| 摘要: | 目的：以系統性回顧及網絡統合分析方式探討不同強度及種類的運動訓練對於低收縮分率心臟衰竭患者的成效。
方法： 本研究為之系統性文獻回顧及網絡統合分析，將納入探討運動強度改善低收縮分率心臟衰竭患者的生理指標、生活品質及憂鬱的隨機臨床試驗。預計於Embase、PubMed、Web of Science、ProQuest等電子資料庫進行搜索，納入英文、文獻不限年分。經由兩位研究者獨立透過revised The Joanna Briggs Institute appraisal tool for Randomized control trials進行文獻品質評估。本研究採隨機效應模型網絡統合分析方式進行資料分析，使用R 4.2.3統計軟體操作。
結果：本研究共納82篇隨機對照試驗，總樣本數為7,311人。在尖峰攝氧量的部分，相較於常規治療，高強度間歇性有氧運動、阻力運動、中強度有氧運動、中強度有氧運動合併阻力運動在尖峰攝氧量可分別改善3.46、3.38、2.53以及2.42 ml/kg/min。在左心室射出分率的成效，高強度間歇性有氧運動比起中強度有氧運動合併阻力運動、阻力運動以及常規治療，分別可改善4.93%、7.15%以及6.45%。當中強度有氧運動與常規治療相比較，可以增加3.76%的左心室射出分率。在六分鐘走路測試的部分，與常規治療相比，中強度有氧運動合併阻力運動、高強度間歇性有氧運動以及中強度有氧運動在六分鐘走路運動的總效果量分別可改善61.56、64.17以及40.13公尺。在生活品質的部分，與常規治療相比，高強度間歇性有氧運動、中強度有氧運動合併阻力運動以及中強度有氧運動分別可減少1.94 分、1.73分以及1.32分。而無論何種運動訓練組合皆無法統計顯著的改善憂鬱。在治療累積排名的部分，高強度間歇性有氧運動分別在尖峰攝氧量、左心室射出分率、生活品質皆有最高機率成為最佳治療；中強度有氧運動合併阻力運動則在六分鐘走路測試部分有最高機率成為最佳治療。
結論：本研究建議高強度間歇性有氧運動可用於改善低收縮分率心臟衰竭患者的生理指標以及生活品質。建議患者可於醫護人員指導下執行高強度間歇性有氧運動
Purpose: To compare the effects of different intensities and types of exercise training on physical performance, quality of life, and depression in patients with reduced ejection fraction heart failure.
Method: This study was a systematic review and network meta-analysis. Only randomized clinical trials exploring the effects of exercise intensity on physiological indicators, quality of life, and depression in patients with heart failure with reduced ejection fraction were included. We searched four electronic databases (the Embase, PubMed, Web of Science, and ProQuest） with no restrictions on the search period. Two researchers independently evaluated the study quality using the revised Joanna Briggs Institute appraisal tool for randomized control trials. Data analysis was performed using a network meta-analysis with a random effects model, utilizing R 4.2.3 statistical software.
Results: This study included 82 randomized controlled trials with a total sample size of 7,311 patients. In terms of peak oxygen uptake, compared to usual care, the effects for high-intensity interval training, resistance training, moderate intensity endurance training, and moderate intensity endurance training combined with resistance training improved by 3.46, 3.38, 2.53, and 2.42 ml/kg/min, respectively. Regarding the effects on left ventricular ejection fraction, high-intensity interval training showed improvements of 4.93%, 7.15%, and 6.45% compared to moderate intensity endurance training combined with resistance training, resistance training, and usual care, respectively. When comparing moderate intensity endurance training to usual care, the effect increased by 3.76%. For the six-minute walking test, compared to usual care, the improvements for moderate intensity endurance training combined with resistance training, high-intensity interval training, and moderate intensity endurance training were 61.56, 64.17, and 40.13 meters, respectively. In terms of quality of life, compared to usual care, the improvements for high-intensity interval training, moderate intensity endurance training combined with resistance training, and moderate intensity endurance training decreased by 1.94, 1.73, and 1.32, respectively. No exercise training significantly improved depression. In the cumulative ranking of treatments, high-intensity interval training has the highest probability of becoming the best treatment for peak oxygen uptake, left ventricular ejection fraction, and quality of life, while moderate intensity endurance training combined with resistance training is most likely to be the best for the six minutes walking test.
Conclusion: This study suggests that high-intensity interval training can be used to improve physical performance and quality of life in patients with reduced ejection fraction heart failure. We suggest that patients perform high-intensity interval training under the supervision of medical staff in hospital or rehabilitation. |
