فیزیولوژی ورزشی گروههای خاص
تاثیر برنامه پیاده روی در منزل بر شاخص های قلبی عروقی بیماران دیابتی مبتلا به نارسایی قلبی
نوع مقاله : مقاله پژوهشی
نویسنده
دانشگاه علوم پزشکی گیلان
چکیده
چکیده
مقدمه:
بیماریهای مزمن از جمله دیابت در دنیا عامل اصلی مرگ و میر است. نارسایی قلبی (HF) در این بیماران شیوع بیشتری دارد و همچنین HF خطر ابتلا به دیابت را افزایش می دهد. هدف این مطالعه، تـاثیر پیاده روی بر شاخص قلبی عروقی بیماران دیابتی مبتلا بهHF بود.
مواد و روشها:
در این پژوهش، در گروه تجربی 6 مرد و 5 زن و در گروه شاهد 5 مرد و 3 زن، دیابتی مبتلا به HF در بیمارستان دکتر حشمت شرکت کردند. ابزار گردآوری داده ها شامل فرم دموگرافیک و فرم زمان بندی برنامـه پیاده روی در منزل بمدت 30 دقیقه سه بار در هفته تا هشت هفته بر مبنای تحمل فرد بـود. ابتـدا و انتهای مداخله اندازه گیری اکوکاردیوگرافی، قندخون(FBS)، فشارخون و ضربان قلب(HR) انجام شد. نتایج از نرم افزار آماری SPSS با آزمونهای paired-t و t-مستقل تعیین گردید.
یافته ها:
با توجه به توزیع طبیعی داده ها، بین گروه ها در متغیر FBS و HbA1c در پیش آزمون تفاوت معنی دار نبود (05/0p>) و در پس آزمون معنی دار بود (05/0p<). تغییرات درون گروهی کاهش معنی دار FBS و HbA1c در گروه تجربی داشت (05/0p<). بین گروه ها در فشارخون دیاستول در پیش آزمون تفاوت معنی دار بود (05/0>p). درون گروه ها افزایش کسر تخلیه و DIVS و کاهش حجم پایان سیستول و دیاستول در گروه تجربی داشتند (05/0>p).
نتیجهگیری:
مطالعه نشان داد، پیاده روی در منزل می تواند بعنـوان یـک روش درمانی در بیماران دیابتی مبتلا به نارسایی قلبی باعث بهبودی در شاخص قلبی عروقی گردد.
کلیدواژهها
Harrison, TR. Harrison's Principles of Internal Medicine. Diseases of the heart and blood vessels.
Translation: Mina Fathi Kazroni. Tehran. Respected publications. Year 2018.
McDonagh TA, Metra M, Adamo M, ESC Scientific Document Group, et al. 2021 ESC guidelines
for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.
2021;42(36):3599–3726.
Aune D, Schlesinger S, Neuenschwander M, et al. Diabetes mellitus, blood glucose and the risk of
heart failure: a systematic review and meta-analysis of prospective studies. Nutr Metab
Cardiovasc Dis. 2018;28:1081–1091. [PubMed] [Google Scholar]
Antakly-Hanon Y, Ben Hamou A, Garçon P, et al. Asymptomatic left ventricular dysfunction in
patients with type 2 diabetes free of cardiovascular disease and its relationship with clinical
characteristics: the DIACAR cohort study. Diabetes Obes Metab 2021;23:434-43.
American Diabetes Association. Diagnosis and Classification of Diabetes Melitus. Diabetes care.
2011 Jan;34 Suppl 1:S62-69.
Sinning C, Makarova N, Völzke H, Schnabel RB, Ojeda F, Dörr M, et al. Association of glycated
hemoglobin A1c levels with cardiovascular outcomes in the general population: results from
the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium.
Cardiovasc Diabetol. 2021;20(1):223.
Radzewitz A, Miche E, Herrmann G, Nowak M, Montanus U, Adam U, et al. Exercise and muscle
strength training and their effect on quality of life in patients with chronic heart failure. Eur J
Heart Fail. 2002;4(5):627-34.
Nielsen J, Duncan K, Pozehl B. Patient-Selected Strategies for Post Cardiac Rehabilitation Exercise
Adherence in Heart Failure. Rehabil Nurs J. 2019;44(3):181-5.
