基于評估結(jié)果指導(dǎo)方針-運動訓(xùn)練在心臟康復(fù)中的應(yīng)用-力量訓(xùn)練-基礎(chǔ)理論知識

Prof.Dr.B.Bjarnason-WehrensInstituteforCardiologyandSportsMedicine心臟病學(xué)和運動醫(yī)學(xué)研究所GermanSportUniversityCologne德國科隆體育大學(xué)Resistanceexerciseincardiacrehabilitation

Implementationofexercisetrainingintocardiacrehabilitationprogramaccordingtotheguidelinebasedontheresultsoftheassessments

-resistancetraining-theoreticalbasicknowledge

基于評估結(jié)果指導(dǎo)方針，運動訓(xùn)練在心臟康復(fù)中的應(yīng)用-力量訓(xùn)練-基礎(chǔ)理論知識Componentsofexercisebasedtraininginterventions

運動訓(xùn)練干預(yù)成份AerobicendurancetrainingPerceptiontraining,

bodyawareness,

practicalskillsofself-controlResistancetrainingExercisetoimproveflexibility,agilitycoordination,balance,...Modifiedmovementgamesandteamgames...Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne有氧耐力訓(xùn)練感知訓(xùn)練、身體意識、自控實際技能改善靈活性、敏捷性、協(xié)調(diào)性、平衡性...的運動修改過的活動游戲和團(tuán)體游戲抗阻訓(xùn)練Exercisetherapieincardiacrehabilitationguidelines

心臟康復(fù)指南中的運動療法Pollocketal.Circulation101(2000),828-833

AHAScienceAdvisory.Resistanceexerciseinindividualswithandwithoutcardiovasculardisease:benefits,rationale,safety,andprescription:Fletcheretal.Circulation104(2001),1694-1740ExerciseStandardsforTestingandTraining.AStatementforHealthcareProfessionalsFromtheAmericanHeartAssociation.

Baladyetal.Circulation115(2007),2675-2682CoreComponentsofcardiacRehabilitation/SecondaryPreventionPrograms:2007Update.

Thompsonetal.Circulation107(2003),3109-16

Exerciseandphysicalactivityinthepreventionandtreatmentofatheroscleroticcardiovasculardisease:Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil.2004;11:352-61.Recommendationsforresistanceexerciseincardiacrehabilitation.RecommendationsoftheGermanFederationforCardiovascularPreventionandRehabilitation.

Braithetal.Circulation2006;113;2642-2650ResistanceExerciseTraining:ItsRoleinthePreventionofCardiovascularDiseaseWilliamsetal.Circulation.2007;116:572-84AmericanHeartAssociationCouncilonClinicalCardiology;AmericanHeartAssociationCouncilonNutrition,PhysicalActivity,andMetabolism.Resistanceexerciseinindividualswithandwithoutcardiovasculardisease:2007update:ascientificstatementfromtheAmericanHeartAssociationCouncilonClinicalCardiologyandCouncilonNutrition,PhysicalActivity,andMetabolism.

Bjarnason-WehrensB,etal.ClinicalResearchinCardiology2009;4:1-44

Leitliniek?rperlicheAktivit?tzurSekund?rpr?ventionundTherapiekardiovaskul?rerErkrankungen.Vanheesetal.EJPC,2012DOI10.1177/2047487312437063Importanceofcharacteristicsandmodalitiesofphysicalactivityandexerciseinthemanagementofcardiovascularhealthinindividualswithcardiovasculardisease(PartIII)…

Giannuzzietal.EJCPR10(2003),319-27

Physicalactivityforprimaryandsecondaryprevention.PositionpaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology.Giannuzzietal.EurHeartJ24(2003),1273-8

Secondarypreventionthroughcardiacrehabilitation:positionpaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology.

Corraetal.EJCPR12(2005),321-2

ExecutivesummaryofthePositionPaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology(ESC)corecomponentsofcardiac

rehabilitationinchronicheartfailure.Piepolietal.EJCPR(2010),Secondarypreventionthroughcardiacrehabilitation.2009Update;FromKnowledgetoImplementation.APositionpaperfromtheCardiacRehabilitationNucleusoftheEuropeanAssociationofCardiacRehabilitationandPreventionSmithetal.JAmCollCardiol.2011;58:2432-46.

