脑卒中后心肺适应性的研究进展

doi:10.3969/j.issn.1006-9771.2017.11.010

摘要/Abstract

摘要： 脑卒中后患者的心肺适应性下降,可能与骨骼肌系统、胰岛素、心血管系统、呼吸系统等发生改变相关。有氧训练可改善脑卒中患者的心肺适应性,而机器人辅助下的运动训练被认为是脑卒中后超早期及重度脑卒中患者心肺康复的有效方法。

Abstract: Cardiorespiratory fitness (CRF) descends after stroke because of hemiplegia and adaption of insulin, musculoskeletal, cardiovascular and respiratory system. Aerobic exercise training can improve CRF of individuals with stroke, while robotic-assisted exercise is probably safety and effectiveness for patients with severe stroke or patients within one week after stroke.

Key words: stroke, cardiorespiratory fitness, aerobic exercise training, robotics-assisted exercise, review

中图分类号:

R743.3

何庆权, 刘畅, 张志强. 脑卒中后心肺适应性的研究进展[J]. 《中国康复理论与实践》, 2017, 23(11): 1290-1293.

HE Qing-quan, LIU Chang, ZHANG Zhi-qiang. Advance in Cardiorespiratory Fitness after Stroke (review)[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2017, 23(11): 1290-1293.

