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Клинические эффекты годичной программы физических тренировок у больных артериальной гипертензией трудоспособного возраста, перенесших острый инфаркт миокарда (Российское рандомизированное контролируемое клиническое исследование)
Клинические эффекты годичной программы физических тренировок у больных артериальной гипертензией трудоспособного возраста, перенесших острый инфаркт миокарда (Российское рандомизированное контролируемое клиническое исследование)
Аронов Д.М., Бубнова М.Г., Красницкий В.Б. и др. Клинические эффекты годичной программы физических тренировок у больных артериальной гипертензией трудоспособного возраста, перенесших острый инфаркт миокарда (Российское рандомизированное контролируемое клиническое исследование). Системные гипертензии. 2015; 12 (4): 61–68.
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Аннотация
Цель исследования. Изучение эффективности длительных физических тренировок средней интенсивности у больных артериальной гипертензией (АГ) трудоспособного возраста, перенесших острый инфаркт миокарда (ОИМ) в рамках Российского рандомизированного исследования.
Материалы и методы. В исследование включены 206 больных АГ, перенесших ОИМ (не ранее 3 нед от события). Пациенты были рандомизированы на 2 группы: основную («О») – 102 человека и контрольную («К») – 104 человека. Все больные получали стандартную медикаментозную терапию. В группе «О» применялись физические тренировки (ФТ) в режиме средней интенсивности (50–60% от выполненной мощности при нагрузочной пробе) 3 раза в неделю в течение 1 года. Эффективность воздействия оценивали по клиническим данным и результатам инструментально-лабораторного анализа.
Результаты. После годичных ФТ у больных АГ, перенесших ОИМ, отмечался достоверный рост физической работоспособности (ФРС) в виде увеличения длительности нагрузки (на 38%; p<0,001) и суммарного объема выполненной физической работы (на 89,7%; p<0,001) на фоне уменьшения нагрузочной величины двойного произведения – ДП (на 8,2%); p<0,01. Это сопровождалось достоверным увеличением фракции выброса левого желудочка на 7,6% (p<0,001) и ударным объемом сердца на 5,1% (p<0,01). В группе «К» не было отмечено положительных сдвигов, напротив, отмечалось достоверное увеличения размеров левого предсердия (на 4,3%, p<0,05) на фоне отсутствия динамики показателей ФРС. При этом под влиянием ФТ произошло снижение уровней артериального давления (АД): систолического АД – на 3,1% (р<0,05) и диастолического АД – на 3,5% (р<0,001) против их повышения в группе нетренировавшихся больных (на 3,1%; р<0,05; и на 3,4%; р<0,05 соответственно). ФТ оказывали антиишемическое воздействие, проявляющееся в снижении эпизодов ишемии миокарда, включая безболевые, приступов стенокардии и потребности применения нитроглицерина в отличие от пациентов группы «К». У тренировавшихся больных обнаруживалось достоверное снижение развития первичной конечной точки на 50% (р<0,05) и дней нетрудоспособности (на 43,2%; p<0,05) против пациентов группы «К».
Заключение. Длительные (годичные) ФТ средней интенсивности у больных АГ, осложненной ОИМ, проводимые на III поликлиническом этапе кардиореабилитации, обеспечивают стабильное течение заболевания, уменьшают вероятность развития сердечно-сосудистых осложнений, улучшают качество жизни пациента и являются безопасными у подавляющего большинства.
Ключевые слова: артериальная гипертензия, инфаркт миокарда, реабилитация, физические тренировки, качество жизни.
Materials and methods. The study included 206 patients with arterial hypertension after acute myocardial infarction (not earlier than 3 weeks from the event). Patients were randomized into 2 groups: basic group 102 and control 104. All patients received standard medical therapy. In the main group used physical training in a mode of medium intensity (50–60% power during a load test) 3 times a week for 1 year. The effectiveness of the intervention was assessed by clinical data and results of instrumental and laboratory analysis.
Results. After a year of physical training in patients with arterial hypertension after acute myocardial infarction, there was a significant increase in physical performance by increasing the load duration (38%; p<0.001) and total volume of performed physical work (89.7 per cent; p<0,001) on the background of decreasing load magnitude a double of the work (8.2%); p<0.01. This was accompanied by a significant increase in ejection fraction of the left ventricle by 7.6% (p<0.001) and stroke volume of the heart by 5.1% (p<0.01). In the control group was not noted positive developments, in contrast, showed a significant increase in the left atrium (4.3%, p<0.05) on the absence of dynamics of indicators of physical performance. Under the effect of physical training decreased blood pressure levels: systolic blood pressure –3.1% (p<0.05) and diastolic blood pressure by 3.5% (p<0.001) against the increase in the group natrenirovavshit patients (3.1%; p<0.05; and 3.4%; p<0.05 respectively). Physical exercise exerted anti-ischemic effect, which is manifested in the reduction of episodes of myocardial ischemia, including silent, and of angina attacks and consumption of nitroglycerin unlike patients of the control group. The trained patients showed a significant decrease in the primary endpoint of 50% (p<0.05) and disability days (by 43.2%; p<0.05) against the control group.