AHA/ACCFsecondarypreventionandriskreductiontherapyforpatientswithcoronaryandotheratheroscleroticvasculardisease:2011update:aguidelinefromtheAmericanHeartAssociationandAmericanCollegeofCardiologyFoundationendorsedbytheWorldHeartFederationandthePreventiveCardiovascularNursesAssociation.Flegetal.Circulation.2013;128:2422–2446SecondaryPreventionofAtheroscleroticCardiovascularDiseaseinOlderAdults:AScientificStatementFromtheAmericanHeartAssociation.…

Increaseinmuscularstrengthandendurance

肌肉力量和耐力的增長

-byincreasingmusclemassand/orimprovingcoordination

andmetabolicsituation

通過增加肌肉質(zhì)量和/或改善協(xié)調(diào)性和代謝情況

Workagainstlossinskeletalmusclemassandstrength;

reduceandpreventdecreasesinbonemass

針對骨骼肌肉質(zhì)量和力量的損失；減少并預(yù)防骨質(zhì)下降-

agerelated;postmenopausal

年齡相關(guān)；絕經(jīng)后

-long-termbed-confinementorinactiveduetoillness因為疾病長期臥床或靜止

-catabolismofskeletalmuscles(e.g.CHF)

骨骼肌的分解代謝（比如充血性心力衰竭）

-long-lastingimmunosuppressivetherapy長期免疫抑制療法ResistanceTraininginCardiacRehabilitation心臟康復(fù)中的抗阻訓(xùn)練Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne

increaseexerciseaswellasfunctionalcapacity增加活動力同時增加功能能力

reduceactivitylimitation減少活動受限

improvefunctionalityincarryingouteverydayactivity改善每天執(zhí)行的日?；顒拥墓δ苄?/p>

preventingfalls摔倒預(yù)防

positivelyinfluenceself-confidenceandpsychosocialwell

being,socialre-adaptationandre-integration對自信心，心理健康，社會再適應(yīng)和再融入有積極影響

improvequalityoflife改善生活質(zhì)量ResistanceTraininginCardiacRehabilitation心臟康復(fù)中的抗阻訓(xùn)練

Increaseinmuscularstrengthandendurance增加肌力和耐力

Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneImpactofmusclestrengthintheelderly

肌力對老年人的影響Reducedmuscularstrengthinolderpersonshasbeendeterminedtobeamajorcauseofdisability老年人肌力的減少已被認(rèn)為是殘疾的主要原因之一。Reducedlowerlegstrengthhasbeenassociatedwithreductionin下肢力量減少已被與下列方面變差聯(lián)系起來：gaitspeed步態(tài)速度balance平衡stair-climbingability上臺階能力abilitytogetupfromaseatedposition從坐位站起的能力ValenzuelaTJAMDA13(2012)418-428MangioneKKetal.PHYSTHER.2010;90:1711-1715.Impactofimprovingmusclestrengthintheelderly…

改善老年人肌力的影響Enhancedmuscularstrength增強(qiáng)肌力可以reducesactivitylimitation減少活動限制improvesfunctionalcapacity改善功能性能力maximizesindependence使自理能力最大化slowstheprogressionofDementia減緩老年癡呆癥的進(jìn)展promotessleep改善睡眠enhancesqualityoflifeandwell-being提高生活質(zhì)量和健康狀況reducesriskoffalls降低摔倒風(fēng)險ValenzuelaTJAMDA13(2012)418-428balancetrainingintheelderly…老年人的平衡訓(xùn)練

Theexerciseprogramshouldincludeexercisesthatmaintainorimprovebalanceinordertoreducethe

riskofinjuryfromfalls.運動計劃應(yīng)包含保持或改善平衡性的運動練習(xí)，以減少因跌倒而受傷的風(fēng)險。

Balanceexercisesshouldbeperformeddailyoratleastonthreedaysaweek平衡性練習(xí)應(yīng)每天或至少一周訓(xùn)練3天Exampleofexercises:運動范例：-walkingbackwards,

向后走-toewalking,

用腳尖走路-standingfromasittingposition…從坐位站起NelsonME.etal.PhysicalActivityandPublicHealthinOlderAdultsRecommendationFromtheAmerican

CollegeofSportsMedicineandtheAmericanHeartAssociation.Circulation.2007;116:1094-1105Elsawyetal.PhysicalactivityguidelinesforOlderAdults;AmericanFamilyPhysician20108155-59

Positiveeffectsoncardiovascularriskfactors

對心血管疾病風(fēng)險因素的積極影響

enhancementofweightreductionandstabilization

幫助減重和增強(qiáng)穩(wěn)定性

improvementofinsulinsensitivity,independentfromchangesinbodyweightandendurancecapacity

改善胰島素敏感度，不受體重和耐力變化影響

reductionofbloodpressure

降低血壓ResistanceTraininginCardiacRehabilitation心臟康復(fù)中的抗阻訓(xùn)練Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneInSearchoftheIdealResistanceTrainingProgramtoImproveGlycemicControlanditsIndicationforPatientswithType2DiabetesMellitus:ASystematicReviewandMeta-Analysis.

