Effect of CPET-based Precisely Prescribed Aerobic Exercise on Cardiopulmonary Fitness and Sleep Quality in Stroke Patients

doi:10.12114/j.issn.1007-9572.2022.0030

Chinese General Practice ›› 2022, Vol. 25 ›› Issue (20): 2468-2474.DOI: 10.12114/j.issn.1007-9572.2022.0030

Special Issue: 睡眠研究最新文章合辑；神经系统疾病最新文章合辑；睡眠问题专题研究；运动相关研究最新文章合辑；全科质控专项研究；脑健康最新研究合辑

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Effect of CPET-based Precisely Prescribed Aerobic Exercise on Cardiopulmonary Fitness and Sleep Quality in Stroke Patients

¹Rehabilitation Department, Changzhou Dean Hospital, Changzhou 213000, China
²Rehabilitation Department, Northern Jiangsu People's Hospital, Yangzhou 225000, China

Received:2021-11-24 Revised:2022-04-07 Published:2022-07-15 Online:2022-04-28
Contact: Xin WANG
About author:
QIAN Z, LU T B, HE J, et al. Effect of CPET-based precisely prescribed aerobic exercise on cardiopulmonary fitness and sleep quality in stroke patients[J]. Chinese General Practice, 2022, 25 (20) : 2468-2474.

精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响研究

¹213000　江苏省常州市德安医院康复科
²225000　江苏省扬州市，苏北人民医院康复科

通讯作者: 王鑫
作者简介:
钱贞，卢同波，何俊，等.精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响研究[J].中国全科医学，2022，25（20）：2468-2474. [www.chinagp.net] 作者贡献：钱贞提出研究思路，制定具体研究方案，包括负责CPET具体操作及精准化运动处方的制定；何俊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、统计学分析、绘制图表；阮秋香负责数据收集、采集；汪超兰负责CPET定标及测试完成后仪器整理；钱贞、卢同波负责论文起草；钱贞、王鑫负责最终版本修订，对论文负责；所有作者确认论文终稿。
基金资助:
常州市卫健委科技项目青年课题(QN202053); 江苏省高层次卫生人才"六个一工程"拔尖人才科研项目(LGY2018027); 常州市卫生健康青苗人才培养工程资助项目

Abstract

Abstract:

Background

Cardiopulmonary problems will increase the risk of health harms yet they are often neglected in clinical rehabilitation treatment for stroke patients. In addition, sleep problems also often affect the rehabilitation effect in these patients, while routine drug treatment could not achieve satisfactory effect.

Objective

To assess the effect of precisely prescribed exercise on cardiopulmonary fitness and sleep quality in stroke patients.

Methods

Sixty-four stroke inpatients were recruited from Rehabilitation Department, Changzhou Dean Hospital from April 2020 to August 2021, and equally randomized into a control group and an experimental group. At baseline, cardiopulmonary fitness was assessed using cardiopulmonary exercise testing (CPET) , and sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI) for both groups. Then control group received 12-week routine rehabilitation training, while experimental group received 12-week routine rehabilitation training plus aerobic exercise precisely prescribed based on baseline CPET parameters. Intra- and inter-group comparisons were made between pre- and post-training major CPET parameters, dyspnea and leg fatigue measured by the Borg Scale and sleep quality.

Results

At the end of training, the experimental group demonstrated higher peak oxygen uptake (VO₂peak) , percentage of predicted peak oxygen uptake (VO₂peak%pred) , peak metabolic equivalent (METpeak) , peak heart rate (HRpeak) , peak load, and anaerobic threshold (AT) , and lower intensity of perceived dyspnea and leg fatigue than the control group (P<0.05) . The above-mentioned eight parameters improved significantly after training in the experimental group (P<0.05) . The experimental group had lower post-training scores of six domains (subjective sleep quality, sleep latency, sleep duration, sleep disturbances, use of sleep medication, daytime dysfunction) and lower post-training total score of PSQI than the control group (P<0.05) . The total score of PSQI and the scores of its seven domains were all lowered significantly when the training was finished (P<0.05) .

Conclusion

The precisely prescribed aerobic exercise by the results of CPET could effectively improve the cardiopulmonary fitness, exercise intensity, exercise endurance, and sleep quality as well as the sense of exercise fatigue in stroke patients.

Key words: Stroke, Cardiopulmonary exercise testing, Precise exercise prescription, Peak oxygen uptake, Sleep quality, Cardiopulmonary fitness

摘要：

背景

脑卒中患者的心肺问题常在临床康复治疗中被忽视，其会引起一系列危害；此外脑卒中患者的睡眠问题也常影响患者的康复效果，常规药物治疗效果不佳。

目的

观察精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响。

方法

选取2020年4月至2021年8月在常州市德安医院康复科住院的脑卒中患者64例为研究对象。按照随机数字表法将患者分为对照组、试验组，各32例。患者进入康复训练前均进行心肺运动试验（CPET）以及匹兹堡睡眠质量指数（PSQI）评估，之后对照组进行常规康复训练，试验组在常规康复训练的基础上，根据CPET客观定量评估的结果制定精准化运动处方，患者进行12周有氧训练。比较康复训练前后CPET主要评估指标、Borg Scale自感劳累分级（呼吸困难、腿部劳累）及睡眠质量。