Conclusion. Long-term (one year) of physical exercise of moderate intensity in patients with arterial hypertension complicated by acute myocardial infarction, conducted on III outpatient phase of cardiac rehabilitation provides a stable course of the disease, reduce the risk of cardiovascular complications, improve the patient's quality of life and are safe in the vast majority.
Key words: arterial hypertension, myocardial infarction, rehabilitation, physical exercise, quality of life.
Материалы и методы. В исследование включены 206 больных АГ, перенесших ОИМ (не ранее 3 нед от события). Пациенты были рандомизированы на 2 группы: основную («О») – 102 человека и контрольную («К») – 104 человека. Все больные получали стандартную медикаментозную терапию. В группе «О» применялись физические тренировки (ФТ) в режиме средней интенсивности (50–60% от выполненной мощности при нагрузочной пробе) 3 раза в неделю в течение 1 года. Эффективность воздействия оценивали по клиническим данным и результатам инструментально-лабораторного анализа.
Результаты. После годичных ФТ у больных АГ, перенесших ОИМ, отмечался достоверный рост физической работоспособности (ФРС) в виде увеличения длительности нагрузки (на 38%; p<0,001) и суммарного объема выполненной физической работы (на 89,7%; p<0,001) на фоне уменьшения нагрузочной величины двойного произведения – ДП (на 8,2%); p<0,01. Это сопровождалось достоверным увеличением фракции выброса левого желудочка на 7,6% (p<0,001) и ударным объемом сердца на 5,1% (p<0,01). В группе «К» не было отмечено положительных сдвигов, напротив, отмечалось достоверное увеличения размеров левого предсердия (на 4,3%, p<0,05) на фоне отсутствия динамики показателей ФРС. При этом под влиянием ФТ произошло снижение уровней артериального давления (АД): систолического АД – на 3,1% (р<0,05) и диастолического АД – на 3,5% (р<0,001) против их повышения в группе нетренировавшихся больных (на 3,1%; р<0,05; и на 3,4%; р<0,05 соответственно). ФТ оказывали антиишемическое воздействие, проявляющееся в снижении эпизодов ишемии миокарда, включая безболевые, приступов стенокардии и потребности применения нитроглицерина в отличие от пациентов группы «К». У тренировавшихся больных обнаруживалось достоверное снижение развития первичной конечной точки на 50% (р<0,05) и дней нетрудоспособности (на 43,2%; p<0,05) против пациентов группы «К».
Заключение. Длительные (годичные) ФТ средней интенсивности у больных АГ, осложненной ОИМ, проводимые на III поликлиническом этапе кардиореабилитации, обеспечивают стабильное течение заболевания, уменьшают вероятность развития сердечно-сосудистых осложнений, улучшают качество жизни пациента и являются безопасными у подавляющего большинства.
Ключевые слова: артериальная гипертензия, инфаркт миокарда, реабилитация, физические тренировки, качество жизни.
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Materials and methods. The study included 206 patients with arterial hypertension after acute myocardial infarction (not earlier than 3 weeks from the event). Patients were randomized into 2 groups: basic group 102 and control 104. All patients received standard medical therapy. In the main group used physical training in a mode of medium intensity (50–60% power during a load test) 3 times a week for 1 year. The effectiveness of the intervention was assessed by clinical data and results of instrumental and laboratory analysis.
Results. After a year of physical training in patients with arterial hypertension after acute myocardial infarction, there was a significant increase in physical performance by increasing the load duration (38%; p<0.001) and total volume of performed physical work (89.7 per cent; p<0,001) on the background of decreasing load magnitude a double of the work (8.2%); p<0.01. This was accompanied by a significant increase in ejection fraction of the left ventricle by 7.6% (p<0.001) and stroke volume of the heart by 5.1% (p<0.01). In the control group was not noted positive developments, in contrast, showed a significant increase in the left atrium (4.3%, p<0.05) on the absence of dynamics of indicators of physical performance. Under the effect of physical training decreased blood pressure levels: systolic blood pressure –3.1% (p<0.05) and diastolic blood pressure by 3.5% (p<0.001) against the increase in the group natrenirovavshit patients (3.1%; p<0.05; and 3.4%; p<0.05 respectively). Physical exercise exerted anti-ischemic effect, which is manifested in the reduction of episodes of myocardial ischemia, including silent, and of angina attacks and consumption of nitroglycerin unlike patients of the control group. The trained patients showed a significant decrease in the primary endpoint of 50% (p<0.05) and disability days (by 43.2%; p<0.05) against the control group.
Conclusion. Long-term (one year) of physical exercise of moderate intensity in patients with arterial hypertension complicated by acute myocardial infarction, conducted on III outpatient phase of cardiac rehabilitation provides a stable course of the disease, reduce the risk of cardiovascular complications, improve the patient's quality of life and are safe in the vast majority.
