抗阻训练的心血管调控机制及其在心脏康复中的应用

抗阻训练的心血管调控机制

及其在心脏康复中的应用

Cardiovascularregulationmechanismwithresistancetrainingincardiacrehabilitation心血管康复的内容

approachincardiacrehab康复rehabAerobic有氧训练作业训练OTBehavior行为治疗抗阻训练Resistancetraining心血管康复的内容

approachincardiacrehab康复rehabAerobic有氧训练作业训练OTBehavior行为治疗抗阻训练ResistancetrainingStudystructureCentralhemodynamicsMechanismClinicalobservationBrainSpineEOPsMuscleRecording6Animalstudy20dogsIntra-ThoracicPressureisrelatedtoPWP(r=0.89)7CardiacresponsestoRTCardiacresponsetoRThasitsownruleanddoesnotinduceunduecardiovascularresponses.抗阻运动并不诱发不可预期的高心血管反应RTinducedPWPelevationisneitheraresultofLVfailurenormyocardialischemia,buttheincreaseofintra-thoracicpressure.抗阻运动引起肺毛压增高的原因是胸内压增高，而不是左心功能障碍。8CardiacresponsestoRTIncreaseofMVO2wasweakerduringRTthanDE.抗阻运动时心肌耗氧量的增加低于动力性运动RTresultedinparallelincreaseofSBPandDBPwhichisdecreasedduringDE.

RT时SBP和DBP同时升高TherewasnosignofmyocardialischemiaduringRTmax,buthappenedinDEmax.

RTmax时心肌缺血少于DEmaxWhynoischemiaduringIE？ischemiaIE<DEMVO2IE<DECAperfusionIE>DEHRIE<DEhymodynamicsIE<DEDBPIE>DEPerfusiontimeIE>DEPerfusionpressureIE>DEPublicationsEffectsofisometricexerciseonhemodynamicsandleftventricularsystolicanddiastolicfunctioninnormalsubjectsandpatRTntsconvalescentfrommyocardialinfarction.AustNewZealandJmed1990;20(3):325RegulationofcardiovascularresponsestoisometricexerciseincoronarypatRTnts.AustNewZealandJMed1991;21(4):524

MechanismofPulmonaryWedgePressureElevationDuringIsometricExerciseinPatRTntswithCoronaryArteryDisease.JNanjingMedColl1993;7(2):1-10冠心病人等长收缩运动时肺毛细血管嵌顿压升高的机理。中国康复医学杂志1993;8(1):1分级等长收缩运动对正常人和心肌梗塞患者二尖瓣血流的影响。中国康复医学杂志1993;8(6):244-247乏氏动作对冠心病人等长收缩运动心血管反应的影响。中国康复医学杂志，1995;10(1):13-16影响正常人和心肌梗塞病人对等长收缩运动心血管反应的有关因素.中国康复医学杂志1995;10(5):193-19711

WhyRTproduceweakercardiovascularresponsethanDE?

EndogenousOpioids(EOPs),amodulatorofcardiacneuro-control,increasemoresignificantlyduringRTthanDEandthusadjustcardiacresponsetoRT.EOPsEnkephalin,ENK,LEKβ-endorphin,β-ENDDynaphin,DYN12Publications等长收缩运动时血浆内啡肽对心血管反应的调节作用.中华物理医学杂志,1998；20(2):105-108

等长收缩运动时生理性肺毛细血管楔嵌压增高的机理。中国运动医学杂志；2000;19(3):251-253

电刺激等长收缩运动心血管反应与肌群质量的关系。中国运动医学杂志

2000；19（4）：392-395

MaycardiovascularresponsetoIEbemodified?

CentralcommandhasmoreprofoundeffectonEOPs.BrainbehaviormodificationmayadjustcardiovascularresponsetoIEthroughmechanismofenhancedreleaseofEOPs.14Publications中枢内啡肽对等长收缩运动时心血管反应的调控意义。中华物理医学与康复杂志，2000;22(4):211-214血浆内啡肽对等长收缩运动心血管反应的中枢调节定位。中华物理医学与康复杂志，2000;22(5):287-290大脑行为对等长收缩运动时心血管反应的调控作用与机制。中国康复医学杂志2000;15(3):140-143

CollateralcirculationblockadeStudystructureEvidenceofexerciseinducedcoronarycollateralformationRelationshipofischemiaandcollateralformationRelationshipofexerciseandischemiaOptimizationofexercisetrainingEffectoftheoptimaltrainingprogramChronicCAstenosis28swines(22.5±2kg）AmeroidConstrictorplacedoncoronaryartery(LCX)LCXwasoccludedgradually4weekspostoperation.ConclusionTreadmillexercisemayimprovecollateralcirculationformation,butunclearintensity,durationandfrequency.VEGFproductionand/oractivityisrelatedtoIE,butmechanismneedmorestudies.JChinRehabMed，2002;17(1):22-25JChinRehabMed，2002;17(2):72-74safetyPathologicalischemiaEPCshomingPathologicalischemiaPhysiologicalischemiaBiologicalbypassVEGF-NOLocaleffectRemoteeffectCollateralformationTheeffectandmechanismofexerciseandischemiatrainingoncollateralformation（No.30370687）Theeffectandmechanismofisometriccontractionandischemiatrainingonvascularreserve（No.30570893）Myocardialischemia(MI)theischemicheartCapillarydensityintheotherorgansIschemiaexerciseProjectssupportedbytheNationalNaturalScienceFoundationofChina(PNSF)Physiologicalischemiatraining(PIT)CapillarydensityRemoteareaVEGFVEGFRemoteareaPhysiologicalIschemiaTraining(PIT)sciaticnerveESPIT--isometriccontraction--normalskeletalmusclesRepeatedPITdidincreasetheVEGFandcapillarydensityintheotherlimbwhichwasinischemiccondition.Cellularmechanism

GroupingPISOITPTMIonlyPITonlyMI+PITShameoperatedPB-EPCs(EPCsinperipheralblood)***weekIH-EPCs(EPCsinischemicheartregion)***AttheendpointsoftheexperimentsCapillaryDensity*Attheendpointsoftheexperiments●Imagesof7.0Tmicro-MRIPBSinjectionSPIO-EPCsinjectionPrussianbluestainCM-DilRelationbetweenPB-EPCs

and

IH-EPCsITPIConclusion

PIT