O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of
exercise training in patients with chronic heart failure: HF-ACTION randomized controlled
trial. Jama. 2009;301(14):1439-50.
Liguori G, Medicine ACoS. ACSM's guidelines for exercise testing and prescription: Lippincott
Williams & Wilkins; 2020.
Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and heart
failure: a statement from the American Heart Association Committee on exercise,
rehabilitation, and prevention. Circulation. 2003;107(8):1210-25.
Bearne LM, Volkmer B, Peacock J, Sekhon M, Fisher G, Holmes MNG, Douiri A, Amirova A, Farran
D, Quirke-McFarlane S, et al. Effect of a Home-Based, Walking Exercise Behavior Change
Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease. Jama.
2022;327:1344–1355.
Amirova A, Fteropoulli T, Williams P, Haddad M. Efficacy of interventions to increase physical
activity for people with heart failure: a meta-analysis. Open Heart. 2021;8:e001687.
Vetrovsky T, Borowiec A, Juřík R, Wahlich C, Śmigielski W, Steffl M, Tufano JJ, Drygas W, Stastny
P, Harris T, et al. Do physical activity interventions combining selfmonitoring with other
components provide an additional benefit compared with selfmonitoring alone? A systematic
review and meta-analysis. Brit J Sport Med. 2022;56:1366– 1374.
Franssen WMA, Franssen GHLM, Spaas J, Solmi F, Eijnde BO. Can consumer wearable activity
tracker-based interventions improve physical activity and cardiometabolic health in patients
with chronic diseases? A systematic review and meta-analysis of randomised controlled trials.
Int J Behav Nutr Phys Act. 2020;17:57.
Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH. Walking for hypertension.
Cochrane Database Syst Rev. 2021;2021:CD008823.
Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ,
Kitzman DW, Regensteiner JG, et al. Home-Based Cardiac Rehabilitation: A Scientific
Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation,
the American Heart Association, and the American College of Cardiology. Circulation.
2019;140:e69–e89.
Vetrovsky T, Siranec M, Frybova T, Gant I, Semerad M, Miklikova M, Bunc V, Vesely J, Stastny J,
Griva M, et al. Statistical analysis plan for a randomized controlled trial examining pedometerbased walking intervention in patients with heart failure with reduced ejection fraction: the
WATCHFUL trial. Trials. 2023;24:539.
Talebi M, Lotfian S, Khalili Y, Taghavi S, Masoudi S. The Effect of Home-Based Exercise Training
on Functional Capacity and Quality of Life in Patients with Heart Failure. Razi J Med Sci.
2021;28(12):249-258.
Fayazi S, Zarea K, Abbasi A, Ahmadi F. Effect of home‐based walking on performance and quality
of life in patients with heart failure. Scand J Caring Sci. 2013;27(2):246-52.
Mohammadi F, Taherian A, Hosseini MA, Rahgozar M. Effect of home-based cardiac rehabilitation
quality of life in the patients with myocardical infarction. Arch Rehabil. 2006;7(3):0-.
Lans C, Cider A, Nylander E, Brudin L. The relationship between six-minute walked distance and
health-related quality of life in patients with chronic heart failure. Scand Cardiovasc J.
2022;56:310–5
Gary RA, Sueta CA, Dougherty M, Rosenberg B, Cheek D, Preisser J, et al. Home-based exercise
improves functional performance and quality of life in women with diastolic heart failure. Heart
Lung. 2004;33(4):210-8
Brubaker, P.H.; Avis, T.; Rejeski, W.J.; Mihalko, S.E.; Tucker, W.J.; Kitzman, D.W. Exercise
Training Effects on the Relationship of Physical Function and Health-Related Quality of Life
Among Older Heart Failure Patients With Preserved Ejection Fraction. J. Cardiopulm. Rehabil.
Prev. 2020, 40, 427–433. [Google Scholar] [CrossRef] [PubMed]
Stamler, J.; Vaccaro, O.; Neaton, J.D.; Wentworth, D. Diabetes, Other Risk Factors, and 12-Yr
Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial.
