主观用力感觉在预测心脏康复适宜运动度中的作用

主观用力感觉在预测心脏康复适宜运动度中的作用 主观用力感觉在预测心脏康复适宜运动度 中的作用 2006年第21卷第3期JournalD,TUSVo1.21No.32006匝圆 主观用力感觉在预测心脏康复适宜运动度中的作用 刘洵.原晓晶 摘要:目的:探讨主观用力感觉(RPE)在预测急性期后心梗患者(PMIP)对运动的生理和临床 反应中的作用,这将有利于适宜运动强度的制定.:46 名服用B阻断剂的男性PMIP(年龄6o.9?7.5岁),55名未服用p阻断剂的男性PMIP(年龄 63.6?7_3岁)在活动跑台上进行递增负荷实验,终止实验的标 准依美国运动医学会的指南(ACSM)或病人的主观要求.运动中每30s测量一次摄氧量(vo) 和通气量(VE),每3min记录一次心率(HR),血乳酸(BL) 和主观用力感觉(RPE),并连续监测12导心电图.结果:两组病人在VO,BL,VE和sT段降低 与RPE的关系方面无显着差异(J口>0.05).然而,在运动实 验过程中,两组病人在心率方面有显着差异(P<0.O1).无论是服用还是未服用p阻断剂的 PMIP,RPE达到13都是其运动中有氧代谢向无氧代谢过渡的 转折点.结论:基于以上结果,建议PMIP在运动心脏康复中感觉到”稍费力”时即不应再加大 运动强度. 关键词:急性期后心梗患者;心脏康复;主观用力感觉;运动强度 中图分类号:G804.5文献标识码:A文章编号:1005—0000(2006)03—0194—03 Theuseofratingsofperceivedexertiontoindicateappropriateexerciseintensitiesincardiacrehabilitation LIUXun,YUANXiao—jing (DepartmentofHumanMovementScience,TianjinInstituteofPhysicalEducation,Tianjin300381,China) Abstract:Purpose:Theobjectiveofthestudywastoexaminetheextentthatratingsofperceivedexertion(RPE)canbeusedtopredictphysiologicaland clinicalresponsestoexerciseinpostmyocardialinfarctionpatients(PMIP).Thismayenableappropriateexerciseintensitiestoberecommended.Methods: Forty-sixmalerecentPMIPwithbetablocktherapy(aged60.9~7.5years)and55malerecentPMIPwithoutbetablockadetherapy(aged63.6~7.3years) performedagradedexercisetestonamotorizedtreadmilluntilvolitionalcessationorreachinganyoftheAmericanCoflegeofSportsMedicine(ACSM) criteria.OxygenuptakefV02)andvolumeofexpiredgas(vo9weremeasuredevery30secondsduringtheexercise.Heartrate(HR),bloodlactate(BL)and ratingsofperceivedexertion(RPE)wererecordedeverythreeminutes,anda12leadelectrocardiogramwasmonitoredcontinuously.Results:Theresults showedthattherewasanon—significantdifferencebetweenthetwogroupsinVO2,BL,VEandSTsegmentdepressioninrelationtotheRPEscale.(.p> O.05).HoweverasignificantdifferenceinHRwasobservedbetweenthetwogroupsthroughouttheexer cisetest<0,o1),AnRPElevelof13callbere— gardedasthetransferpointfromaerobictoanaerobicmetabolismforthepatientsbothwithandwithoutbe tablockadetherapy.Conclusion:Basedonabove evidence,itisrecommendedthatduringcardiacrehabilitationPMIPshouldnotincreaseexerciseintensi tyfurtherwhenitfeelssomewhathard. Keywords:PMIP;Cardiacrehabilitation;Ratingsofperceivedexertion;Exerciseintensity Commonly,ratingsofperceivedexertion(RPE)areusedasa dependentvariablewiththeindividualgivingasubjectiveestima— tionofintensityofeffort.Thesubjectiveestimatesarethenusually comparedagainstsomemeasureofexerciseintensityonasubse— quentoccasion[1].Anotherstrategy,whichhasnotbeenusedasof- ten,istomanipulatetheRPEastheindependentvariabletoregu— lateexerciseintensity.Inthisway.theindividualproducesanef- fortperceivedtobeofamagnituderelatedtotheRPEscale.This approachisparticularbeneficialincardiacrehabilitationbecause 0fitssimplicityandlowcostinpractice.Thepurposeofthestudy wastoexaminetheextentthatratingsofperceivedexertion(RPE) canbeusedtopredictphysiologicalandclinicalresponsestoex— ercise.Thismayenableappropriateexerciseintensitiestoberec— ommended.Thestudyalsoprovidedtheopportunitytocompare postmyocardialinfarctionpatients(PMIP)withandwithoutbeta blockademedication 1Materialsandmethods Subiects:OBehundredandonemalerecentPMIPundertook agradedexercisetest(themodifiedBrucetreadmillprotoco1)ona motorizedtreadmil1fMarquette).Thedetailsofthisstudywerede— scribedtothesubjectsandtheirwritten.informedconsentwasob— tained.EthicalacceptancewasprovidedbytheWirralandWest