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노인 심근경색 환자에서 고강도 간헐적 유산소운동의 효과

The Effects of High-Intensity Aerobic Interval Training In The Elderly With Myocardial Infarction

  • 김지희 (원광대학교병원 재활의학과)
  • Kim, Ji Hee (Department of Physical Medicine and Rehabilitation, Wonkwang University Hospital)
  • 투고 : 2018.12.14
  • 심사 : 2019.02.01
  • 발행 : 2019.02.28

초록

본 연구는 심근경색 환자에서 고강도 간헐적 운동 프로그램이 나이에 따라 심폐운동 기능에 미치는 효과를 비교하여 노인환자에서의 효과를 알아보고자 하였다. 2015년에서 2017년까지 심장 재활을 실시하였던 환자 중 외래 경과 관찰중인 환자의 기록을 후향적으로 분석하였다. 총 39명 (60세 이상의 노인 20명, 19명의 60세 미만의 젊은 환자군)이 연구에 포함되었다. 고강도 간헐적 심장 재활프로그램은 준비운동 5-10 분, 고강도 간헐적 유산소 운동 28분 및 마무리 운동 5-10분으로 구성되었다. 대상자들은 초기 운동부하 검사 결과를 바탕으로 심장재활 치료실에서 심전도 감시 하에 유산소 운동을 여유 산소 섭취량을 기준으로 70-90%의 고강도의 훈련 4분, 60-70% 로 3 분가량의 일반적인 강도의 훈련을 반복적으로 4 회간 실시하고 마무리운동을 시행하였다. 심폐기능은 심장재활 실시 전, 후로 운동부하 검사에 의해 평가되었다. 심장재활 후 두 군 모두에서 운동기능의 개선의 효과가 있었다. 심장재활을 실시하기 전 시행한 운동 부하 검사에서 최대 산소 소모량, 최대 운동시의 신진대사 해당치, 무산소 역치 등이 60 세 이상의 노인에서 의미 있는 운동 기능 저하가 관찰되었다(p<0.05). 심장 재활 전과 후의 운동 능력을 비교하였을 때, 두 군에서 최대 운동 가능시간, 심근부담률, 최대 심박수, 안정시 심박수, 최대 산소 소모량, 최대 산소소모량 측정시의 최대 환기량, 최대 운동 시 의 신진대사 해당치, 무산소 역치 지표에서 통계학적으로 유의한 변화가 관찰되어(p<0.05), 고강도 간헐적 운동방법은 노인환자에게서도 안전하며 효과적이다. 그러므로 60 세 이상의 노인 환자에서의 효과적인 고강도 간헐적 운동 참여를 확대하는 것이 필요할 것으로 생각된다.

To investigate the effect of high-intensity interval training (HIIT) on the outcomes of cardiac rehabilitation(CR) in elderly and younger patients with myocardial infarction(MI). Of the MI patients who received hospital-based CR from 2015 to 2017, we retrospectively reviewed the medical records of the patients who continued follow-up through the outpatient clinic. A total of 39 patients (20 elderly patients (${\geq}60year$($64.1{\pm}3.6$)) and 19 younger patients (< 60 year($55.6{\pm}2.3$)) was included in this study. The HIIT program was composed of 10 minutes of warm-up, 30 minutes of interval aerobic exercise, and 10 minutes of cool down. The aerobic exercise based on their initial exercise tolerance test outcome consisted of 3-minute usual intensity phase (60-70% of heart rate/VO2 reserve) and 4-minute of high-intensity phase (70-90% of heart rate/VO2 reserve). Exercise capacity was measured by exercise tests before and after hospital- based CR. Before CR, elderly group had a significantly lower exercise capacity in Exercise time, peak VO2, METs, Anaerobic threshold, VEmax, 02pulse than younger group. Both group showed similar improvement of cardiopulmonary exercise capacity after CR. And HIIT is safe and effective in elderly patients. It is considered necessary to further expansion for the participation of high intensity interval training in elderly patients.