Key words: arterial hypertension, myocardial infarction, rehabilitation, physical exercise, quality of life.
Полный текст
Список литературы
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40. Бубнова М.Г., Аронов Д.М., Перова Н.В., Зволинская Е.Ю. Физические нагрузки и атеросклероз: влияние динамических нагрузок разной интенсивности на показатели липид-транспортной системы и углеводного обмена у больных коронарной болезнью сердца и сахарным диабетом 2 типа. Кардиология. 2005; 11: 33–40. / Bubnova M.G., Aronov D.M., Perova N.V., Zvolinskaia E.Iu. Fizicheskie nagruzki i ateroskleroz: vliianie dinamicheskikh nagruzok raznoi intensivnosti na pokazateli lipid-transportnoi sistemy i uglevodnogo obmena u bol'nykh koronarnoi bolezn'iu serdtsa i sakharnym diabetom 2 tipa. Kardiologiia. 2005; 11: 33–40. [in Russian]
41. Аронов Д.М., Бубнова М.Г., Перова Н.В., Бондаренко И.З. Разнонаправленное влияние физических нагрузок разного вида и интенсивности на показатели липидтранспортной системы крови у здоровых и больных коронарной болезнью сердца. Терапевт. арх. 2005; 9: 43–9. / Aronov D.M., Bubnova M.G., Perova N.V., Bondarenko I.Z. Raznonapravlennoe vliianiе fizicheskikh nagruzok raznogo vida i intensivnosti na pokazateli lipidtransportnoi sistemy krovi u zdorovykh i bol'nykh koronarnoi bolezn'iu serdtsa. Terapevt. arkh. 2005; 9: 43–9. [in Russian]
42. Yuhanna IS, Zhu Y, Cox BE et al. High-density lipoprotein binding to scavenger receptor-BI activates endothelial nitric oxide synthase. Nat Med 2001; 7: 853–7.
43. Taylor RS, Brown A, Ebrahim S et al. Exercise-based rehabilitation for patients with coronary heart disease: review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682–92.
44. Clark AM, Hartling L, Vandermeer B et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659–72.
45. Hambrecht R, Niebauer J, Marburger CH et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol 1993; 22: 468–77.
46. Niebauer J, Hambrecht R, Velich T et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96: 2534–41.
47. Martin BJ, Hauer T, Arena R et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients/clinical perspective. Circulation 2012; 126: 677–87.
48. Zwisler ADO, Soja AMB, Rasmussen S et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J 2008; 155: 1106–13.
2. De Ciuceis C, Porteri E, Rizzoni D et al. Structural alterations of subcutaneous small-resistance arteries may predict major cardiovascular events in patients with hypertension. Am J Hypertens 2007; 20: 846–52.
3. Rizzoni D, Palombo C, Porteri E et al. Relationships between coronary flow vasodilator capacity and small artery remodeling in hypertensive patients. J Hypertens 2003; 21: 625–31.
4. Li JJ, Chen JL. Inflammation may be a bridge connecting hypertension and atherosclerosis. Med Hypotheses 2005; 64 (5): 925–9.
5. Rosenfeld ME. An overview of the evolution of the atherosclerotic plaque: from fatty streak to plaque rupture and thrombosis. Z Kardiol 2000; 89 (Suppl. 7): 2–6.
6. Matsushita M, Nishikimi N, Sakurai T, Nimura Y. Relationship between aortic calcification and atherosclerotic disease in patients with abdominal aortic aneurysm. Int Angiol 2000; 19 (3): 276–9.
7. Theroux P, Fuster V. Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction. Circulation 1998; 97 (12): 1195–206.
8. Wasserman BA. Clinical carotid atherosclerosis. Neuroimaging Clin N Am 2002; 12 (3): 403–19.
9. Natali A, Vichi S, Landi P et al. Coronary artery disease and arterial hypertension: clinical, angiographic and follow-up data. Intern Med 2000; 247: 219–30.
10. Bubnova M.G., Aronov D.M., Oganov R.G. i dr. (ot imeni issledovatelei) Klinicheskaia kharakteristika i obshchie podkhody k lecheniiu patsientov so stabil'noi stenokardiei v real'noi praktike. Rossiiskoe issledovanie «PERSPEKTIVA» (chast' I). Kardiovask. terapiia i profilaktika. 2010; 6: 47–56. [in Russian]
11. Steg PhG, Greenlaw N, Tardif J-C et al. on behalf of the CLARIFY Registry Investigators. Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry. Eur Heart J 2012; 33: 2831–40. Doi:10.1093/eurheartj/ehs289.
12. Teylor RS et al. Exercise-based rehabilitation for patients with coronary heart disease: review and metaanalysis of randomized controlled trials. Am J Med 2004; 116: 682–97.
13. Arakawa K. Antihypertensive mechanism of exercise. J Hypertens 1993; 11: 223–9.
14. Hornig B, Maier V, Drexler H. Physical training improves endothelial function in patients with chronic heart failure. Circulation 1996; 93: 210–4.