Diabetes Care 1993, 16, 434–444. [Google Scholar] [CrossRef] [PubMed]
American Diabetes Association. 4. Lifestyle management: Standards of medical care in diabetes2018. Diabetes Care 2018, 41, S38–S50. [Google Scholar] [CrossRef] [PubMed][Green
Version]
Crisafulli, A.; Pagliaro, P.; Roberto, S.; Cugusi, L.; Mercuro, G.; Lazou, A.; Beauloye, C.; Bertrand,
L.; Hausenloy, D.J.; Aragno, M.; et al. Diabetic Cardiomyopathy and Ischemic Heart Disease:
Prevention and Therapy by Exercise and Conditioning. Int. J. Mol. Sci. 2020, 21, 2896. [Google
Scholar] [CrossRef] [PubMed][Green Version]
Andrade GN, Umeda II, Fuchs AR, Mastrocola LE, Rossi-Neto JM, Moreira DA, et al. Home-based
training program in patients with chronic heart failure and reduced ejection fraction: a
randomized pilot study. Clinics (Sao Paulo). 2021;76:e2550.
Gardner AW, Montgomery PS, Wang M, Shen B. Minimal clinically important differences in daily
physical activity outcomes following supervised and home-based exercise in peripheral artery
disease. Vasc Med. 2022;27:142–149.
Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB,
Chen H, Upadhya B, Reed SD, et al. Physical Rehabilitation for Older Patients Hospitalized for
Heart Failure. New Engl J Med. 2021;385:203–216.
Pandey A, Keshvani N, Zhong L, Mentz RJ, Piña IL, DeVore AD, Yancy C, Kitzman DW, Fonarow
GC. Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation
Among Medicare Beneficiaries With Heart Failure. JACC Heart Fail. 2021;9:471–481.
Piepoli MF, Binno S, Corrà U, Seferovic P, Conraads V, Jaarsma T, Schmid J-P,
Filippatos G, Ponikowski PP, ESC C on EP& T of the HFA of the. ExtraHF survey: the first
European survey on implementation of exercise training in heart failure patients. Eur J Heart
Fail. 2015;17:631–638.
Nelson RK, Solomon R, Hosmer E, Zuhl M. Cardiac rehabilitation utilization, barriers,
and outcomes among patients with heart failure. Heart Fail Rev. 2023. Ahead of print. doi:
10.1007/s10741-023-10309-2.
Taylor RS, Dalal HM, Zwisler A-D. Cardiac rehabilitation for heart failure: ‘Cinderella’
or evidence-based pillar of care? Eur Heart J. 2023;44:1511–1518.
Heizmann A-N, Chapelle C, Laporte S, Roche F, Hupin D, Hello CL. Impact of wearable
device-based interventions with feedback for increasing daily walking activity and physical
capacities in cardiovascular patients: a systematic review and meta-analysis of randomized
controlled trials. BMJ Open. 2023;13:e069966.
Harris T, Kerry SM, Limb ES, Victor CR, Iliffe S, Ussher M, Whincup PH, Ekelund U,
Fox-Rushby J, Furness C, et al. Effect of a Primary Care Walking Intervention with and
without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And
Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial.
Translation: Mina Fathi Kazroni. Tehran. Respected publications. Year 2018.
McDonagh TA, Metra M, Adamo M, ESC Scientific Document Group, et al. 2021 ESC guidelines
for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J.
2021;42(36):3599–3726.
Aune D, Schlesinger S, Neuenschwander M, et al. Diabetes mellitus, blood glucose and the risk of
heart failure: a systematic review and meta-analysis of prospective studies. Nutr Metab
Cardiovasc Dis. 2018;28:1081–1091. [PubMed] [Google Scholar]
Antakly-Hanon Y, Ben Hamou A, Garçon P, et al. Asymptomatic left ventricular dysfunction in
patients with type 2 diabetes free of cardiovascular disease and its relationship with clinical
characteristics: the DIACAR cohort study. Diabetes Obes Metab 2021;23:434-43.
American Diabetes Association. Diagnosis and Classification of Diabetes Melitus. Diabetes care.
2011 Jan;34 Suppl 1:S62-69.
Sinning C, Makarova N, Völzke H, Schnabel RB, Ojeda F, Dörr M, et al. Association of glycated
hemoglobin A1c levels with cardiovascular outcomes in the general population: results from
the BiomarCaRE (Biomarker for Cardiovascular Risk Assessment in Europe) consortium.
Cardiovasc Diabetol. 2021;20(1):223.