키워드

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Fig. 1. Protocol of high-intensity interval training

Table 1. Clinical characteristics of the subjects

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Table 2. Comparison of exercise capacity after CR (all patients)

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Table 3. Comparison of exercise capacity before cardiac rehabilitation in 60 group and 60 group

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Table 4. Comparison of exercise capacity after cardiac rehabilitation in 60 group and 60 group

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Table 5. Comparison of percent changes in exercise capacity before and after cardiac rehabilitation in 60 group and 60 group

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참고문헌

  1. Korean Statistical Office, "Statistics of Cause of Death in 2017", 2017. http://www.kostat.go.kr/
  2. World Health Organization, "The top 10 causes of death (Fact Sheet No. 310)", World Health Organization, Geneva, 2017.
  3. G.J. Balady, P.A. Ades, V.A. Bittner, B.A. Franklin, N.F. Gordon, R.J. Thomas, G.F. Tomaselli, C.W. Yancy, "Referral, enrollment, and delivery of cardiac rehabilitation/secondary prevention programs at clinical centers and beyond: a presidential advisory from the American Heart Association", Circulation, vol. 124, no. 25, pp. 2951-2960, 2011. DOI: https://dx.doi.org/10.1161/CIR.0b013e31823b21e2
  4. G.J. Balady, M.A. Williams, P.A. Ades, V. Bittner, P. Comoss, J.M. Foody, B. Franklin, B. Sanderson, D. Southard, "Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation", Circulation, vol. 115, no. 20, pp. 2675-2682, 2007. DOI: https://dx.doi.org/10.1161/circulationaha.106.180945
  5. R. Menezis, Carl JM, Richard VM, Ross AA, Timothy SC. Cardiac rehabilitation and exercise therapy in the elderly : Should we invest in the aged? J of Geriatric Cardiology 2012;9:68-75. DOI: https://dx.doi.org/10.3724/SP.J.1263.2012.00068
  6. J. Myers, M. Prakash, V. Froelicher, D. Do, S. Partington, J.E. Atwood, "Exercise capacity and mortality among men referred for exercise testing", N Engl J Med, vol. 346, no. 11, pp. 793- 801, 2002. DOI: https://dx.doi.org/10.1056/NEJMoa011858
  7. Suaya JA, Stason WB, Ades PA, Normand SL, Shepard DS. Cardiac rehabilitation and survival in older coronary patients. J Am Coll Cardiol 2009;54:25-33 DOI: https://dx.doi.org/10.1016/j.jacc.2009.01.078
  8. Sugiura M, Hiraoka K, Ohkawa S. Severity of coronary sclerosis in the aged: a pathological study in 968 consecutive autopsy cases. Jpn Heart J 1976;17:471-478 https://doi.org/10.1536/ihj.17.471
  9. R.Menezis, Carl JL, Daniel EF, Ross AA, Richard VM, Barry AF. Cardiac Rehabilitation in the elderly Progress of Cardiovascular Disease 2014;57:152-159 DOI: https://dx.doi.org/10.1016/j.pcad.2014.01.002
  10. K. Liou, S. Ho, J. Fildes, S.Y. Ooi, "High Intensity Interval versus Moderate Intensity Continuous Training in Patients with Coronary Artery Disease: A Meta-analysis of Physiological and Clinical Parameters", Heart Lung Cire, vol. 25, no. 2, pp. 166-174,2016 DOI: https://dx.doi.org/10.1016/j.hlc.2015.06.828
  11. Loe H, Steinshamn S, Wisloff U "Cardio-Respiratory Reference Data in 4631 Healthy Men and Women 20-90 YHears: The HUNT 3 Fitness Study "PLOS ONE 9(11): e113884 https://doi.org/10.1371/journal.pone.0113884 DOI: https://dx.doi.org/10.1371/journal.pone.0113884
