Efficacy and Preliminary Mechanism of Precise Exercise Prescriptions for Anxiety, Depression, and Cognitive Function in Patients with Stroke: a Randomized Controlled Trial

doi:10.12114/j.issn.1007-9572.2023.0738

Chinese General Practice ›› 2024, Vol. 27 ›› Issue (20): 2445-2450.DOI: 10.12114/j.issn.1007-9572.2023.0738

Special Issue: 心理健康最新文章合辑；运动相关研究最新文章合辑；神经系统疾病最新文章合辑；脑健康最新研究合辑

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Efficacy and Preliminary Mechanism of Precise Exercise Prescriptions for Anxiety, Depression, and Cognitive Function in Patients with Stroke: a Randomized Controlled Trial

1. Rehabilitation Department, Changzhou Dean Hospital, Changzhou 213000, China
2. Rehabilitation Department, Xuzhou Central Hospital, Xuzhou 221000, China
3. Rehabilitation Department, Affiliated Xuzhou Rehabilitation Hospital of Xuzhou Medical University, Xuzhou 221000, China

Received:2023-10-20 Revised:2024-01-15 Published:2024-07-15 Online:2024-04-08
Contact: GONG Zunke

精准化运动处方对脑卒中患者焦虑和抑郁状态及认知功能的疗效及机制初探：一项随机对照试验

1．213000　江苏省常州市德安医院康复科
2．221000　江苏省徐州市中心医院康复科
3．221000　江苏省徐州市，徐州医科大学附属徐州康复医院康复科

通讯作者: 巩尊科
作者简介:
作者贡献：钱贞提出利用精准化运动处方干预脑卒中患者焦虑、抑郁、认知功能的研究思路，制订具体研究方案，包括负责CPET具体操作及精准化运动处方的制订；朱海颖负责CPET定标及测试完成后仪器整理以及精准化运动处方的实施；王瑾负责脑卒中患者的选取、基本信息的采集、干预前后相关量表的收集整理，数据收集、采集；何俊负责统计学分析、绘制图表等；钱贞、卢同波负责论文起草；钱贞、巩尊科负责最终版本修订，对论文负责。
基金资助:
江苏省卫生健康委科研基金项目(K2019012); 常州市卫生健康青苗人才培养工程资助项目; 常州市卫健委青年项目(QN202053)

Abstract

Abstract:

Background

In the current rehabilitation environment, emotional issues and cognitive dysfunctions in stroke patients are often overshadowed by physical, speech, and swallowing difficulties, leading to their underestimation in clinical rehabilitation. This oversight can result in adverse outcomes, impacting the overall success of rehabilitation. Currently, clinical treatments primarily rely on pharmacotherapy to alleviate symptoms, which has limited effectiveness and can cause a range of adverse reactions.

Objective

To observe the efficacy of precision exercise prescriptions on anxiety, depression, and cognitive functions in stroke patients and to preliminarily analyze the underlying mechanisms of action.

Methods

A total of 84 stroke patients hospitalized in the Rehabilitation Department of Changzhou Dean Hospital from January 2022 to March 2023 were selected. They were randomly divided into a control group (42 patients) and an experimental group (42 patients). The control group received standard rehabilitation treatment, while the experimental group received precision exercise prescriptions based on cardiopulmonary exercise testing (CPET) results in addition to standard rehabilitation, over 12 weeks. The Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Mini-mental State Examination (MMSE) scores, and Homocysteine (Hcy) levels were compared before and after rehabilitation training in both groups. A Pearson correlation analysis was conducted between pre-rehabilitation Hcy levels and SAS, SDS, MMSE scores.

Results

All 42 patients in the experimental group completed the CPET and the 12-week precision exercise prescription rehabilitation without any adverse events. Before rehabilitation training, there were no statistically significant differences in SAS, SDS, MMSE scores, and Hcy levels between the two groups (P>0.05). After rehabilitation training, the scores of SAS, SDS, and Hcy levels in the experimental group were significantly lower compared to pre-treatment values (P<0.05), and which were significantly lower than those of the control group (P<0.05). The MMSE score in experimental groups increased significantly after interventions compared to pre-treatment value (P<0.05), and it was significantly higher than that of the control group (P<0.05). There were no significant differences in SAS, SDS, MMSE scores, and Hcy levels before and after rehabilitation training in the control group (P>0.05). Pearson correlation analysis revealed a positive correlation between Hcy levels and SAS, SDS scores (r-values of 0.420 and 0.507, respectively, P<0.05) and no correlation with MMSE scores (r=0.079, P=0.473) .