结果

试验组患者康复训练12周后峰值摄氧量（VO₂peak）、峰值摄氧量占预计值百分比（VO₂peak%pred）、峰值代谢当量（METpeak）、峰值心率（HRpeak）、峰值负荷（负荷peak）、无氧阈（AT）高于对照组，Borg Scale自感劳累分级（呼吸困难）、Borg Scale自感劳累分级（腿部劳累）低于对照组（P<0.05）。康复训练12周后试验组患者VO₂peak、VO₂peak%pred、METpeak、HRpeak、负荷peak、AT高于组内康复训练前，Borg Scale自感劳累分级（呼吸困难）、Borg Scale自感劳累分级（腿部劳累）低于组内康复训练前（P<0.05）。试验组患者康复训练12周后主观睡眠质量、睡眠潜伏期、睡眠持续性、睡眠紊乱、使用睡眠药物、白天功能紊乱评分及PSQI总分均低于对照组（P<0.05）。康复训练12周后试验组患者主观睡眠质量、睡眠潜伏期、睡眠持续性、习惯性睡眠效率、睡眠紊乱、使用睡眠药物、白天功能紊乱评分及PSQI总分均低于组内康复训练前（P<0.05）。

结论

通过CPET制定的精准化运动处方，能有效提高脑卒中患者的心肺适能、运动强度、运动耐力，改善患者的睡眠质量，并且降低运动疲劳感。

关键词: 卒中, 心肺运动试验, 精准化运动处方, 峰值摄氧量, 睡眠质量, 心肺适能

Zhen QIAN,Tongbo LU,Jun HE, et al. Effect of CPET-based Precisely Prescribed Aerobic Exercise on Cardiopulmonary Fitness and Sleep Quality in Stroke Patients[J]. Chinese General Practice, 2022, 25(20): 2468-2474. DOI: 10.12114/j.issn.1007-9572.2022.0030.
钱贞,卢同波,何俊等. 精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响研究[J]. 中国全科医学, 2022, 25(20): 2468-2474. DOI: 10.12114/j.issn.1007-9572.2022.0030.

Figures/Tables 3

References 21

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组别	例数	年龄（岁）	性别〔n（%）〕		BMI（±s，kg/m²）	病程（±s，月）	脑卒中类型〔n（%）〕		病灶侧〔n（%）〕
组别	例数	年龄（岁）	男	女	BMI（±s，kg/m²）	病程（±s，月）	脑出血	脑梗死	左	右
对照组	32	65.3±7.0	20（62.5）	12（37.5）	24.1±2.2	0.87±0.63	10（31.2）	22（68.8）	16（50.0）	16（50.0）
试验组	32	66.0±7.9	18（56.2）	14（43.8）	24.0±2.2	0.99±0.73	11（34.4）	21（65.6）	19（59.4）	13（40.6）
t（χ²）值		0.354	0.259^a		0.151	0.732	0.071^a		0.567^a
P值		0.725	0.611		0.880	0.467	0.790		0.451

组别	例数	年龄（岁）	性别〔n（%）〕		BMI（±s，kg/m²）	病程（±s，月）	脑卒中类型〔n（%）〕		病灶侧〔n（%）〕
组别	例数	年龄（岁）	男	女	BMI（±s，kg/m²）	病程（±s，月）	脑出血	脑梗死	左	右
对照组	32	65.3±7.0	20（62.5）	12（37.5）	24.1±2.2	0.87±0.63	10（31.2）	22（68.8）	16（50.0）	16（50.0）
试验组	32	66.0±7.9	18（56.2）	14（43.8）	24.0±2.2	0.99±0.73	11（34.4）	21（65.6）	19（59.4）	13（40.6）
t（χ²）值		0.354	0.259^a		0.151	0.732	0.071^a		0.567^a
P值		0.725	0.611		0.880	0.467	0.790		0.451

组别	例数	VO₂peak（ml·kg^-1·min^-1）				VO₂peak%pred（%）				METpeak
组别	例数	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	32	12.69±3.19	12.77±3.27	0.360	0.721	50.94±10.73	51.16±11.27	0.546	0.589	3.91±0.90	3.91±0.89	0.102	0.919
试验组	32	12.88±3.07	14.48±2.72	7.830	<0.001	49.00±10.28	57.25±8.64	7.415	<0.001	3.82±1.15	4.46±0.92	6.635	<0.001
t值		0.248	2.272			0.737	2.428			0.376	2.440
P值		0.805	0.027			0.464	0.018			0.708	0.018
组别	HRpeak（次/min）				负荷peak（W）				AT（ml·kg^-1·min^-1）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	107.09±10.79	108.59±12.73	1.326	0.195	50.28±10.05	51.87±10.29	1.594	0.121	5.27±2.60	5.28±2.45	0.013	0.989
试验组	106.66±9.59	119.94±11.12	10.411	<0.001	53.06±10.46	66.84±10.02	10.255	<0.001	6.58±3.89	8.32±3.62	9.137	<0.001
t值	0.171	3.796			1.085	5.894			1.574	3.949
P值	0.864	<0.001			0.282	<0.001			0.121	<0.001
组别	RERpeak				Borg Scale自感劳累分级（呼吸困难）（级）				Borg Scale自感劳累分级（腿部劳累）（级）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	1.08±0.13	1.10±0.13	1.833	0.076	15.59±1.04	15.94±1.05	1.938	0.062	15.94±1.32	16.19±1.40	1.856	0.073
试验组	1.05±0.11	1.05±0.11	0.641	0.526	15.19±1.23	12.47±1.50	12.841	<0.001	15.59±0.91	12.94±1.54	12.441	<0.001
t值	1.040	1.411			1.425	10.721			1.214	8.818
P值	0.302	0.163			0.159	<0.001			0.230	<0.001

