抗阻訓(xùn)練的心血管調(diào)控機制及其在心臟康復(fù)中的應(yīng)用

1、心血管康復(fù)的內(nèi)容 approach in cardiac rehab 康復(fù)康復(fù) rehab Aerobic 有氧訓(xùn)練有氧訓(xùn)練 作業(yè)訓(xùn)練作業(yè)訓(xùn)練 OT Behavior 行為治療行為治療 抗阻訓(xùn)練抗阻訓(xùn)練 Resistance training 心血管康復(fù)的內(nèi)容 approach in cardiac rehab 康復(fù)康復(fù) rehab Aerobic 有氧訓(xùn)練有氧訓(xùn)練 作業(yè)訓(xùn)練作業(yè)訓(xùn)練 OT Behavior 行為治療行為治療 抗阻訓(xùn)練抗阻訓(xùn)練 Resistance training Study structure Central hemodynamics Mechanism Clinical

2、observation Brain Spine EOPs Muscle Recording 5 Animal study 20 dogs Intra- Thoracic Pressure is related to PWP (r=0.89) 6 Cardiac responses to RT Cardiac response to RT has its own rule and does not induce undue cardiovascular responses. 抗阻運動并不誘發(fā)不可預(yù)期的高心血管反應(yīng)抗阻運動并不誘發(fā)不可預(yù)期的高心血管反應(yīng) RT induced PWP elevati

3、on is neither a result of LV failure nor myocardial ischemia, but the increase of intra-thoracic pressure. 抗阻運動引起肺毛壓增高的原因是胸內(nèi)壓增高，抗阻運動引起肺毛壓增高的原因是胸內(nèi)壓增高， 而不是左心功能障礙。而不是左心功能障礙。 7 Cardiac responses to RT Increase of MVO2 was weaker during RT than DE. 抗阻運動時心肌耗氧量的增加低于動力性運動抗阻運動時心肌耗氧量的增加低于動力性運動 RT resulted in

4、parallel increase of SBP and DBP which is decreased during DE. RT時時SBP和和DBP同時升高同時升高 There was no sign of myocardial ischemia during RTmax, but happened in DEmax. RTmax時心肌缺血少于時心肌缺血少于DEmax Why no ischemia during IE？ ischemia IEDE MVO2 IEDE HR IEDE hymodynamics IEDE Perfusion time IEDE Perfusion pressu

5、re IEDE Publications 1.Effects of isometric exercise on hemodynamics and left ventricular systolic and diastolic function in normal subjects and patRTnts convalescent from myocardial infarction. Aust New Zealand J med 1990;20(3):325 2.Regulation of cardiovascular responses to isometric exercise in c

6、oronary patRTnts. Aust New Zealand J Med 1991; 21(4):524 3.Mechanism of Pulmonary Wedge Pressure Elevation During Isometric Exercise in PatRTnts with Coronary Artery Disease. J Nanjing Med Coll 1993;7(2):1-10 4.冠心病人等長收縮運動時肺毛細(xì)血管嵌頓壓升高的機理。中國康復(fù)醫(yī)學(xué)冠心病人等長收縮運動時肺毛細(xì)血管嵌頓壓升高的機理。中國康復(fù)醫(yī)學(xué) 雜志雜志 1993;8(1):1 5.分級等長收縮運

7、動對正常人和心肌梗塞患者二尖瓣血流的影響。中國康分級等長收縮運動對正常人和心肌梗塞患者二尖瓣血流的影響。中國康 復(fù)醫(yī)學(xué)雜志復(fù)醫(yī)學(xué)雜志1993;8(6):244-247 6.乏氏動作對冠心病人等長收縮運動心血管反應(yīng)的影響。中國康復(fù)醫(yī)學(xué)雜乏氏動作對冠心病人等長收縮運動心血管反應(yīng)的影響。中國康復(fù)醫(yī)學(xué)雜 志，志，1995;10(1):13-16 7.影響正常人和心肌梗塞病人對等長收縮運動心血管反應(yīng)的有關(guān)因素影響正常人和心肌梗塞病人對等長收縮運動心血管反應(yīng)的有關(guān)因素. 中中 國康復(fù)醫(yī)學(xué)雜志國康復(fù)醫(yī)學(xué)雜志 1995;10(5):193-197 10 Why RT produce weaker cardio

8、vascular response than DE? Endogenous Opioids (EOPs) , a modulator of cardiac neuro-control, increase more significantly during RT than DE and thus adjust cardiac response to RT. EOPs Enkephalin, ENK, LEK - endorphin,-END Dynaphin, DYN 11 Publications 等長收縮運動時血漿內(nèi)啡肽對心血管反應(yīng)的調(diào)節(jié)作用等長收縮運動時血漿內(nèi)啡肽對心血管反應(yīng)的調(diào)節(jié)作用.