15. Hambrecht R, Wolf A, Gielen S et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J 2000; 342 (7): 454–60.
16. Schuler G, Hambrecht R, Schiert G et al. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation 1992; 86 (1): 1–11.
17. Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis. Semin Thromb Hemost 2009; 35: 269–76.
18. Aronov D.M., Bubnova M.G. Problemy vnedreniia novoi sistemy kardioreabilitatsii v Rossii. Ros. kardiol. zhurn. 2013; 4 (102): 14–22. [in Russian]
19. Aronov D.M., Bubnova M.G., Krasnitskii V.B. Kompleksnaia reabilitatsiia kardiologicheskikh bol'nykh: novye realii. Vestn. vosstanovitel'noi meditsiny. 2014, 6: 2–10. [in Russian]
20. Aronov D.M., Krasnitskii V.B., Bubnova M.G. i dr. Vliianie fizicheskikh trenirovok na fizicheskuiu rabotosposobnost', gemodinamiku, lipidy krovi, klinicheskoe techenie i prognoz u bol'nykh ishemicheskoi bolezn'iu serdtsa posle ostrykh koronarnykh sobytii pri kompleksnoi reabilitatsii i vtorichnoi profilaktike na ambulatorno-poliklinicheskom etape (Rossiiskoe kooperativnoe issledovanie). Kardiologiia. 2009; 3: 49–56. [in Russian]
21. Krasnitskii V.B., Aronov D.M., Dzhankhotov S.O. Izuchenie fizicheskoi aktivnosti u bol'nykh IBS s pomoshch'iu spetsializirovannogo Oprosnika Dvigatel'noi Aktivnosti «ODA-23+». Kardiovask. terapiia i profilaktika. 2011; 8: 90–7. [in Russian]
22. Gladkov A.G., Zaitsev V.P., Aronov D.M., Sharfnadel' M.G. Otsenka kachestva zhizni bol'nykh s serdechno-sosudistymi zabolevaniiami. Kardiologiia. 1982; 2: 100–3. [in Russian]
23. Leon AS, Franklin BA, Costa F et al. Cardiac rehabilitation and secondary prevention of coronary heart disease:an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369–76.
24. Sallis JF, Hovell MF, Hofstetter CR. Predictors of adoption and maintenance of vigorous physical activity in men and women. Prev Med 1992; 21: 237–51.
25. Bubnova M.G., Aronov D.M., Krasnitskii V.B. i dr. Programma domashnikh fizicheskikh trenirovok posle ostrogo koronarnogo sindroma i/ili endovaskuliarnogo vmeshatel'stva na koronarnykh arteriiakh: effektivnost' i problema motivatsii bol'nykh. Terapevt. arkh. 2014; 86 (1): 23–32. [in Russian]
26. Bubnova M.G. Diet, atherogenic hyperlipidemia and statins. Cardiosomatics. 2011; 2 (2): 81–9. [in Russian]
27. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001; 33 (Suppl.): S484–S492.
28. Whelton SP, Chin A, Xin X, He J. Effects of aerobic exercise on blood pressure: A meta-analysis of randomised, controlled trials. Ann Intern Med 2002; 136: 493–503.
29. Turnbull F, Neal B, Ninomiya T et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008; 336: 1121–3.
30. Nelson L, Jennings GL, Esler MD, Korner PI. Effect of changing levels of physical activity on blood-pressure and haemodynamics in essential hypertension. Lancet 1986; 2: 473–6.
31. Brown MD, Dengel DR, Hogikyan RV, Supiano MA. Sympathetic activity and the heterogenous blood pressure response to exercise training in hypertensives. J Appl Physiol 2002; 92: 1434–42.
32. Maeda S, Miyauchi T, Kakiyama T. Effects of exercise training of 8 weeks and detraining on plasma levels of endothelium-derived factors, endothelin-1 a, endothelin-1 and nitric oxide, in healthy young humans. Life Sci 2001; 69: 1005–16.
33. Kingwell BA. Nitric oxide-mediated metabolic regulation during exercise: effects of training in health and cardiovascular disease. FASEB J 2000; 14: 1685–96.
34. Schuler G, Adams V, Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. Eur Heart J 2013; 34: 1790–9. Doi: 10.1093/eurheartj/eht111.
35. Roth DM, White FC, Nichols ML et al. Effect of long-term exercise on regional myocardial function and coronary collateral development after gradual coronary artery occlusion in pigs. Circulation 1990; 82: 1778–89.
36. Heaps CL, Parker JL. Effects of exercise training on coronary collateralization and control of collateral resistance. J Appl Physiol 2011; 111: 587–98.
37. Zbinden R, Zbinden S, Meier P et al. Coronary collateral flow in response to endurance exercise training. Eur J Cardiovasc Prev Rehabil 2007; 14: 250–7.