Radzewitz A, Miche E, Herrmann G, Nowak M, Montanus U, Adam U, et al. Exercise and muscle
strength training and their effect on quality of life in patients with chronic heart failure. Eur J
Heart Fail. 2002;4(5):627-34.
Nielsen J, Duncan K, Pozehl B. Patient-Selected Strategies for Post Cardiac Rehabilitation Exercise
Adherence in Heart Failure. Rehabil Nurs J. 2019;44(3):181-5.
O’Connor CM, Whellan DJ, Lee KL, Keteyian SJ, Cooper LS, Ellis SJ, et al. Efficacy and safety of
exercise training in patients with chronic heart failure: HF-ACTION randomized controlled
trial. Jama. 2009;301(14):1439-50.
Liguori G, Medicine ACoS. ACSM's guidelines for exercise testing and prescription: Lippincott
Williams & Wilkins; 2020.
Piña IL, Apstein CS, Balady GJ, Belardinelli R, Chaitman BR, Duscha BD, et al. Exercise and heart
failure: a statement from the American Heart Association Committee on exercise,
rehabilitation, and prevention. Circulation. 2003;107(8):1210-25.
Bearne LM, Volkmer B, Peacock J, Sekhon M, Fisher G, Holmes MNG, Douiri A, Amirova A, Farran
D, Quirke-McFarlane S, et al. Effect of a Home-Based, Walking Exercise Behavior Change
Intervention vs Usual Care on Walking in Adults With Peripheral Artery Disease. Jama.
2022;327:1344–1355.
Amirova A, Fteropoulli T, Williams P, Haddad M. Efficacy of interventions to increase physical
activity for people with heart failure: a meta-analysis. Open Heart. 2021;8:e001687.
Vetrovsky T, Borowiec A, Juřík R, Wahlich C, Śmigielski W, Steffl M, Tufano JJ, Drygas W, Stastny
P, Harris T, et al. Do physical activity interventions combining selfmonitoring with other
components provide an additional benefit compared with selfmonitoring alone? A systematic
review and meta-analysis. Brit J Sport Med. 2022;56:1366– 1374.
Franssen WMA, Franssen GHLM, Spaas J, Solmi F, Eijnde BO. Can consumer wearable activity
tracker-based interventions improve physical activity and cardiometabolic health in patients
with chronic diseases? A systematic review and meta-analysis of randomised controlled trials.
Int J Behav Nutr Phys Act. 2020;17:57.
Lee LL, Mulvaney CA, Wong YKY, Chan ES, Watson MC, Lin HH. Walking for hypertension.
Cochrane Database Syst Rev. 2021;2021:CD008823.
Thomas RJ, Beatty AL, Beckie TM, Brewer LC, Brown TM, Forman DE, Franklin BA, Keteyian SJ,
Kitzman DW, Regensteiner JG, et al. Home-Based Cardiac Rehabilitation: A Scientific
Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation,
the American Heart Association, and the American College of Cardiology. Circulation.
2019;140:e69–e89.
Vetrovsky T, Siranec M, Frybova T, Gant I, Semerad M, Miklikova M, Bunc V, Vesely J, Stastny J,
Griva M, et al. Statistical analysis plan for a randomized controlled trial examining pedometerbased walking intervention in patients with heart failure with reduced ejection fraction: the
WATCHFUL trial. Trials. 2023;24:539.
Talebi M, Lotfian S, Khalili Y, Taghavi S, Masoudi S. The Effect of Home-Based Exercise Training
on Functional Capacity and Quality of Life in Patients with Heart Failure. Razi J Med Sci.
2021;28(12):249-258.
Fayazi S, Zarea K, Abbasi A, Ahmadi F. Effect of home‐based walking on performance and quality
of life in patients with heart failure. Scand J Caring Sci. 2013;27(2):246-52.
Mohammadi F, Taherian A, Hosseini MA, Rahgozar M. Effect of home-based cardiac rehabilitation
quality of life in the patients with myocardical infarction. Arch Rehabil. 2006;7(3):0-.
Lans C, Cider A, Nylander E, Brudin L. The relationship between six-minute walked distance and
health-related quality of life in patients with chronic heart failure. Scand Cardiovasc J.