尋找理想的抗阻訓(xùn)練計劃，以改善2型糖尿病患者的血糖控制及其適應(yīng)癥:一個系統(tǒng)回顧和薈萃分析。

Ishiguroetal.SportsMed.2016;46:67-77.ResistancetrainingisassociatedwithHbA1creduction

-0,34%(p<0,001).抗阻訓(xùn)練與糖化血紅蛋白減少0.34%有關(guān)。（p<0,001)Exercisetrainingforbloodpressure:asystematicreviewandmeta-analysis.

血壓運動訓(xùn)練：一個系統(tǒng)性回顧和薈萃分析

Cornelissen&SmartJAmHeartAssoc.2013;2:e004473.Metaanalysesincluding29RCSresistanceexercise薈萃分析包含29項回顧性群組研究，抗阻訓(xùn)練Meanbloodpressure平均血壓

resistanceexercise抗阻訓(xùn)練-1,8/-3,2mmHgnormalbloodpressure正常血壓

-0,59/-3,4mmHgprehypertension高血壓前期-4,0/-3,8mmHgHypertension高血壓+0,47/-1,0mmHgComparisonoftheEffectsofAerobicTrainingtoResistanceTrainingonHealthandFitnessVariables有氧訓(xùn)練和抗阻訓(xùn)練對健康變量影響的對比Variable變量 AerobicExercise ResistanceExerciseBonemineraldensity骨礦物質(zhì)密度

↑ ↑↑↑

Bodycomposition身體成分Fatmass脂肪質(zhì)量

↓↓ ↓ Musclemass肌肉質(zhì)量 ? ↑↑

Strength肌力

Glucosemetabolism葡萄糖代謝Insulinresponsetoglucosechallenge胰島素反應(yīng)↓↓ ↓↓Basalinsulinlevels基礎(chǔ)胰島素水平

↓ ↓Insulinsensitivity胰島素敏感度

↑↑ ↑↑Serumlipids血清脂質(zhì)High-densitylipoprotein高密度脂蛋白

↑? ↑?Low-densitylipoprotein低密度脂蛋白

↓? ↓?Restingheartrate靜息心率

↓↓ ↓Bloodpressureatrest靜息血壓Systolic收縮壓

↓↓ ↓Diastolic舒張壓

↓↓ ↓Physicalendurance身體耐力

↑↑↑ ↑↑Basalmetabolism基礎(chǔ)代謝 ↑ ↑↑

↑indicatesincreased;↓,decreased;and?negligibleeffect↑表明升高;↓,降低;而?表明可以忽略的影響(Randyetal.Circulation2006;113;2642-2650)Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneEffectofcombinedaerobicandresistancetrainingversusaerobictrainingaloneinindividualswithcoronaryarterydisease:ameta-analysis

對比有氧抗阻綜合訓(xùn)練與單獨有氧訓(xùn)練對冠狀動脈疾病患者的影響：一個薈萃分析

Marzolinietal.EJPC(2012);19;81-94Aim:Tocomparetheeffectofaerobictrainingaloneversuscombinedaerobicandresistancetrainingonbodycomposition,cardiovascularfitness(VO2peak),strength,andquality-of-life(QOL)incoronaryarterydisease(CAD).目標(biāo)：比較單獨有氧訓(xùn)練和有氧抗阻綜合訓(xùn)練對冠狀動脈疾病患者身體成份、心血管健康（耗氧量峰值）、力量和生活質(zhì)量的影響。Metaanalyses:12studiesN=504;CAD-Patient薈萃分析：12項研究N=504；冠狀動脈疾病患者

n:229aerobictrainingpatients

229名有氧訓(xùn)練患者n:275combinedaerobicandresistancetrainingpatients

275名有氧抗阻綜合訓(xùn)練患者

Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneExerciseCapacity運動能力

Differencecombinedvs.Aerobicexercieonly綜合訓(xùn)練與單獨有氧訓(xùn)練的對比

a)+0.41mL/min/kgV02peak(ns)+0.41毫升/分鐘/千克

耗氧量峰值(未明確)

b)+0.88watt/exercisetime(p<0.01)+0.88瓦特/運動時間(p<0.01)

Marzolinietal.PrevCardiol2012;19:81-91

bodycomposition(DEXA):

combinedvs.

aerobicexerciseonly:

