehabilitation, the experimental group received high-intensity training with 50%-80% maximum heart rate, and the control group received low-intensity training with <50% maximum heart rate. Fugl-Meyer assessment-lower extremity (FMA-LE), 6 minute walking test (6MWT), and left ventricular ejection fraction (LVEF) were used to evaluate before training, 2 weeks, 4 weeks, and 8 weeks after training.
Results A total of 180 patients were included in this analysis, with an average age of 63.16±8.33 years, 127 males and 53 females. There were no statistical differences in baseline scores between 2 groups in each course before intervention. For patients with stroke course <1 month, the 6MWT (279.7±67.5 m vs. 221.0±48.2 m, P<0.001), LVEF (63.8%±0.8% vs. 61.9%±0.8%, P=0.036) at 4 weeks of training and the 6MWT (355.6±74.8 m vs. 307.6±69.0 m, P=0.012), LVEF (66.4%±0.8% vs. 62.3%±0.8%, P=0.001) at 8 weeks of training in experimental group were better than that in control group; for patients with stroke course 1-3 months, the 6MWT (297.7±46.5 m vs. 254.0±43.3 m, P<0.001), LVEF (63.3%±0.8% vs. 60.8%±0.8%, P=0.031) at 4 weeks of training and the 6MWT (412.3±64.4 m vs. 349.3±54.2 m, P<0.001), LVEF (65.8%±0.8% vs. 61.7%±0.8%, P<0.001) at 8 weeks of training in experimental group were also better than that in control group. All scores in the two groups with stroke course >3 months all had no statistical differences.
Conclusions Compared to low-intensity aerobic cycling training, high-intensity aerobic cycling training can effectively improve walking ability and cardiopulmonary fitness in patients with ischemic stroke and stroke course ≤3 months, with a dose-cumulative effect.

Key words: Ischemic stroke; Aerobic cycling training; Motor function; Walking ability; Cardiopulmonary fitness

刘光亮, 韩凯月, 苏文龙, 张皓. 不同强度有氧踏车训练对不同病程缺血性卒中患者运动和心肺适能的影响 [J]. 中国卒中杂志, 2022, 17(11): 1203-1208.

LIU Guangliang, HAN Kaiyue, SU Wenlong, ZHANG Hao. Effects of Aerobic Cycling Training Intensity on Motor and Cardiopulmonary Fitness in Patients with Ischemic Stroke[J]. Chinese Journal of Stroke, 2022, 17(11): 1203-1208.

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