2022;56:310–5
Gary RA, Sueta CA, Dougherty M, Rosenberg B, Cheek D, Preisser J, et al. Home-based exercise
improves functional performance and quality of life in women with diastolic heart failure. Heart
Lung. 2004;33(4):210-8
Brubaker, P.H.; Avis, T.; Rejeski, W.J.; Mihalko, S.E.; Tucker, W.J.; Kitzman, D.W. Exercise
Training Effects on the Relationship of Physical Function and Health-Related Quality of Life
Among Older Heart Failure Patients With Preserved Ejection Fraction. J. Cardiopulm. Rehabil.
Prev. 2020, 40, 427–433. [Google Scholar] [CrossRef] [PubMed]
Stamler, J.; Vaccaro, O.; Neaton, J.D.; Wentworth, D. Diabetes, Other Risk Factors, and 12-Yr
Cardiovascular Mortality for Men Screened in the Multiple Risk Factor Intervention Trial.
Diabetes Care 1993, 16, 434–444. [Google Scholar] [CrossRef] [PubMed]
American Diabetes Association. 4. Lifestyle management: Standards of medical care in diabetes2018. Diabetes Care 2018, 41, S38–S50. [Google Scholar] [CrossRef] [PubMed][Green
Version]
Crisafulli, A.; Pagliaro, P.; Roberto, S.; Cugusi, L.; Mercuro, G.; Lazou, A.; Beauloye, C.; Bertrand,
L.; Hausenloy, D.J.; Aragno, M.; et al. Diabetic Cardiomyopathy and Ischemic Heart Disease:
Prevention and Therapy by Exercise and Conditioning. Int. J. Mol. Sci. 2020, 21, 2896. [Google
Scholar] [CrossRef] [PubMed][Green Version]
Andrade GN, Umeda II, Fuchs AR, Mastrocola LE, Rossi-Neto JM, Moreira DA, et al. Home-based
training program in patients with chronic heart failure and reduced ejection fraction: a
randomized pilot study. Clinics (Sao Paulo). 2021;76:e2550.
Gardner AW, Montgomery PS, Wang M, Shen B. Minimal clinically important differences in daily
physical activity outcomes following supervised and home-based exercise in peripheral artery
disease. Vasc Med. 2022;27:142–149.
Kitzman DW, Whellan DJ, Duncan P, Pastva AM, Mentz RJ, Reeves GR, Nelson MB,
Chen H, Upadhya B, Reed SD, et al. Physical Rehabilitation for Older Patients Hospitalized for
Heart Failure. New Engl J Med. 2021;385:203–216.
Pandey A, Keshvani N, Zhong L, Mentz RJ, Piña IL, DeVore AD, Yancy C, Kitzman DW, Fonarow
GC. Temporal Trends and Factors Associated With Cardiac Rehabilitation Participation
Among Medicare Beneficiaries With Heart Failure. JACC Heart Fail. 2021;9:471–481.
Piepoli MF, Binno S, Corrà U, Seferovic P, Conraads V, Jaarsma T, Schmid J-P,
Filippatos G, Ponikowski PP, ESC C on EP& T of the HFA of the. ExtraHF survey: the first
European survey on implementation of exercise training in heart failure patients. Eur J Heart
Fail. 2015;17:631–638.
Nelson RK, Solomon R, Hosmer E, Zuhl M. Cardiac rehabilitation utilization, barriers,
and outcomes among patients with heart failure. Heart Fail Rev. 2023. Ahead of print. doi:
10.1007/s10741-023-10309-2.
Taylor RS, Dalal HM, Zwisler A-D. Cardiac rehabilitation for heart failure: ‘Cinderella’
or evidence-based pillar of care? Eur Heart J. 2023;44:1511–1518.
Heizmann A-N, Chapelle C, Laporte S, Roche F, Hupin D, Hello CL. Impact of wearable
device-based interventions with feedback for increasing daily walking activity and physical
capacities in cardiovascular patients: a systematic review and meta-analysis of randomized
controlled trials. BMJ Open. 2023;13:e069966.
Harris T, Kerry SM, Limb ES, Victor CR, Iliffe S, Ussher M, Whincup PH, Ekelund U,
Fox-Rushby J, Furness C, et al. Effect of a Primary Care Walking Intervention with and
without Nurse Support on Physical Activity Levels in 45- to 75-Year-Olds: The Pedometer And
Consultation Evaluation (PACE-UP) Cluster Randomised Clinical Trial.
)