身體成份（骨密度）：

綜合訓(xùn)練與單獨有氧訓(xùn)練的對比：

a)fat-freemass

去脂肪質(zhì)量

+0.88(p<0.001)

b)percentbodyfat

體脂含量

-2.30(p<0.001)

c)trunkfat

軀干脂肪

-0.56(p<0,001)

Marzolinietal.PrevCardiol

2012;19:81-91Marzolinietal.PrevCardiol

2012;19:81-91Combinedvs.aerobicexerciseonly綜合訓(xùn)練與單獨有氧訓(xùn)練的對比

a)upperbodystrength +0.77(p<0.001)

上身力量

b)lowerbodystrength +1.07(p<0,001)

下身力量

Aim:toinvestigatetheeffectsofRTonexercisecapacity,musclestrength,andmobilityinmiddle-agedandelderlypatientswithcoronaryarterydisease(CAD).目標(biāo)：研究抗阻訓(xùn)練對中老年冠狀動脈疾病患者運動能力、肌力和活動性的影響Metaanalysis:22RCSN=1095;CAD-Patienten;薈萃分析：22個回顧性群組研究N=1095；冠狀動脈疾病患者7RCS strengthvs.ControlGroup7RCS力量vs.對照組16RCS strengthvs.combinedaerobicandstrengthtraining16RCS力量vs.有氧力量綜合訓(xùn)練Effectsofresistancetrainingonmusclestrength,exercisecapacity,andmobilityinmiddle-agedandelderlypatientswithcoronaryarterydisease:Ameta-analysis.抗阻訓(xùn)練對中老年冠狀動脈疾病患者肌力、運動能力和活動性的影響：一個薈萃分析Yamamotoetal.JCardiol2016;68:125-34exercisecapacity運動能力

differencescomparedtocontrol與對照組相比的差異

middle-aged

中年

+0.90mL/min/kgV02peak

elderly 老年

+0.70mL/Min/kgV02peakYamamotoetal.JCardiol2016;68:125-134lowerextremitymusclestrength(kneeextension)下肢肌力

（伸膝）

-differencescomparedtocontrol與對照組相比的差異

middle-aged中年人 SMD+0.65

elderly老年人 SMD+0.63Yamamotoetal.JCardiol2016;68:125-134upperextremitymusclestrength

(chestpress–bicepscurls)

上肢肌力（胸推--二頭肌卷曲）

differencescomparedtocontrol與對照組相比的差異

middle-aged中年人 SMD+0.73

elderly 老年人 SMD+1.18

Yamamotoetal.JCardiol2016;68:125-134mobility(six-mintes-walking-distance)靈活性（6分鐘步行距離）

differencescomparedtocontrole

與對照組相比的差異

middle-aged中年人 SMD+0.13ns.

elderly 老年人 SMD+0.61(p=0,003)Yamamotoetal.JCardiol2016;68:125-134Metaanalysis:27RCS(29exercisegroups)薈萃分析：27個回顧性群組研究（RCS）（29個運動組）N=2321;chronicheartfailureN=2321；慢性心力衰竭6RCSstrengthvs.control6RCS力量訓(xùn)練vs.對照組18RCScombinedstrengthandaerobicexercisevs.control18RCS有氧力量綜合訓(xùn)練vs.對照組5RCScombinedstrengthandaerobicexercisevs.aerobicexerciseonly5RCS有氧力量綜合訓(xùn)練vs.單獨有氧訓(xùn)練Intensity:

60-80%1RM強(qiáng)度：60-80%1次最大肌力值Programduration:≤6weeks–26weeks項目持續(xù)時間：

≤6周–26周OutcomeParameter:結(jié)果參數(shù)：mortality,hospitalization,peakVO2,peakHR,LVEF%,6MWD,Qual,死亡率、住院、

耗氧量峰值、心率峰值、左心室射血分?jǐn)?shù)、6分鐘步行距離、質(zhì)量Theeffectofresistancetrainingonclinicaloutcomesinheartfailure:Asystematicreviewandmeta-analysis抗阻訓(xùn)練對心力衰竭臨床結(jié)果的影響：一個系統(tǒng)性回顧和薈萃分析

Jewissetal.IntJCardiol2016;221:674-681

exercisecapacity運動能力

+3.99mL/min/kgV02peak;p<0.001(strengthvs.control)（力量訓(xùn)練vs.對照組）

+1.43mL/Min/kgV02peak;p=0,002(combinedvs.control)（綜合訓(xùn)練vs.對照組）

+0.61mL/Min/kgV02peakns.(combinedvs.aerobiconly)（綜合訓(xùn)練vs.有氧訓(xùn)練）

Jewissetal.IntJCardiol2016;221:674-681

qualityofLife

(MLwHFQ)