  12. Osteras H, Hoff J, Helgerud J. Effects of high-intensity endurance training on maximal oxygen consumption in healthy elderly people. J Appl Gerontol. Vol 24, pp377 -87, 2005. DOI: https://dx.doi.org/10.1007/s00421-002-0717-y
  13. O. Rognmo, E. Hetland, J. Helgerud, J. Hoff, S.A. Slordahl, "High intensity aerobic interval exercise is superior to moderate intensity exercise for increasing aerobic capacity in patients with coronary artery disease", Eur J Cardiovasc Prev Rehabil, vol. 11, no. 3, pp. 216-222, 2004. https://doi.org/10.1097/01.hjr.0000131677.96762.0c
  14. E. Warburton, D.C. McKenzie, M.J. Haykowsky, A. Taylor, P. Shoemaker, A.P. Ignaszewski, S.Y. Chan, "Effectiveness of high-intensity interval training for the rehabilitation of patients with coronary artery disease", Am J Cardiol, vol. 95, no. 9, pp. 1080-1084, 2005. DOI: https://dx.doi.org/10.1016/j.amjcard.2004.12.063
  15. G.G. Cardozo, R.B. Oliveira, P.T. Farinatti, "Effects of high intensity interval versus moderate continuous training on markers of ventilatory and cardiac efficiency in coronary heart disease patients", ScientificWorldJournal, vol. 2015, pp. 192479, 2015. DOI: https://dx.doi.org/10.1155/2015/192479
  16. Storen, O. Helgerud, J. Saebo, M. Stoa, E. M. "The Effect of Age on the V O2max Response to High-Intensity Interval Training" Med Sci Sports Exerc vol 49, 1, pp78-85, 2016 DOI: http://dx.doi.org/10.1249/mss.0000000000001070
  17. American Association of Cardiovascular and Pulmonary Rehabilitation. Guidelines for Cardiac Rehabilitation and Secondary Prevention Programs. 4th edition. Champaign, Ill: Human Kinetics; 2004. Chapter 4, Cardiac Rehabilitation in the Inpatient and Transitional Settings;31-51.
  18. Keteyian SJ1, Hibner BA, Bronsteen K, Kerrigan D et al. "Greater improvement in cardiorespiratory fitness using higher-intensity interval training in the standard cardiac rehabilitation setting." J Cardiopulm Rehabil Prev. , vol. 34, no. 2, pp. 98-105, 2014. DOI: https://dx.doi.org/10.1097/HCR.0000000000000049
  19. Schopfer, D. W. Forman, D. E. "Cardiac Rehabilitation in Older Adults" Can J Cardiol, vol. 32, no. 9, pp. 1088-96, 2016. DOI: https://dx.doi.org/10.1016/j.cjca.2016.03.003
  20. ijssen DH, Cable NT, Green DJ. Impact of exercise training on arterial wall thickness in humans. Clin Sci. vol.122, no. 7, pp. 311-22 2012. DOI: https://dx.doi.org/10.1042/CS20110469
  21. Molmen-Hansen HE, Stolen T, Tjonna AE, Aamot IL, Ekeberg IS, Tyldum GA, Wisloff U, Ingul CB, Stoylen A. "Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients." Eur J Prev Cardiol, vol. 19, pp.151-160, 2012. DOI: https://dx.doi.org/10.1177/1741826711400512
  22. Haram PM, Kemi OJ, Wisloff U. "Adaptation of endothelium to exercise training: insights from experimental studies." Front Biosci. vol. 13, pp. 336-46, 2008. DOI: https://dx.doi.org/10.2741/2683
  23. Myers J, Prakash M, Froelicher V, et al. "Exercise capacity and mortality among men referred for exercise testing" N Engl J Med. vol. 346, pp. 793-801, 2002. DOI: https://dx.doi.org/10.1056/NEJMoa011858