组别	例数	VO₂peak（ml·kg^-1·min^-1）				VO₂peak%pred（%）				METpeak
组别	例数	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	32	12.69±3.19	12.77±3.27	0.360	0.721	50.94±10.73	51.16±11.27	0.546	0.589	3.91±0.90	3.91±0.89	0.102	0.919
试验组	32	12.88±3.07	14.48±2.72	7.830	<0.001	49.00±10.28	57.25±8.64	7.415	<0.001	3.82±1.15	4.46±0.92	6.635	<0.001
t值		0.248	2.272			0.737	2.428			0.376	2.440
P值		0.805	0.027			0.464	0.018			0.708	0.018
组别	HRpeak（次/min）				负荷peak（W）				AT（ml·kg^-1·min^-1）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	107.09±10.79	108.59±12.73	1.326	0.195	50.28±10.05	51.87±10.29	1.594	0.121	5.27±2.60	5.28±2.45	0.013	0.989
试验组	106.66±9.59	119.94±11.12	10.411	<0.001	53.06±10.46	66.84±10.02	10.255	<0.001	6.58±3.89	8.32±3.62	9.137	<0.001
t值	0.171	3.796			1.085	5.894			1.574	3.949
P值	0.864	<0.001			0.282	<0.001			0.121	<0.001
组别	RERpeak				Borg Scale自感劳累分级（呼吸困难）（级）				Borg Scale自感劳累分级（腿部劳累）（级）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	1.08±0.13	1.10±0.13	1.833	0.076	15.59±1.04	15.94±1.05	1.938	0.062	15.94±1.32	16.19±1.40	1.856	0.073
试验组	1.05±0.11	1.05±0.11	0.641	0.526	15.19±1.23	12.47±1.50	12.841	<0.001	15.59±0.91	12.94±1.54	12.441	<0.001
t值	1.040	1.411			1.425	10.721			1.214	8.818
P值	0.302	0.163			0.159	<0.001			0.230	<0.001

组别	例数	主观睡眠质量〔M（P₂₅，P₇₅）〕				睡眠潜伏期（±s）				睡眠持续性（±s）
组别	例数	康复训练前	康复训练12周后	Z值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	32	2.0（1.5，2.0）	2.0（1.0，2.0）	-1.181	0.238	1.97±0.74	1.78±0.79	1.982	0.056	2.06±0.76	1.91±0.78	1.539	0.134
试验组	32	2.0（1.5，2.0）	1.0（0，1.0）	-4.435	<0.001	2.03±0.74	1.38±0.49	5.685	<0.001	2.03±0.74	1.47±0.57	4.447	<0.001
t（Z）值		-0.365^a	-5.186^a			0.338	2.464			0.167	2.573
P值		0.715	<0.001			0.737	0.017			0.868	0.012
组别	习惯性睡眠效率（±s）				睡眠紊乱（±s）				使用睡眠药物（±s）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	2.31±0.64	2.09±0.69	1.752	0.090	2.13±0.87	2.09±0.89	0.273	0.786	2.09±0.69	2.06±0.72	0.297	0.768
试验组	2.28±0.63	1.91±0.53	2.339	0.026	2.22±0.66	1.69±0.47	4.477	<0.001	2.03±0.82	1.66±0.65	2.436	0.021
t（Z）值	0.196	1.220			0.486	2.276			0.330	2.372
P值	0.846	0.227			0.629	0.027			0.743	0.021
组别	白天功能紊乱（±s）				PSQI总分（±s）
组别	康复训练前	康复训练12周后	t_配对值	P值	康复训练前	康复训练12周后	t_配对值	P值
对照组	2.16±0.68	2.31±0.74	1.222	0.231	14.50±3.31	13.87±2.60	1.679	0.103
试验组	2.13±0.71	1.03±0.65	7.568	<0.001	14.59±3.01	9.69±1.71	9.919	<0.001
t（Z）值	0.181	7.387			0.118	7.610
P值	0.857	<0.001			0.906	<0.001

Effect of CPET-based Precisely Prescribed Aerobic Exercise on Cardiopulmonary Fitness and Sleep Quality in Stroke Patients

精准化运动处方对脑卒中患者心肺适能及睡眠质量的影响研究

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