生活質(zhì)量（心力衰竭問卷）

strengthvs.control-8.31(p<0,001)

力量訓(xùn)練vs.對照組

-8.31(p<0,001)

Jewissetal.IntJCardiol2016;221:674-681

6minutewalkingdistance

6分鐘步行距離

+41,77m;p<0.001(strengthvs.control)（力量訓(xùn)練vs.對照組）

+13,49m;p=0,002(combinedvs.control)（綜合訓(xùn)練vs.對照組）

Jewissetal.IntJCardiol2016;221:674-681Restingheartrate

靜息心率

+5.43;p<0.001(strengthvs.control)（力量訓(xùn)練vs.對照組）

-0.56;ns.(combinedvs.control)（綜合訓(xùn)練vs.對照組）Jewissetal.IntJCardiol2016;221:674-68Noadvantageinimproving在改善以下方面并無優(yōu)勢：Mortality死亡率Re-Hospitalisation再入院治療LVEF%左心室射血分?jǐn)?shù)比率Conclusions:結(jié)論：Resistanceonlyorcombinedtrainingimproves：單獨抗阻訓(xùn)練或綜合訓(xùn)練能改善：

-peakVO2,

耗氧量峰值-qualityoflifeand

心力衰竭患者的生活質(zhì)量和

-walkingperformanceinheartfailurepatients.行走能力Theeffectofresistancetrainingonclinicaloutcomesinheartfailure:Asystematicreviewandmeta-analysis抗阻訓(xùn)練對心力衰竭臨床結(jié)果的影響：一個系統(tǒng)性回顧和薈萃分析

Jewissetal.IntJCardiol2016;221:674-681ImplementationofexerciseTrainingincardiacrehabilitation

運動訓(xùn)練在心臟康復(fù)中的應(yīng)用Carefulclinicalevaluationincluding:riskstratification,

symptomlimitedexercisetestingIndividualobjectivesoftheexerciseprogramIndividualexerciseprescriptionandtrainingprotocolIndividuallydosedandadaptedexercisetrainingControlofefficacy

Modificationandadaptationoftheexerciseprescriptionandtrainingprotocolreferringtothepatientsobjectivemedicalandsubjectivehealthstatus細(xì)致的臨床評估，包括：風(fēng)險分級、非觸發(fā)癥狀強(qiáng)度運動測試運動項目的個人目標(biāo)個人運動處方和訓(xùn)練方案基于個人設(shè)定劑量的適應(yīng)性運動訓(xùn)練對療效的控制參考患者的客觀醫(yī)學(xué)情況和主觀健康情況調(diào)整其運動處方和訓(xùn)練方案Resistancetrainingincardiacrehabilitation

心臟康復(fù)中的抗阻訓(xùn)練Resistancetrainingisprescribedaccordingtodosageparameterssuchas:抗阻訓(xùn)練應(yīng)按照如下劑量參數(shù)制定：Intensity(resistance)強(qiáng)度（抗阻）Volume訓(xùn)練量Frequency頻率Duration時長

Rateofprogression訓(xùn)練逐級進(jìn)展情況Anumberofmethodsfordeterminingtheintensityforresistancetrainingexist要確定抗阻訓(xùn)練強(qiáng)度，有一系列方法。

Onemethodisbasedonapercentageoftheonerepetitionmaximum(1RM)其中一個是根據(jù)一次最大重復(fù)值比率Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine^,GermanSportUniversityCologneImplementationofresistancetrainingincardiacrehabilitation

抗阻訓(xùn)練在心臟康復(fù)中的實施應(yīng)用pre-training-Implementationofexercise;improvementofselfperceptionandcoordination;

learningtocorrectlyperformexerciseEvaluationofmusclestrength

-onerepetitionmaximummeasurementsImprovementstageI

ImprovementofaerobicenduranceandcoordinationImprovementstageIIincreaseofmusclemass;improvementofcoordinationImprovementstageIIIncreaseinmusclestrength訓(xùn)練前-運動實施；自我感知和協(xié)調(diào)能力的改善；學(xué)習(xí)正確的運動方式肌力評估-

一次最大重復(fù)值測量改善階段I有氧耐力和協(xié)調(diào)性的改善改善階段II肌肉質(zhì)量的增長；協(xié)調(diào)性改善

改善階段III肌肉力量的增長Resistancetrainingincardiacrehabilitationrecommendations

心臟康復(fù)中的抗阻訓(xùn)練推薦Intensity強(qiáng)度%onerepetitionmaximum(1RM)一次最大重復(fù)值比率30-60%1RM- (70-801RM)Numberofreps重復(fù)次數(shù)dependingonintensity(8-25reps)根據(jù)強(qiáng)度（8-25次重復(fù)）Numberofsets組數(shù)1-3Restingtimebetweensets/exercises