Conclusion

Our findings suggest that precision exercise prescriptions significantly improve anxiety, depression, and cognitive functions in stroke patients, suggesting their potential as a novel therapeutic approach in clinical applications. Hcy may be one of the mechanisms through which precision exercise prescriptions improve anxiety and depression in stroke patients. Further research is needed to determine whether Hcy is related to the improvement of cognitive functions through this prescription.

Key words: Stroke, Cardiopulmonary exercise testing, Precise exercise prescription, Anxiety, Depression, Cognitive function, Homocysteine

摘要： 背景在目前的康复环境下，脑卒中患者的情绪问题以及认知功能障碍较肢体、言语、吞咽等问题隐匿，在临床康复中不被重视，但会造成不良后果，影响康复结局。目前临床治疗上主要依靠药物改善症状，但收效甚微，还会引起一系列的不良反应。目的观察精准化运动处方对脑卒中患者焦虑、抑郁状态以及认知功能的疗效，并初步分析其作用机制。方法选取2022年1月—2023年3月在常州市德安医院康复科住院的脑卒中患者84例，按照随机数字表法分为对照组（42例）和试验组（42例）。对照组给予常规康复治疗，试验组在常规康复的基础上同时实施精准化运动处方，该处方根据心肺运动试验（CPET）的结果精准制订，处方共执行12周。比较两组患者康复训练前后焦虑自评量表（SAS）、抑郁自评量表（SDS）、简易智力状态检查量表（MMSE）评分，以及血浆同型半胱氨酸（Hcy）水平，并将康复训练前患者Hcy水平和SAS、SDS、MMSE评分进行Pearson相关性分析。结果试验组42例患者均顺利完成CPET，以及12周的精准化运动处方康复，无不良事件发生。康复训练前，两组患者SAS、SDS、MMSE评分和Hcy水平比较，差异均无统计学意义（P>0.05）。康复训练后，试验组SAS、SDS评分和Hcy水平均较治疗前降低（P<0.05），且均低于对照组（P<0.05）；MMSE评分较治疗前升高（P<0.05），且高于对照组（P<0.05）。对照组康复训练前后SAS、SDS、MMSE评分和Hcy水平比较，差异均无统计学意义（P>0.05）。Pearson相关性分析结果显示，康复训练前，患者Hcy水平和SAS、SDS评分呈正相关关系（r值分别为0.420、0.507，P<0.05），与MMSE评分无相关关系（r=0.079，P=0.473）。结论精准化运动处方能显著改善脑卒中患者的焦虑、抑郁状态以及认知功能，该运动处方可以作为一种新颖治疗方案在临床推广应用。Hcy可能是精准化运动处方改善脑卒中患者焦虑、抑郁的作用机制之一，关于Hcy是否和该处方改善认知功能有关，有待进一步研究。

关键词: 卒中, 心肺运动试验, 精准化运动处方, 焦虑, 抑郁, 认知功能, 同型半胱氨酸

CLC Number:

R 743

QIAN Zhen,LU Tongbo,HE Jun, et al. Efficacy and Preliminary Mechanism of Precise Exercise Prescriptions for Anxiety, Depression, and Cognitive Function in Patients with Stroke: a Randomized Controlled Trial[J]. Chinese General Practice, 2024, 27(20): 2445-2450. DOI: 10.12114/j.issn.1007-9572.2023.0738.
钱贞,卢同波,何俊等. 精准化运动处方对脑卒中患者焦虑和抑郁状态及认知功能的疗效及机制初探：一项随机对照试验[J]. 中国全科医学, 2024, 27(20): 2445-2450. DOI: 10.12114/j.issn.1007-9572.2023.0738.

Figures/Tables 4

References 26

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组别	例数	年龄（岁）	性别（例）		BMI （kg/m²）	脑卒中病程[M（P₂₅，P₇₅），月]	脑卒中类型（例）		偏瘫侧（例）
组别	例数	年龄（岁）	男	女	BMI （kg/m²）	脑卒中病程[M（P₂₅，P₇₅），月]	脑出血	脑梗死	左	右
对照组	42	65.5±7.3	27	15	24.1±2.5	0.8（0.4，1.3）	13	29	21	21
试验组	42	66.0±7.9	24	18	24.2±2.6	0.9（0.5，1.3）	15	27	25	17
检验统计量值		-0.344^a	0.449^b		-0.059^a	-0.305^c	0.214^b		0.769^b
P值		0.732	0.503		0.953	0.761	0.643		0.381

