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1、9/13/2020,1,適者生存：心臟運(yùn)動(dòng)測試的新風(fēng)貌Survival of the fittest: A new look at cardiac exercise test,2007物理治療繼續(xù)再教育課程 中華民國物理治療學(xué)會(huì)主辦 慈濟(jì)技術(shù)學(xué)院物理治療系與研發(fā)中心承辦,講員：黃千惠,9/13/2020,2,主題大綱,傳統(tǒng)心臟運(yùn)動(dòng)測試（cardiac ex test，CET）介紹：歷史沿革與方法；強(qiáng)調(diào)運(yùn)動(dòng)中的變化 新近心臟運(yùn)動(dòng)測試發(fā)展：預(yù)測死亡率；強(qiáng)調(diào)運(yùn)動(dòng)開始運(yùn)動(dòng)恢復(fù)的變化，主要是心跳 文獻(xiàn)回顧：運(yùn)動(dòng)後心跳恢復(fù)率的預(yù)後意義 臺灣資料：血管正常者之心跳恢復(fù)率,9/13/2020,3,Cardia

2、c exercise test: CET,,,,,,Cardiac pulmonary exercise test: CPET,9/13/2020,4,傳統(tǒng)心臟運(yùn)動(dòng)測試,起源：the discovery that exercise in pt with coronary disease produced ST segment depression Feil 體適能高於,等於平均者有較高的心跳恢復(fù)率 與已知趨勢符合, 體適能高心跳反應(yīng)及時(shí) 雖本研究未探討死亡率, 但過去研究結(jié)果顯示,體適能高死亡率低, 心跳恢復(fù)率高死亡率低, 兩者方向一致,9/13/2020,45,血管正常者之心跳恢復(fù)率：討論,

3、而肥胖的程度對心跳恢復(fù)率的影響在本研究中並無發(fā)現(xiàn) 肥胖對自主神經(jīng)的影響不一,有的認(rèn)為腹部脂肪影響較大 本研究所使用的肥胖指數(shù)為BMI, 無法從BMI得知肌肉骨骼脂肪之相對比例 另一思考方向, 所有危險(xiǎn)因子的加總結(jié)果為血管正常, 亦即肥胖之效果為其他因子所抵銷 統(tǒng)計(jì)上因素, 肥胖組有較少的人,9/13/2020,46,血管正常者之心跳恢復(fù)率：結(jié)果,在導(dǎo)管證實(shí)冠狀動(dòng)脈正常者之受試者身上, 接受最大運(yùn)動(dòng)測試, 達(dá)90% 年齡預(yù)測心跳保留量者發(fā)現(xiàn), 體適能較佳者有較高之運(yùn)動(dòng)後心跳恢復(fù)率 但在以BMI分類的肥胖指數(shù)上, 不同的肥胖指數(shù)對運(yùn)動(dòng)後心跳恢復(fù)率並未造成影響 為臺灣首度以冠動(dòng)正常者為對象所完成的運(yùn)

4、動(dòng)後心跳恢復(fù)率研究, 更多這方面的研究可以幫助我們更進(jìn)一步了解機(jī)轉(zhuǎn),9/13/2020,47,要運(yùn)動(dòng)多少才夠？,The amount, intensity, and duration of physical activity required to reduce the risk of coronary heart disease is debated. Harvard Alumni Study: no further reduction in events associated with CAD in men with an energy expenditure of more than 2

5、000 Kcal per week. Either a threshold effect or a progressive decline with progressive activity, possibly because of differences in the range of activity in the populations.,9/13/2020,48,要運(yùn)動(dòng)多少才夠？,大多數(shù)文獻(xiàn)將運(yùn)動(dòng)強(qiáng)度大於6MET定義為強(qiáng)烈，中度強(qiáng)烈則是產(chǎn)生輕微的喘及達(dá)到50的最大運(yùn)動(dòng)強(qiáng)度。 一天一個(gè)小時(shí)中度以上運(yùn)動(dòng)即接近最佳狀況，而漸進(jìn)增加運(yùn)動(dòng)量則導(dǎo)致漸進(jìn)降低心臟危險(xiǎn)性。 ACSM的運(yùn)動(dòng)建議是謹(jǐn)慎的，

6、當(dāng)作一個(gè)最低的建議量。More vigorous exercise is probably more beneficial, but also carries a cardiovascular risk, especially for those who are usually inactive.,9/13/2020,49,Survival of the fittest適者生存,Cardiorespiratory fitness enables a person to perform physical activity and is influenced by several other fa

7、ctors, including age, sex, heredity, and medical status. A nearly linear reduction in mortality was observed as fitness levels increased, and each increase of 1MET in exercise capacity conferred a 12% improvement in survival.,9/13/2020,50,結(jié)論,The lowest threshold for a dose and an intensity that woul

8、d confer specific survival and cardiovascular benefits is not known. To compel the clinician to go beyond the identification of risk to the initiation of interventions, such as the prescription of increased physical activity and exercise to modify risk, particularly in patients with low levels of fitness.,9/13/2020,51,結(jié)論,建議盡量每日運(yùn)動(dòng)，因?yàn)檫\(yùn)動(dòng)對於部分危險(xiǎn)因子的效果；如三高的血糖、血壓，血脂的三酸甘油脂、與HDL皆具有程度上的運(yùn)動(dòng)急性效果。,9/13/2020,52,