38. Lu X, Wu T, Huang P et al. Effect and mechanism of intermittent myocardial ischemia induced by exercise on coronary collateral formation. Am J Phys Med Rehabil 2008; 87: 803–14.
39. Bubnova M.G., Aronov D.M., Perova N.V. i dr. Fizicheskie nagruzki i ateroskleroz: dinamicheskie fizicheskie nagruzki vysokoi intensivnosti kak faktor, indutsiruiushchii ekzogennuiu dislipidemiiu. Kardiologiia. 2003; 3: 43–9. [in Russian]
40. Bubnova M.G., Aronov D.M., Perova N.V., Zvolinskaia E.Iu. Fizicheskie nagruzki i ateroskleroz: vliianie dinamicheskikh nagruzok raznoi intensivnosti na pokazateli lipid-transportnoi sistemy i uglevodnogo obmena u bol'nykh koronarnoi bolezn'iu serdtsa i sakharnym diabetom 2 tipa. Kardiologiia. 2005; 11: 33–40. [in Russian]
41. Aronov D.M., Bubnova M.G., Perova N.V., Bondarenko I.Z. Raznonapravlennoe vliianiе fizicheskikh nagruzok raznogo vida i intensivnosti na pokazateli lipidtransportnoi sistemy krovi u zdorovykh i bol'nykh koronarnoi bolezn'iu serdtsa. Terapevt. arkh. 2005; 9: 43–9. [in Russian]
42. Yuhanna IS, Zhu Y, Cox BE et al. High-density lipoprotein binding to scavenger receptor-BI activates endothelial nitric oxide synthase. Nat Med 2001; 7: 853–7.
43. Taylor RS, Brown A, Ebrahim S et al. Exercise-based rehabilitation for patients with coronary heart disease: review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682–92.
44. Clark AM, Hartling L, Vandermeer B et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659–72.
45. Hambrecht R, Niebauer J, Marburger CH et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol 1993; 22: 468–77.
46. Niebauer J, Hambrecht R, Velich T et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96: 2534–41.
47. Martin BJ, Hauer T, Arena R et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients/clinical perspective. Circulation 2012; 126: 677–87.
48. Zwisler ADO, Soja AMB, Rasmussen S et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J 2008; 155: 1106–13.
2. De Ciuceis C, Porteri E, Rizzoni D et al. Structural alterations of subcutaneous small-resistance arteries may predict major cardiovascular events in patients with hypertension. Am J Hypertens 2007; 20: 846–52.
3. Rizzoni D, Palombo C, Porteri E et al. Relationships between coronary flow vasodilator capacity and small artery remodeling in hypertensive patients. J Hypertens 2003; 21: 625–31.
4. Li JJ, Chen JL. Inflammation may be a bridge connecting hypertension and atherosclerosis. Med Hypotheses 2005; 64 (5): 925–9.
5. Rosenfeld ME. An overview of the evolution of the atherosclerotic plaque: from fatty streak to plaque rupture and thrombosis. Z Kardiol 2000; 89 (Suppl. 7): 2–6.
6. Matsushita M, Nishikimi N, Sakurai T, Nimura Y. Relationship between aortic calcification and atherosclerotic disease in patients with abdominal aortic aneurysm. Int Angiol 2000; 19 (3): 276–9.
7. Theroux P, Fuster V. Acute coronary syndromes: unstable angina and non-Q-wave myocardial infarction. Circulation 1998; 97 (12): 1195–206.
8. Wasserman BA. Clinical carotid atherosclerosis. Neuroimaging Clin N Am 2002; 12 (3): 403–19.
9. Natali A, Vichi S, Landi P et al. Coronary artery disease and arterial hypertension: clinical, angiographic and follow-up data. Intern Med 2000; 247: 219–30.
10. Бубнова М.Г., Аронов Д.М., Оганов Р.Г. и др. (от имени исследователей) Клиническая характеристика и общие подходы к лечению пациентов со стабильной стенокардией в реальной практике. Российское исследование «ПЕРСПЕКТИВА» (часть I). Кардиоваск. терапия и профилактика. 2010; 6: 47–56. / Bubnova M.G., Aronov D.M., Oganov R.G. i dr. (ot imeni issledovatelei) Klinicheskaia kharakteristika i obshchie podkhody k lecheniiu patsientov so stabil'noi stenokardiei v real'noi praktike. Rossiiskoe issledovanie «PERSPEKTIVA» (chast' I). Kardiovask. terapiia i profilaktika. 2010; 6: 47–56. [in Russian]
11. Steg PhG, Greenlaw N, Tardif J-C et al. on behalf of the CLARIFY Registry Investigators. Women and men with stable coronary artery disease have similar clinical outcomes: insights from the international prospective CLARIFY registry. Eur Heart J 2012; 33: 2831–40. Doi:10.1093/eurheartj/ehs289.
12. Teylor RS et al. Exercise-based rehabilitation for patients with coronary heart disease: review and metaanalysis of randomized controlled trials. Am J Med 2004; 116: 682–97.