每組運動后的休息時間>oneminute

1分鐘progression(gradualincrease)進(jìn)展（逐漸增加）4-8exercises4-8次運動Frequency頻率2-3daysperweek每周2-3天–withrestingdayinbetween

中間有休息日Table2:Implementationofdynamicstrengthtraininginpatientswithcardiovasculardisease(modifiedaccordingtoBjarnason-WehrensBetal.118,WilliamsMAetal.119)Generalrecommendations:ifpossibletrainingshouldincludeallmusclegroups.Trainingshouldchangebetweenagonistandantagonistmusclegroups.Betweentrainingofeachmusclegroupthereshouldbeapauseofmorethan1minute.AimIntensityNumberofrepetitionspermusclegroupTrainingfrequencyInitialstage(pre-training)Implementationofexercise;improvementofselfperceptionandcoordination;learningtocorrectlyperformexercise<30%1-RMRPE≤115-102-3trainingunitsperweek,1-3setseachunitImprovementstageIImprovementofaerobicenduranceandcoordination30-50%1-RMRPE12-1310-152-3trainingunitsperweek;1–3setseachunitImprovementstageIIincreaseofmusclemass;improvementofcoordination40-60%1-RM(>60%inselectedpatients)RPE≤1510-152-3trainingunitsperweek;1–3setseachunitImprovementstageIIIIncreaseinmusclestrength60to80%of1-RM(inselectedpatientsingoodclinicalconditionandwithheavyphysicalemploymentorthosereturningtosport)8-102-3trainingunitsperweek;1–3setseachunit1-RM=onerepetitionmaximum;RPE=rateofperceivedexertionImportanceofcharacteristicsandmodalitiesofphysicalactivityandexerciseinthemanagementofcardiovascularhealthinindividualswithcardiovasculardisease(PartIII)Vanheesetal.EJPC2012Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne表2：動態(tài)力量訓(xùn)練在心血管疾病患者身上的應(yīng)用（根據(jù)Bjarnason-WehrensBetal.118,WilliamsMAetal.119修改）一般建議：如果可能的話，訓(xùn)練應(yīng)涉及所有的肌肉群。對主動肌群和拮抗肌群的訓(xùn)練應(yīng)該有變化。開始訓(xùn)練另一個肌肉群前，應(yīng)有1分鐘以上的停頓。目標(biāo)

強(qiáng)度每個肌肉群的重復(fù)速度訓(xùn)練頻率最初階段（訓(xùn)練前）運動實施；自我感知和協(xié)調(diào)能力的改善；學(xué)習(xí)正確的運動方式<30%1次最大重復(fù)值主觀體力感覺評定≤115-10每周2-3個訓(xùn)練單元，每單元1-3組訓(xùn)練改善階段I有氧耐力和協(xié)調(diào)性的改善30-50%1次最大重復(fù)值主觀體力感覺評定12-1310-15每周2-3個訓(xùn)練單元，每單元1-3組訓(xùn)練改善階段II肌肉質(zhì)量的增長；協(xié)調(diào)性改善40-60%1次最大重復(fù)值(入選患者>60%)主觀體力感覺評定≤1510-15每周2-3個訓(xùn)練單元，每單元1-3組訓(xùn)練改善階段III肌肉力量的增長60to80%1次最大重復(fù)值(臨床狀況好、體力活動程度高或者繼續(xù)運動的入選患者)8-10每周2-3個訓(xùn)練單元，每單元1-3組訓(xùn)練1-RM=1次最大重復(fù)值;RPE=主觀體力感覺評定在心血管疾病患者的心血管健康管理中，體育活動和運動特點及其方式的重要性(第三部分)Vanheesetal.《歐洲預(yù)防心臟病學(xué)雜志》,2012Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneFamiliarisationpriortoresistanceexercise

抗阻訓(xùn)練前的熟悉階段Afamiliarisationprocessasabeginoftheresistanceexerciseprogramisessentialtoavoidinjury,toassureaproperliftingtechnique,withoutcompensatorymovementsandwithoutbreathholding將熟悉過程作為抗阻訓(xùn)練的開端很重要，這樣是為了避免受傷，確保恰當(dāng)?shù)奶崂记?，沒有代償性運動和憋氣的情況。Teachandpracticecorrectliftingandbreathingtechniqueatverylowload在負(fù)荷很低的情況下，教導(dǎo)患者并使其練習(xí)正確的提拉和呼吸技巧-onesessioninyoungerandexperiencedindividuals