CheshirecommunityHealthcareTrust. Testprotocol:ThemodifiedBrucetreadmillprotocolwasused forthegradedexercisetest.Thecriteriatoendtheexercisetest followedtheAmericanCollegeofSportsMedicine(ACSM)guide一 1ines[!IandincludedanyabnoY/na1electrocardiogramfECG),reach- ingtheage-predictedheartratemaximum(HRmax),anyabnormal bloodpressurereadings,aratingofperceivedexertion(RPE)of17 收稿日期:2006—02—10;修回日期:2006—03—15;录用日期:2006—04—0l 基金项目:天津市高等学校科技发展基金项目(项目编号:20042912) 作者简介:刘洵(1954一),男,北京市人,天津体育学院教授,英国利物浦大学医学院运动心脏 康复专业博士.E-mail:liuxun6212003@yahoo.con.an 作者单位:天津体育学院运动人体科学系,天津300381. 圜JournalofTUSVo1.21No.320062006~Z第21卷第3期医蓝盈譬霉蟊蚕圈 estimationofexerciseintensityandasanaccuratepredictorof functionalcapacityinhealthyadults/6,n.Therationalesupportingits useisitsstrongrelationshipwithheartrate,oxygenuptake,volume ofexpiredair,andotherphysiologicalvariableswithinawiderange ofpopulations~.Itwasexpectedthattherelationshipbetweenphys- iologicalandperceptualvariablesinthepatientswithbetablock- adetherapyshouldpresentadifferentpatternfromthatofnon blockadeusers.Thisisbecausebetablockadedrugscauseade- creaseinHR.bloodpressureandthemaximaloxygenuptakef. 80 薯6o l40 2O O 579lll3l5l7l9 RPE(units) Figure4VEversusRPEinblockadeandnon-blockade Fgure5showsthatforbothgroupstheSTsegmentlevelof-1 tonioccuratanRPElevelof15. 0.4 l0.2 i0 一 O.2 善一0.4 二 一 1 — 1.2 RPE(units) 17l? 15~一 _ 13lY +Blockade +Nonbolckade一l\ L Figure5STsegmentlevelversusRPEinblockade andnon_bIockade Inthepresentstudy,however,therewasanonsignificant differencebetweenblockadeandnon-blockadegroupsinboth RPEpeakvaluesandinVO2peakvalues.Thissuggeststhatthe oxygenattainableatsubmaximalworkrateswasnotaffectedby betablockadedrugs.Possibly,thesimilarvaluesofVO2inthetwo groupsCallbeattributedtothecompensatoryadjustmentsinthe circulatorysystemsuchasanincreaseintheexercisestroke volumeorallenhancementintheopeningofmusclebloodvessels tomaintainanadequatebloodflowandoxygendeliveryI1Inthis circumstance,thesimilarconcen~ationofBLandlevelofST segmentseemstobeunderstandable,becausebothofthemcould beinfluencedbyavailableoxygen. Duringthegradedexercisetest,VO2andHRinbothgroups increasedlinearlywiththeperceptionofexerciseintensity, althoughtheHRintheblockadegroupwasmuchlowerthanthat oftIlenon—blockadegroup.BloodlactateandVEontheother handincreasedexponentially.Theinflexionpoint,i.e.when bothBLandVEappearedfromgraphicalanalysistochangethe slopeoftheassociationwithexerciseintensity,correspondedin bothcasesto13ontIleRPEscale(Figure3andFigure4).With furtherintensiveexercise.tIleindicationofmyocardialischaemia wouldoccuronECGrecordings/I31andthisisevidentfromtheST segmentdepression(Figure5).ThusanintensityofRPE13can beregardedastheinitiationofthetransferpointfromaerobicto anaerobicmetabolism.BasedonthisevidenceitisrecommendedtIlat tomaintainaerobicexercise’PMIPwitIlandwithoutbetablockade therapyshouldnotincreasetheintensitybeyondalevelconsidered bvtIlemtobesomewhathard. nisrecognizedthatthisstatementisbasedonmeanvalues andtIlatindividualdifferencesinresponsewiIIoccur.Howeverfor thosehealthprofessionalsincardiacrehabilitationwhohave limitedaccesstotechnicalequipmenttomonitorphysiological responses,thisguidelinemaybeusefu1. 4Acknowledgements SpecialthankstoProfessorBrodieandmycolleaguesfortheir adviceandcooperationforpartofthisstudy.Ialnalsoindebtedto allthesubjectswhovolunteeredtoparticipateintheexperimentof theresearch. 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