13. Arakawa K. Antihypertensive mechanism of exercise. J Hypertens 1993; 11: 223–9.
14. Hornig B, Maier V, Drexler H. Physical training improves endothelial function in patients with chronic heart failure. Circulation 1996; 93: 210–4.
15. Hambrecht R, Wolf A, Gielen S et al. Effect of exercise on coronary endothelial function in patients with coronary artery disease. N Engl J 2000; 342 (7): 454–60.
16. Schuler G, Hambrecht R, Schiert G et al. Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease. Circulation 1992; 86 (1): 1–11.
17. Lippi G, Maffulli N. Biological influence of physical exercise on hemostasis. Semin Thromb Hemost 2009; 35: 269–76.
18. Аронов Д.М., Бубнова М.Г. Проблемы внедрения новой системы кардиореабилитации в России. Рос. кардиол. журн. 2013; 4 (102): 14–22. / Aronov D.M., Bubnova M.G. Problemy vnedreniia novoi sistemy kardioreabilitatsii v Rossii. Ros. kardiol. zhurn. 2013; 4 (102): 14–22. [in Russian]
19. Аронов Д.М., Бубнова М.Г., Красницкий В.Б. Комплексная реабилитация кардиологических больных: новые реалии. Вестн. восстановительной медицины. 2014, 6: 2–10. / Aronov D.M., Bubnova M.G., Krasnitskii V.B. Kompleksnaia reabilitatsiia kardiologicheskikh bol'nykh: novye realii. Vestn. vosstanovitel'noi meditsiny. 2014, 6: 2–10. [in Russian]
20. Аронов Д.М., Красницкий В.Б., Бубнова М.Г. и др. Влияние физических тренировок на физическую работоспособность, гемодинамику, липиды крови, клиническое течение и прогноз у больных ишемической болезнью сердца после острых коронарных событий при комплексной реабилитации и вторичной профилактике на амбулаторно-поликлиническом этапе (Российское кооперативное исследование). Кардиология. 2009; 3: 49–56. / Aronov D.M., Krasnitskii V.B., Bubnova M.G. i dr. Vliianie fizicheskikh trenirovok na fizicheskuiu rabotosposobnost', gemodinamiku, lipidy krovi, klinicheskoe techenie i prognoz u bol'nykh ishemicheskoi bolezn'iu serdtsa posle ostrykh koronarnykh sobytii pri kompleksnoi reabilitatsii i vtorichnoi profilaktike na ambulatorno-poliklinicheskom etape (Rossiiskoe kooperativnoe issledovanie). Kardiologiia. 2009; 3: 49–56. [in Russian]
21. Красницкий В.Б., Аронов Д.М., Джанхотов С.О. Изучение физической активности у больных ИБС с помощью специализированного Опросника Двигательной Активности «ОДА-23+». Кардиоваск. терапия и профилактика. 2011; 8: 90–7. / Krasnitskii V.B., Aronov D.M., Dzhankhotov S.O. Izuchenie fizicheskoi aktivnosti u bol'nykh IBS s pomoshch'iu spetsializirovannogo Oprosnika Dvigatel'noi Aktivnosti «ODA-23+». Kardiovask. terapiia i profilaktika. 2011; 8: 90–7. [in Russian]
22. Гладков А.Г., Зайцев В.П., Аронов Д.М., Шарфнадель М.Г. Оценка качества жизни больных с сердечно-сосудистыми заболеваниями. Кардиология. 1982; 2: 100–3. / Gladkov A.G., Zaitsev V.P., Aronov D.M., Sharfnadel' M.G. Otsenka kachestva zhizni bol'nykh s serdechno-sosudistymi zabolevaniiami. Kardiologiia. 1982; 2: 100–3. [in Russian]
23. Leon AS, Franklin BA, Costa F et al. Cardiac rehabilitation and secondary prevention of coronary heart disease:an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111: 369–76.
24. Sallis JF, Hovell MF, Hofstetter CR. Predictors of adoption and maintenance of vigorous physical activity in men and women. Prev Med 1992; 21: 237–51.
25. Бубнова М.Г., Аронов Д.М., Красницкий В.Б. и др. Программа домашних физических тренировок после острого коронарного синдрома и/или эндоваскулярного вмешательства на коронарных артериях: эффективность и проблема мотивации больных. Терапевт. арх. 2014; 86 (1): 23–32. / Bubnova M.G., Aronov D.M., Krasnitskii V.B. i dr. Programma domashnikh fizicheskikh trenirovok posle ostrogo koronarnogo sindroma i/ili endovaskuliarnogo vmeshatel'stva na koronarnykh arteriiakh: effektivnost' i problema motivatsii bol'nykh. Terapevt. arkh. 2014; 86 (1): 23–32. [in Russian]
26. Бубнова М.Г. Питание, атерогенные гиперлипидемии и статины. КардиоСоматика. 2011; 2: 81–9. / Bubnova M.G. Diet, atherogenic hyperlipidemia and statins. Cardiosomatics. 2011; 2 (2): 81–9. [in Russian]
27. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc 2001; 33 (Suppl.): S484–S492.