参考文献

[1] Ivey FM, Macko RF, Ryan AS, et al. Cardiovascular health and fitness after stroke [J]. Top Stroke Rehabil, 2005, 12(1): 1-16.
[2] Smith AC, Saunders DH, Mead G. Cardiorespiratory fitness after stroke: a systematic review [J]. Int J Stroke, 2012, 7(6): 499-510.
[3] Åberg ND, Kuhn HG, Nyberg J, et al. Influence of cardiovascular fitness and muscle strength in early adulthood on long-term risk of stroke in Swedish men [J]. Stroke, 2015, 46(7): 1769-1776.
[4] Kim BR, Han EY, Joo SJ, et al. Cardiovascular fitness as a predictor of functional recovery in subacute stroke patients [J]. Disabil Rehabil, 2014, 36(3): 227-231.
[5] Mac Kay-Lyons MJ, Makrides L. Exercise capacity early after stroke [J]. Arch Phys Med Rehabil, 2002, 83(12): 1697-1702.
[6] Tang A, Sibley KM, Thomas SG, et al. Maximal exercise test results in subacute stroke [J]. Arch Phys Med Rehabil, 2006, 87(8): 1100-1105.
[7] Brooks D, Tang A, Sibley KM, et al. Profile of patients at admission into an inpatient stroke rehabilitation programme: cardiorespiratory fitness and functional characteristics [J]. Physiotherapy Can, 2008, 60(2): 171-179.
[8] Hafer-Macko CE, Yu S, Ryan AS, et al. Elevated tumor necrosis factor-α in skeletal muscle after stroke [J]. Stroke, 2005, 36(9): 2021-2023.
[9] Ivey FM, Hafer-Macko CE, Ryan AS, et al. Impaired leg vasodilatory function after stroke: adaptations with treadmill exercise training [J]. Stroke, 2010, 41(12): 2913-2917.
[10] Dave JA, Engel ME, Freercks R, et al. Abnormal glucose metabolism in non-diabetic patients presenting with an acute stroke: prospective study and systematic review [J]. QJM, 2010, 103(7): 495-503.
[11] Ivey FM, Ryan AS, Hafer-Macko CE, et al. High prevalence of abnormal glucose metabolism and poor sensitivity of fasting plasma glucose in the chronic phase of stroke [J]. Cerebrovasc Dis, 2006, 22(5-6): 368-371.
[12] Coelho Junior HJ, Gambassi BB, Diniz TA, et al. Inflammatory mechanisms associated with skeletal muscle sequelae after stroke: role of physical exercise [J]. Mediators Inflamm, 2016, 2016: 3957958.
[13] Vermeer SE, Sandee W, Algra A, et al. Impaired glucose tolerance increases stroke risk in nondiabetic patients with transient ischemic attack or minor ischemic stroke [J]. Stroke, 2006, 37(6): 1413-1417.
[14] Williamson JW, Fadel PJ, Mitchell JH. New insights into central cardiovascular control during exercise in humans: a central command update [J]. Exp Physiol, 2006, 91(1): 51-58.
[15] Rincon F, Dhamoon M, Moon Y, et al. Stroke location and association with fatal cardiac outcomes: Northern Manhattan study (NOMAS) [J]. Stroke, 2008, 39(9): 2425-2431.
[16] Billinger SA, Kluding PM. Use of Doppler ultrasound to assess femoral artery adaptations in the hemiparetic limb in people with stroke [J]. Cerebrovasc Dis, 2009, 27(6): 552-558.
[17] Ivey FM, Ryan AS, Hafer-Macko CE, et al. Improved cerebral vasomotor reactivity after exercise training in hemiparetic stroke survivors [J]. Stroke, 2011, 42(7): 1994-2000.
[18] Tomczak CR, Jelani A, Haennel RG, et al. Cardiac reserve and pulmonary gas exchange kinetics in patients with stroke [J]. Stroke, 2008, 39(11): 3102-3106.
[19] van de Port IG, Wood-Dauphinee S, Lindeman E, et al. Effects of exercise training programs on walking competency after stroke: a systematic review [J]. Am J Phys Med Rehabil, 2007, 86(11): 935-951.
[20] Tang A, Eng JJ, Krassioukov AV, et al. Exercise-induced changes in cardiovascular function after stroke: a randomized controlled trial [J]. Int J Stroke, 2014, 9(7): 883-889.
[21] Marzolini S, Tang A, McIlroy W, et al. Outcomes in people after stroke attending an adapted cardiac rehabilitation exercise program: does time from stroke make a difference? [J]. J Stroke Cerebrovasc Dis, 2014, 23(6): 1648-1656.
[22] Kuys S, Brauer S, Ada L. Routine physiotherapy does not induce a cardiorespiratory training effect post-stroke, regardless of walking ability [J]. Physiother Res Int, 2006, 11(4): 219-227.
[23] Boyne P, Welge J, Kissela B, et al. Factors influencing the efficacy of aerobic exercise for improving fitness and walking capacity after stroke: a meta-analysis with meta-regression [J]. Arch Phys Med Rehabil, 2017, 98(3): 581-595.
[24] Jin H, Jiang Y, Wei Q, et al. Effects of aerobic cycling training on cardiovascular fitness and heart rate recovery in patients with chronic stroke [J]. NeuroRehabilitation, 2013, 32(2): 327-335.
[25] 范宏娟. 脑卒中不同时期有氧训练对胰岛素抵抗发生的影响研究[D]. 南京:南京医科大学, 2011.
[26] Ryan AS, Ivey FM, Prior S, et al. Skeletal muscle hypertrophy and muscle myostatin reduction after resistive training in stroke survivors [J]. Stroke, 2011, 42(2): 416-420.
[27] 郭娴. 中年人运动中心血管风险预警及运动改善风险和心肺耐力的效果[D]. 北京:北京体育大学, 2014.
[28] Marsden DL, Dunn A, Callister R, et al. Characteristics of exercise training interventions to improve cardiorespiratory fitness after stroke: a systematic review with meta-analysis [J]. Neurorehabil Neural Repair, 2013, 27(9): 775-788.
[29] Stoller O, de Bruin ED, Knols RH, et al. Effects of cardiovascular exercise early after stroke: systematic review and meta-analysis [J]. BMC Neurol, 2012, 12(45): 1-16.
[30] Mackay-Lyons M, McDonald A, Matheson J, et al. Dual effects of body-weight supported treadmill training on cardiovascular fitness and walking ability early after stroke: a randomized controlled trial [J]. Neurorehabil Neural Repair, 2013, 27(7): 644-653.
[31] Chang WH, Kim MS, Huh JP, et al. Effects of robot-assisted gait training on cardiopulmonary fitness in subacute stroke patients: a randomized controlled study [J]. Neurorehabil Neural Repair, 2012, 26(4): 318-324.
[32] Jack LP, Purcell M, Allan DB, et al. Comparison of peak cardiopulmonary performance parameters during robotics-assisted treadmill exercise and arm crank ergometry in incomplete spinal cord injury [J]. Technol Health Care, 2010, 18(4-5): 285-296.
[33] Stoller O, de Bruin ED, Schindelholz M, et al. Evaluation of exercise capacity after severe stroke using robotics-assisted treadmill exercise: a proof-of-concept study [J]. Technol Health Care, 2013, 21: 157-166.
[34] Stoller O, de Bruin ED, Schindelholz M, et al. Efficacy of feedback-controlled robotics-assisted treadmill exercise to improve cardiovascular fitness early after stroke: a randomized controlled pilot trial [J]. J Neurol Phys Ther, 2015, 39(3): 156-165.
[35] Hoekstra F, van Nunen MP, Gerrits KH, et al. Effect of robotic gait training on cardiorespiratory system in incomplete spinal cord injury [J]. J Rehabil Res Dev, 2013, 50(10): 1411-1422.
[36] Lefeber N, Swinnen E, Kerckhofs E. The immediate effects of robot-assistance on energy consumption and cardiorespiratory load during walking compared to walking without robot-assistance: a systematic review [J]. Disabil Rehabil Assist Technol, 2016, 12(7): 657-671.