對于年輕的、有經(jīng)驗的患者，只要一次課就夠了multiplesessionsinolderinexperiencedpatients

對于年老、缺少經(jīng)驗的患者，要有幾次課Thisfamiliarisationprocessshouldbeperformedpriortostrengthtesting,soitcanbeusedfortestingandtraining這個熟悉過程需要在力量檢測前進(jìn)行，所以它可以被用來做測試和訓(xùn)練前的準(zhǔn)備工作。Levingeraetal.JournalofScienceandMedicineinSport(2009)12,310—316Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneInitialstage–pre-training–familiarisation最初階段-訓(xùn)練前-熟悉過程Toimplementtheexercises;learntocorrectlyperformexercise;improveofselfperceptionand

coordination運動實施；學(xué)習(xí)正確的運動方式；自我感知和協(xié)調(diào)能力的改善verylowintensity,<30%of1RM,RPE≤11;breathingcontrol很低的強(qiáng)度，低于30%的1次最大重復(fù)值負(fù)荷，主觀體力感覺評定≤11；呼吸控制fewrepetitions(5–10)

atlowspeedofmovement,在低速運動的情況下重復(fù)次數(shù)很少（5-10）2-3setswith≥1Minrestbetweenthesets2-3組，每組間休息1分鐘以上2-3trainingunitsperweek,每周2-3個訓(xùn)練單元Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil11

(2004),352-361Implementationofresistancetrainingincardiacrehabilitation心臟康復(fù)中抗阻訓(xùn)練的實施Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneEvaluationofmusclestrengthcardiacrehabilitationrecommended

onerepetitionmaximummeasurements

心臟康復(fù)肌肉力量評估推薦

一次最大重復(fù)值測量toprescribeindividualisedsafeandeffectiveresistancetrainingintensities制定安全有效的個人化抗阻訓(xùn)練強(qiáng)度totracktheprogressofanindividual跟蹤患者的進(jìn)展toevaluatetheefficacyofresistancetrainingregime評估抗阻訓(xùn)練計劃的有效性

Williamsetal.Circulation116(2007),572-854)Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne目標(biāo)耐力力量高強(qiáng)度中等強(qiáng)度低強(qiáng)度Evaluationofmusclestrengthcardiacrehabilitation

onerepetitionmaximum

心臟康復(fù)肌肉力量評估

一次最大重復(fù)值Theonerepetitionmaximumtesthasbeenshowntobereliableforvariouspopulations–alsoinuntrainedmiddle-agedaswellasoldindividuals一次最大重復(fù)值測試被認(rèn)為對多種人群都有可靠的適用性-包括未經(jīng)訓(xùn)練的中老年患者1RMagoldstandardindynamicresistanceexercisetesting一次最大重復(fù)值是動態(tài)抗阻訓(xùn)練中的黃金標(biāo)準(zhǔn)The1RMisdefinedasthemaximumamountofweight/resistancethatcanbeperformedforonlyasinglerepetitionforagivenexercise-withaproperliftingtechnique,withoutcompensatorymovementsandwithoutbreathholding一次最大重復(fù)值的定義，是某一特定運動單一重復(fù)執(zhí)行時所能使用的最大重量/阻力-有恰當(dāng)?shù)奶鸺记?，沒有代償性動作和屏息的情況。Krameretal.CurrSportsMedRep2002;1(3)165-171;Levingeretal.JSciMedSport2009;12(2)310-316;Schroederetal.JGerontolABiolSciMedSci2007;62(5),543-549;Taylor&FletscherJSciMedSport2012;15,69-73)Evaluationofmusclestrengthcardiacrehabilitation

onerepetitionmaximummeasures

心臟康復(fù)肌肉力量評估推薦

一次最大重復(fù)值測量

Thismethodiscomparativelysimpleandrequiresrelativelyinexpensivenon-laboratoryequipment這種方法相對簡單，需要的非實驗用設(shè)備相對便宜。

The1RMtestcanbeperformedusingthesamepatternsasthoseundertakenbytheexercisingindividualsduringtheirnormaltraining