  24. R. Hambrecht, A. Wolf, S. Gielen, A. Linke, J. Hofer, S. Erbs, N. Schoene, G. Schuler, "Effect of exercise on coronary endothelial function in patients with coronary artery disease", N Engl J Med, vol. 342, no. 7, pp. 454-460, 2000. DOI: https://dx.doi.org/10.1056/nejm200002173420702
  25. Frengley, J. D. Sansone, G. R. Alba, A. et al. "Influence of age on rehabilitation outcomes and survival in post-acute inpatient cardiac rehabilitation" J Cardiopulm Rehabil Prev vol. 31, no. 4, pp. 230-8, 2011. DOI: https://dx.doi.org/10.1097/HCR.0b013e318207d314
  26. P. Older, "Anaerobic threshold, is it a magic number to determine fitness for surgery?", Perioper Med (Lond), vol. 2, no. 1, pp. 2, 2013. DOI: https://dx.doi.org/10.1186/2047-0525-2-2
  27. H. Zheng, M. Luo, Y. Shen, Y. Ma, W. Kang, "Effects of 6 months exercise training on ventricular remodelling and autonomic tone in patients with acute myocardial infarction and percutaneous coronary intervention", J Rehabil Med, vol. 40, no. 9, pp. 776-779, 2008. DOI: https://dx.doi.org/10.2340/16501977-0254
  28. K.D. Currie, J.B. Dubberley, R.S. McKelvie, M.J. MacDonald, "Low-volume, high-intensity interval training in patients with CAD", Med Sci Sports Exerc, vol. 45, no. 8, pp. 1436-1442, 2013. DOI: https://dx.doi.org/10.1249/MSS.0b013e31828bbbd4
  29. E.A. Rocco, D.M. Prado, A.G. Silva, J.M. Lazzari, P.C. Bortz, D.F. Rocco, C.G. Rosa, V. Furlan, "Effect of continuous and interval exercise training on the PETCO2 response during a graded exercise test in patients with coronary artery disease", Clinics (Sao Paulo), vol. 67, no. 6, pp. 623-628, 2012. https://doi.org/10.6061/clinics/2012(06)13
  30. A.D. Elliott, K. Rajopadhyaya, D.J. Bentley, J.F. Beltrame, E.C. Aromataris, "Interval training versus continuous exercise in patients with coronary artery disease: a meta-analysis", Heart Lung Circ, vol. 24, no. 2, pp. 149-157, 2015. DOI: https://dx.doi.org/10.1016/j.hlc.2014.09.001
  31. J.D. Bartlett, G.L. Close, D.P. MacLaren, W. Gregson, B. Drust, J.P. Morton, "High-intensity interval running is perceived to be more enjoyable than moderate-intensity continuous exercise: implications for exercise adherence", J Sports Sci, vol. 29, no. 6, pp. 547-553, 2011. DOI: https://dx.doi.org/10.1080/02640414.2010.545427
  32. J.B. Coquart, C. Lemaire, A.E. Dubart, D.P. Luttembacher, C. Douillard, M. Garcin, "Intermittent versus continuous exercise: effects of perceptually lower exercise in obese women", Med Sci Sports Exerc, vol. 40, no. 8, pp. 1546-1553, 2008. DOI: https://dx.doi.org/10.1249/MSS.0b013e31816fc30c
  33. M. Juneau, N. Roy, A. Nigam, J.C. Tardif, L. Larivee, "Exercise above the ischemic threshold and serum markers of myocardial injury", Can J Cardiol, vol. 25, no. 10, pp. e338-341, 2009. DOI: https://doi.org/10.1016/S0828-282X(09)70718-4
  34. M. Noel, J. Jobin, A. Marcoux, P. Poirier, G.R. Dagenais, P. Bogaty, "Can prolonged exercise-induced myocardial ischaemia be innocuous?", Eur Heart J, vol. 28, no. 13, pp. 1559-1565, 2007. DOI: https://dx.doi.org/10.1093/eurheartj/ehm152
  35. U. Wisloff, A. Stoylen, J.P. Loennechen, M. Bruvold, O. Rognmo, P.M. Haram, A.E. Tjonna, J. Helgerud, S.A. Slordahl, S.J. Lee, V. Videm, A. Bye, G.L. Smith, S.M. Najjar, O. Ellingsen, T. Skjaerpe, "Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study", Circulation, vol. 115, no. 24, pp. 3086-3094, 2007. DOI: https://dx.doi.org/10.1161/circulationaha.106.675041