组别	例数	年龄（岁）	性别（例）		BMI （kg/m²）	脑卒中病程[M（P₂₅，P₇₅），月]	脑卒中类型（例）		偏瘫侧（例）
组别	例数	年龄（岁）	男	女	BMI （kg/m²）	脑卒中病程[M（P₂₅，P₇₅），月]	脑出血	脑梗死	左	右
对照组	42	65.5±7.3	27	15	24.1±2.5	0.8（0.4，1.3）	13	29	21	21
试验组	42	66.0±7.9	24	18	24.2±2.6	0.9（0.5，1.3）	15	27	25	17
检验统计量值		-0.344^a	0.449^b		-0.059^a	-0.305^c	0.214^b		0.769^b
P值		0.732	0.503		0.953	0.761	0.643		0.381

观察指标	数值
VO₂peak（mL·kg^-1·min^-1）	12.83±2.96
VO₂peak%pred	49.19±10.02
METpeak	3.80±1.06
HRpeak（次/min）	106.29±10.14
HRrest（次/min）	76.19±5.58
负荷peak（W）	53.45±9.73
AT[M（P₂₅，P₇₅），mL·kg^-1·min^-1]	5.93（3.90，9.19）
RERpeak	1.03±0.12
Borg Scale自感劳累分级表（呼吸困难） [M（P₂₅，P₇₅），级]	15（14，16）
Borg Scale自感劳累分级表（腿部劳累） [M（P₂₅，P₇₅），级]	15（15，16）

观察指标	数值
VO₂peak（mL·kg^-1·min^-1）	12.83±2.96
VO₂peak%pred	49.19±10.02
METpeak	3.80±1.06
HRpeak（次/min）	106.29±10.14
HRrest（次/min）	76.19±5.58
负荷peak（W）	53.45±9.73
AT[M（P₂₅，P₇₅），mL·kg^-1·min^-1]	5.93（3.90，9.19）
RERpeak	1.03±0.12
Borg Scale自感劳累分级表（呼吸困难） [M（P₂₅，P₇₅），级]	15（14，16）
Borg Scale自感劳累分级表（腿部劳累） [M（P₂₅，P₇₅），级]	15（15，16）

组别	例数	SAS（±s，分）				SDS（±s，分）				Hcy（±s，μmol/L）
组别	例数	训练前	训练后	t_配对值	P值	训练前	训练后	t_配对值	P值	训练前	训练后	t_配对值	P值
对照组	42	65.43±8.99	64.52±9.33	1.647	0.107	66.12±7.42	65.26±7.21	0.706	0.484	22.03±3.39	20.53±4.18	1.935	0.060
试验组	42	66.38±8.75	48.62±7.66	12.998	<0.001	66.29±7.89	51.86±7.50	9.524	<0.001	22.79±3.74	12.57±3.78	15.752	<0.001
t（Z）值		-0.492	8.537			-0.100	8.352			-0.977	9.162
P值		0.624	<0.001			0.921	<0.001			0.331	<0.001
组别	MMSE总分（±s，分）				定向力[M（P₂₅，P₇₅），分]				记忆力[M（P₂₅，P₇₅），分]
组别	训练前	训练后	t_配对值	P值	训练前	训练后	Z_配对值	P值	训练前	训练后	Z_配对值	P值
对照组	20.83±2.32	21.74±2.14	-1.912	0.063	7（6，8）	8（7，8）	-0.650	0.516	2（1，2）	2（1，2）	-0.714	0.475
试验组	21.12±2.01	26.02±1.69	-12.882	<0.001	8（7，8）	9（8，10）	-3.994	<0.001	2（1，2）	2（2，3）	-4.418	<0.001
t（Z）值	-0.603	-10.182			-0.728^a	-4.266^a			-0.744^a	-4.467^a
P值	0.548	<0.001			0.467	<0.001			0.457	<0.001
组别	注意力和计算力[M（P₂₅，P₇₅），分]				回忆能力[M（P₂₅，P₇₅），分]				语言[M（P₂₅，P₇₅），分]
组别	训练前	训练后	Z_配对值	P值	训练前	训练后	Z_配对值	P值	训练前	训练后	Z_配对值	P值
对照组	3（3，4）	4（3，4）	-0.627	0.531	1（1，2）	1（1，2）	-0.898	0.369	7（7，8）	7（7，8）	-1.752	0.080
试验组	3（3，4）	4（4，5）	-3.085	0.002	2（1，2）	2（2，3）	-4.641	<0.001	7（6，8）	9（8，9）	-4.741	<0.001
t（Z）值	-0.253^a	-2.650^a			-0.838^a	-5.037^a			-0.327^a	-5.501^a
P值	0.800	0.008			0.402	<0.001			0.744	<0.001

Efficacy and Preliminary Mechanism of Precise Exercise Prescriptions for Anxiety, Depression, and Cognitive Function in Patients with Stroke: a Randomized Controlled Trial

精准化运动处方对脑卒中患者焦虑和抑郁状态及认知功能的疗效及机制初探：一项随机对照试验

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