9、中中 華物理醫(yī)學(xué)雜志華物理醫(yī)學(xué)雜志, 1998；20(2): 105-108 等長收縮運動時生理性肺毛細(xì)血管楔嵌壓增高的機理等長收縮運動時生理性肺毛細(xì)血管楔嵌壓增高的機理。中。中 國運動醫(yī)學(xué)雜志；國運動醫(yī)學(xué)雜志；2000; 19(3): 251-253 電刺激等長收縮運動心血管反應(yīng)與肌群質(zhì)量的關(guān)系。中國電刺激等長收縮運動心血管反應(yīng)與肌群質(zhì)量的關(guān)系。中國 運動醫(yī)學(xué)雜志運動醫(yī)學(xué)雜志 2000；19（4）：）：392-395 May cardiovascular response to IE be modified? Central command has more profound effect

10、on EOPs. Brain behavior modification may adjust cardiovascular response to IE through mechanism of enhanced release of EOPs. 13 Publications 中樞內(nèi)啡肽對等長收縮運動時心血管反應(yīng)的調(diào)控意義。中中樞內(nèi)啡肽對等長收縮運動時心血管反應(yīng)的調(diào)控意義。中 華物理醫(yī)學(xué)與康復(fù)雜志，華物理醫(yī)學(xué)與康復(fù)雜志，2000;22(4):211-214 血漿內(nèi)啡肽對等長收縮運動心血管反應(yīng)的中樞調(diào)節(jié)定位。血漿內(nèi)啡肽對等長收縮運動心血管反應(yīng)的中樞調(diào)節(jié)定位。 中華物理醫(yī)學(xué)與康復(fù)雜志，中華物理

11、醫(yī)學(xué)與康復(fù)雜志，2000;22(5):287-290 大腦行為對等長收縮運動時心血管反應(yīng)的調(diào)控作用與機制大腦行為對等長收縮運動時心血管反應(yīng)的調(diào)控作用與機制 。中國康復(fù)醫(yī)學(xué)雜志。中國康復(fù)醫(yī)學(xué)雜志2000;15(3):140-143 Collateral circulation blockade Study structure Evidence of exercise induced coronary collateral formation Relationship of ischemia and collateral formation Relationship of exercise and

12、 ischemia Optimization of exercise training Effect of the optimal training program Chronic CA stenosis 28 swines (22.52kg） Ameroid Constrictor placed on coronary artery (LCX) LCX was occluded gradually 4 weeks post operation. Conclusion Treadmill exercise may improve collateral circulation formation

13、, but unclear intensity, duration and frequency. VEGF production and/or activity is related to IE, but mechanism need more studies. J Chin Rehab Med，2002;17(1):22-25 J Chin Rehab Med ，2002;17(2):72-74 safety Pathological ischemia EPCs homingEPCs homing Pathological Pathological ischemiaischemia Phys

14、iological ischemia Biological bypass VEGF-NOVEGF-NO Local effect Remote effect Collateral formation The effect and mechanism of exercise and ischemia training on collateral formation（No. 30370687 ） The effect and mechanism of isometric contraction and ischemia training on vascular reserve （No.305708

15、93） Myocardial ischemia(MI) the ischemic heart Capillary density in the other organs Ischemia exercise Projects supported by the National Natural Science Foundation of China (PNSF) Physiological ischemia training(PIT) Capillary density Remote area VEGF VEGF Remote area Physiological Ischemia Trainin

16、g(PIT) sciatic nerve ES PIT -isometric contraction -normal skeletal muscles Repeated PIT did increase the VEGF and capillary density in the other limb which was in ischemic condition. Cellular mechanism Grouping PISOITPT MI onlyPIT onlyMI+PITShame operated l PB-EPCs (EPCs in peripheral blood) 0.000

17、0.010 0.020 0.030 0.040 0.050 0.060 0.070 0.080 0.090 0.100 01234 % % SO PT PI IT * * week l IH-EPCs (EPCs in ischemic heart region) 0.000 0.002 0.004 0.006 0.008 0.010 0.012 0.014 0.016 0.018 SOPTPIIT IH-EPCs % group * * * * At the endpoints of the experiments l Capillary Density 0 100 200 300 400

18、500 600 700 800 900 1000 SOPTPIIT capillary density/ mm2 group * At the endpoints of the experiments Images of 7.0T micro-MRI PBS injectionSPIO-EPCs injection Prussian blue stain CM-Dil Relation between PB-EPCs and IH-EPCs 0.0000.000 0.0020.002 0.0040.004 0.0060.006 0.0080.008 0.0100.010 0.0120.012 0.0140.014 0.0160.016 0.0180.018 0 00.010.010.020.020.030.030.040.040.050.050.060.060.070.070.080.080.090.090.10.1 IH-EPCs % PB-EPCs % IT PI ConclusionConclusion PIT could augment PB-EPCs and IH-EPCs, and improve myocardial angiogenes