一次最大重復(fù)值測量可以按照患者正常訓(xùn)練時的模式進(jìn)行Numerousstudieshavereportedthatthe1RMmethodtoassessmusclestrengthissafeforpatientswithcardiovasculardisease多項研究報告稱，評估肌肉力量的一次最大重復(fù)值測量方法對心血管疾病患者是安全的(Ghilarduccietal.AmJCardiol1989;64:866-70.;Featherstoneetal.AmJCardiol1993;71:287—92).Shaw,etal.JCardiopulmRehabil15:283-287,1995.Barnard,etal.JCardiopulmRehabil19:52-58,1999.Levingeraetal.JournalofScienceandMedicineinSport(2009)12,310—3161.Alightwarm-upof5-10repetitionsat40-60%ofassumed1RM一次輕負(fù)荷的熱身，5-10次重復(fù)，1次最大重復(fù)值的40-60%。

restperiod≥1-min休息時間1分鐘以上2.3-5repetitionsat60-80%ofassumed1RM3-5次重復(fù)，1次最大重復(fù)值的60-80%restperiodof≥2-3min休息時間2-3分鐘以上3.After3-5attemptstheweightwhichcanbeliftedinasinglerepetitionshallbeidentified

3-5次嘗試后，單詞重復(fù)可抬起的重量就可以被確定The1RMvalueisreportedastheweightofthelastsuccessfullycompletedlift1次最大重復(fù)值即最后一次成功抬起的重量

Communicationbetweensupervisorandtestpersonisofparticularimportance監(jiān)督人員和受試者之間的溝通尤為重要Onerepetitionmaximumtestingprescription-standardprotocol-一次最大重復(fù)值測量-標(biāo)準(zhǔn)方案-SkinnerExercisetestingandexerciseprescriptionforspecialcases.LippincotWilliams&Wilkins2005)Predictiveonerepetitionmaximum

預(yù)測性一次重復(fù)最大值

/Calculators/OneRepMax.html

Brzycki′sequationtodeterminemaxload:確定最大負(fù)荷的Brzycki公式 Weight÷(1.0278–(0.0278xnumberofrepetitions))

重量÷(1.0278–(0.0278x重復(fù)次數(shù)))Baechleequationtoderterminemaxload:確定最大負(fù)荷的Baechle公式 Weightx(1+(0.033xnumberofrepetitions))Brzycki,M(1993).Strengthtesting-Predictionaone-repmaxfromreps-to-fatique.JOPERD,68p.88-90BaechleTR,EarleRW,WathenD(2000).ResistanceTrainingIn:NaechleTR&EarleRWeds.EssentialsofStrengthTrainingandConditioning,2nded.Champaign,ILHumanKineticsp:395-425./Calculators/OneRepMax.htmlProf.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne/Calculators/OneRepMax.htmlPredictiveOneRep.Max.

預(yù)測性一次重復(fù)最大值

/Calculators/OneRepMax.html

Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne抬起的重量重復(fù)次數(shù)一次最大重復(fù)值計算重設(shè)輸入“抬起的重量”和“重復(fù)次數(shù)”。重復(fù)次數(shù)必須在1到10之間。按“計算”鍵，就能得出你一次重復(fù)可能抬起的重量。PredictiveOneRep.Max.

預(yù)測性一次重復(fù)最大值

/Calculators/OneRepMax.html

Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne抬起的重量一次最大重復(fù)值重復(fù)次數(shù)計算重設(shè)輸入“抬起的重量”和“重復(fù)次數(shù)”。重復(fù)次數(shù)必須在1到10之間。按“計算”鍵，就能得出你一次重復(fù)可能抬起的重量。ImprovementstageI–muscleendurancetraining改善階段I-肌肉耐力訓(xùn)練To

improvelocalaerobicenduranceandcoordination改善局部有氧耐力和協(xié)調(diào)性

dynamic,lowisometriccomponent!

動態(tài)的、較少等長對抗！lowtomoderateintensity(30–50%1RM)低到中等強(qiáng)度（30-50%1次最大重復(fù)值）numberofrepetitions(10-15)重復(fù)次數(shù)（10-15次）2-3setswith≥1Minrestbetweenthesets2-3組，每組間休息1分鐘以上

2–3daysperweekfor

每周2-3天

RPE(Borg-scale)12-13主觀體力感覺評定（Borg量表）12-13Implementationofresistancetrainingincardiacrehabilitation心臟康復(fù)中抗阻訓(xùn)練的實施應(yīng)用Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil11

(2004),352-361Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneImprovementstageII改善階段IITo

increasemusclemassandimprovecoordination增加肌肉質(zhì)量和協(xié)調(diào)性

dynamic,lowisometriccomponent!

動態(tài)的、較少等長對抗！moderateintensity(40–60%1RM)中等強(qiáng)度（40%-60%1次最大重復(fù)值）numberofrepetitions(10-15)重復(fù)次數(shù)（10-15次）2-3sets