28. Whelton SP, Chin A, Xin X, He J. Effects of aerobic exercise on blood pressure: A meta-analysis of randomised, controlled trials. Ann Intern Med 2002; 136: 493–503.
29. Turnbull F, Neal B, Ninomiya T et al. Effects of different regimens to lower blood pressure on major cardiovascular events in older and younger adults: meta-analysis of randomised trials. BMJ 2008; 336: 1121–3.
30. Nelson L, Jennings GL, Esler MD, Korner PI. Effect of changing levels of physical activity on blood-pressure and haemodynamics in essential hypertension. Lancet 1986; 2: 473–6.
31. Brown MD, Dengel DR, Hogikyan RV, Supiano MA. Sympathetic activity and the heterogenous blood pressure response to exercise training in hypertensives. J Appl Physiol 2002; 92: 1434–42.
32. Maeda S, Miyauchi T, Kakiyama T. Effects of exercise training of 8 weeks and detraining on plasma levels of endothelium-derived factors, endothelin-1 a, endothelin-1 and nitric oxide, in healthy young humans. Life Sci 2001; 69: 1005–16.
33. Kingwell BA. Nitric oxide-mediated metabolic regulation during exercise: effects of training in health and cardiovascular disease. FASEB J 2000; 14: 1685–96.
34. Schuler G, Adams V, Goto Y. Role of exercise in the prevention of cardiovascular disease: results, mechanisms, and new perspectives. Eur Heart J 2013; 34: 1790–9. Doi: 10.1093/eurheartj/eht111.
35. Roth DM, White FC, Nichols ML et al. Effect of long-term exercise on regional myocardial function and coronary collateral development after gradual coronary artery occlusion in pigs. Circulation 1990; 82: 1778–89.
36. Heaps CL, Parker JL. Effects of exercise training on coronary collateralization and control of collateral resistance. J Appl Physiol 2011; 111: 587–98.
37. Zbinden R, Zbinden S, Meier P et al. Coronary collateral flow in response to endurance exercise training. Eur J Cardiovasc Prev Rehabil 2007; 14: 250–7.
38. Lu X, Wu T, Huang P et al. Effect and mechanism of intermittent myocardial ischemia induced by exercise on coronary collateral formation. Am J Phys Med Rehabil 2008; 87: 803–14.
39. Бубнова М.Г., Аронов Д.М., Перова Н.В. и др. Физические нагрузки и атеросклероз: динамические физические нагрузки высокой интенсивности как фактор, индуцирующий экзогенную дислипидемию. Кардиология. 2003; 3: 43–9. / Bubnova M.G., Aronov D.M., Perova N.V. i dr. Fizicheskie nagruzki i ateroskleroz: dinamicheskie fizicheskie nagruzki vysokoi intensivnosti kak faktor, indutsiruiushchii ekzogennuiu dislipidemiiu. Kardiologiia. 2003; 3: 43–9. [in Russian]
40. Бубнова М.Г., Аронов Д.М., Перова Н.В., Зволинская Е.Ю. Физические нагрузки и атеросклероз: влияние динамических нагрузок разной интенсивности на показатели липид-транспортной системы и углеводного обмена у больных коронарной болезнью сердца и сахарным диабетом 2 типа. Кардиология. 2005; 11: 33–40. / Bubnova M.G., Aronov D.M., Perova N.V., Zvolinskaia E.Iu. Fizicheskie nagruzki i ateroskleroz: vliianie dinamicheskikh nagruzok raznoi intensivnosti na pokazateli lipid-transportnoi sistemy i uglevodnogo obmena u bol'nykh koronarnoi bolezn'iu serdtsa i sakharnym diabetom 2 tipa. Kardiologiia. 2005; 11: 33–40. [in Russian]
41. Аронов Д.М., Бубнова М.Г., Перова Н.В., Бондаренко И.З. Разнонаправленное влияние физических нагрузок разного вида и интенсивности на показатели липидтранспортной системы крови у здоровых и больных коронарной болезнью сердца. Терапевт. арх. 2005; 9: 43–9. / Aronov D.M., Bubnova M.G., Perova N.V., Bondarenko I.Z. Raznonapravlennoe vliianiе fizicheskikh nagruzok raznogo vida i intensivnosti na pokazateli lipidtransportnoi sistemy krovi u zdorovykh i bol'nykh koronarnoi bolezn'iu serdtsa. Terapevt. arkh. 2005; 9: 43–9. [in Russian]
42. Yuhanna IS, Zhu Y, Cox BE et al. High-density lipoprotein binding to scavenger receptor-BI activates endothelial nitric oxide synthase. Nat Med 2001; 7: 853–7.
