慕尼黑工业大学Martin Halle团队研究了高强度间歇训练、中等强度连续训练或基于指南的体力活动对射血分数保留的心力衰竭患者峰值耗氧量的影响。2021年2月9日，该研究发表在《美国医学会杂志》上。

耐力运动能有效地改善射血分数（HFpEF）保留的心力衰竭患者的峰值耗氧量（峰值Vo2）。然而，不同锻炼方式是否会产生不同的效果还不得而知。

为了探讨高强度间歇训练、中等强度持续训练和指导性体育锻炼对HFpEF患者Vo2峰值变化的影响，2014年7月至2018年9月，研究组在德国、比利时和挪威的5个研究机构进行了一项随机临床试验。共纳入180名久坐的慢性稳定型HFpEF患者，将其按1：1：1随机分组，每组60例，分别进行12个月的高强度间歇训练（3 × 38分钟/周）、中等强度持续训练（5 × 40分钟/周）或根据指南建议锻炼（对照），前3个月在门诊，后9个月远程医疗监督下在家庭锻炼。主要终点是3个月后V?o2峰值的变化，最小临床重要差异设定为2.5 mL/kg/min。次要终点包括3个月和12个月后心肺功能、舒张功能和利钠肽指标的变化。

180例患者的平均年龄为70岁，女性占67%，分别有166例（92%）和154例（86%）在3个月和12个月时完成评估。高强度间歇训练组3个月内的峰值V?o2增加了1.1 mL/kg/min，中等强度持续训练组增加了1.6 mL/kg/min，指南对照组减少了0.6 mL/kg/min，组间差异均不显著。12个月后三组间比较无统计学差异。舒张功能和利钠肽均无明显变化。高强度间歇训练组中有4例（7%）出现急性冠脉综合征，中等强度连续训练组有3例（5%），指南对照组有5例（8%）。

研究结果表明，对于HFpEF患者，高强度间歇训练组和中等强度连续训练组在3个月时的峰值V?o2变化无统计学显著性差异，与指南对照组相比，两组均未达到预先规定的最小临床重要差异。该发现不支持HFpEF患者接受高强度间歇训练或中度强度持续训练。

附：英文原文

Title: Effect of High-Intensity Interval Training, Moderate Continuous Training, or Guideline-Based Physical Activity Advice on Peak Oxygen Consumption in Patients With Heart Failure With Preserved Ejection Fraction: A Randomized Clinical Trial

Author: Stephan Mueller, Ephraim B. Winzer, André Duvinage, Andreas B. Gevaert, Frank Edelmann, Bernhard Haller, Elisabeth Pieske-Kraigher, Paul Beckers, Anna Bobenko, Jennifer Hommel, Caroline M. Van de Heyning, Katrin Esefeld, Pia von Korn, Jeffrey W. Christle, Mark J. Haykowsky, Axel Linke, Ulrik Wislff, Volker Adams, Burkert Pieske, Emeline M. van Craenenbroeck, Martin Halle, OptimEx-Clin Study Group

Issue&Volume: 2021/02/09

Abstract:

Importance Endurance exercise is effective in improving peak oxygen consumption (peak Vo2) in patients with heart failure with preserved ejection fraction (HFpEF). However, it remains unknown whether differing modes of exercise have different effects.

Objective To determine whether high-intensity interval training, moderate continuous training, and guideline-based advice on physical activity have different effects on change in peak Vo2 in patients with HFpEF.

Design, Setting, and Participants Randomized clinical trial at 5 sites (Berlin, Leipzig, and Munich, Germany; Antwerp, Belgium; and Trondheim, Norway) from July 2014 to September 2018. From 532 screened patients, 180 sedentary patients with chronic, stable HFpEF were enrolled. Outcomes were analyzed by core laboratories blinded to treatment groups; however, the patients and staff conducting the evaluations were not blinded.

Interventions Patients were randomly assigned (1:1:1; n=60 per group) to high-intensity interval training (3×38 minutes/week), moderate continuous training (5×40 minutes/week), or guideline control (1-time advice on physical activity according to guidelines) for 12 months (3 months in clinic followed by 9 months telemedically supervised home-based exercise).

Main Outcomes and Measures Primary end point was change in peak Vo2 after 3 months, with the minimal clinically important difference set at 2.5 mL/kg/min. Secondary end points included changes in metrics of cardiorespiratory fitness, diastolic function, and natriuretic peptides after 3 and 12 months.

Results Among 180 patients who were randomized (mean age, 70 years; 120 women [67%]), 166 (92%) and 154 (86%) completed evaluation at 3 and 12 months, respectively. Change in peak Vo2 over 3 months for high-intensity interval training vs guideline control was 1.1 vs 0.6 mL/kg/min (difference, 1.5 [95% CI, 0.4 to 2.7]); for moderate continuous training vs guideline control, 1.6 vs 0.6 mL/kg/min (difference, 2.0 [95% CI, 0.9 to 3.1]); and for high-intensity interval training vs moderate continuous training, 1.1 vs 1.6 mL/kg/min (difference, 0.4 [95% CI, 1.4 to 0.6]). No comparisons were statistically significant after 12 months. There were no significant changes in diastolic function or natriuretic peptides. Acute coronary syndrome was recorded in 4 high-intensity interval training patients (7%), 3 moderate continuous training patients (5%), and 5 guideline control patients (8%).

Conclusions and Relevance Among patients with HFpEF, there was no statistically significant difference in change in peak Vo2 at 3 months between those assigned to high-intensity interval vs moderate continuous training, and neither group met the prespecified minimal clinically important difference compared with the guideline control. These findings do not support either high-intensity interval training or moderate continuous training compared with guideline-based physical activity for patients with HFpEF.

DOI: 10.1001/jama.2020.26812

Source: https://jamanetwork.com/journals/jama/article-abstract/2776199