43. Taylor RS, Brown A, Ebrahim S et al. Exercise-based rehabilitation for patients with coronary heart disease: review and meta-analysis of randomized controlled trials. Am J Med 2004; 116: 682–92.
44. Clark AM, Hartling L, Vandermeer B et al. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med 2005; 143: 659–72.
45. Hambrecht R, Niebauer J, Marburger CH et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol 1993; 22: 468–77.
46. Niebauer J, Hambrecht R, Velich T et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997; 96: 2534–41.
47. Martin BJ, Hauer T, Arena R et al. Cardiac rehabilitation attendance and outcomes in coronary artery disease patients/clinical perspective. Circulation 2012; 126: 677–87.
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48. Zwisler ADO, Soja AMB, Rasmussen S et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J 2008; 155: 1106–13.
Авторы
Д.М.Аронов1, М.Г.Бубнова*1, В.Б.Красницкий1, Д.Г.Иоселиани2, Ю.И.Гринштейн3, С.Ф.Гуляева4, Г.Г.Ефремушкин5, Н.П.Лямина6
1 ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
2 ГБУЗ Научно-практический центр интервенционной кардиоангиологии Департамента здравоохранения г. Москвы. 101000, Россия, Москва, Сверчков пер., д. 5;
3 ГБОУ ВПО Красноярский государственный медицинский университет им. проф. В.Ф.Войно-Ясенецкого Минздрава России. 660022, Россия, Красноярск, ул. Партизана Железняка, д. 1;
4 ГБОУ ВПО Кировская государственная медицинская академия Минздрава России. 610998, Россия, Киров, ул. К.Маркса, д. 112;
5 ГБОУ ВПО Алтайский государственный медицинский университет Минздрава России. 656038, Россия, Барнаул, пр-т Ленина, д. 40;
6 ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратов, ул. Большая Казачья, д. 112
*mbubnova@gnicpm.ru
1 State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3;
2 Scientific and Practical Center of interventional cardiology of the Department of Health of Moscow. 101000, Russian Federation, Moscow, Sverchkov per., d. 5;
3 Prof. V.F.Voino-Yasenetski Krasnoyarsk State Medical University of the Ministry of Health of the Russian Federation. 660022, Russian Federation, Krasnoyarsk, ul. Partizana Zhelezniaka, d. 1;
4 Kirov State Medical Academy of the Ministry of Health of the Russian Federation. 610998, Russian Federation, Kirov, ul. K.Marks, d. 112;
5 Altai State Medical University of the Ministry of Health of the Russian Federation. 656038, Russian Federation, Barnaul, pr-t Lenina, d. 40;
6 V.I.Razumovsky State Medical University of the Ministry of Health of the Russian Federation. 410012, Russian Federation, Saratov, ul. Bolshaia Kozachia, d.112
*mbubnova@gnicpm.ru
1 ФГБУ Государственный научно-исследовательский центр профилактической медицины Минздрава России. 101990, Россия, Москва, Петроверигский пер., д. 10, стр. 3;
2 ГБУЗ Научно-практический центр интервенционной кардиоангиологии Департамента здравоохранения г. Москвы. 101000, Россия, Москва, Сверчков пер., д. 5;
3 ГБОУ ВПО Красноярский государственный медицинский университет им. проф. В.Ф.Войно-Ясенецкого Минздрава России. 660022, Россия, Красноярск, ул. Партизана Железняка, д. 1;
4 ГБОУ ВПО Кировская государственная медицинская академия Минздрава России. 610998, Россия, Киров, ул. К.Маркса, д. 112;
5 ГБОУ ВПО Алтайский государственный медицинский университет Минздрава России. 656038, Россия, Барнаул, пр-т Ленина, д. 40;
6 ГБОУ ВПО Саратовский государственный медицинский университет им. В.И.Разумовского Минздрава России. 410012, Россия, Саратов, ул. Большая Казачья, д. 112
*mbubnova@gnicpm.ru
________________________________________________
1 State Research Center for Preventive Medicine of the Ministry of Health of the Russian Federation. 101000, Russian Federation, Moscow, Petroverigsky per., d. 10, str. 3;
2 Scientific and Practical Center of interventional cardiology of the Department of Health of Moscow. 101000, Russian Federation, Moscow, Sverchkov per., d. 5;
3 Prof. V.F.Voino-Yasenetski Krasnoyarsk State Medical University of the Ministry of Health of the Russian Federation. 660022, Russian Federation, Krasnoyarsk, ul. Partizana Zhelezniaka, d. 1;
4 Kirov State Medical Academy of the Ministry of Health of the Russian Federation. 610998, Russian Federation, Kirov, ul. K.Marks, d. 112;
5 Altai State Medical University of the Ministry of Health of the Russian Federation. 656038, Russian Federation, Barnaul, pr-t Lenina, d. 40;
6 V.I.Razumovsky State Medical University of the Ministry of Health of the Russian Federation. 410012, Russian Federation, Saratov, ul. Bolshaia Kozachia, d.112
*mbubnova@gnicpm.ru
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