ストレッチング体操が植込み型除細動器あるいは両心室ペーシング機能つき植込み型除細動器を装着した運動習慣のない慢性心不全患者の血管内皮機能と運動耐容能に与える影響
【目的】植込み型除細動器（以下，ICD）あるいは両心室ペーシング機能つき植込み型除細動器（以下，CRT-D）を装着した慢性心不全（以下，CHF）患者に対するストレッチング体操が，血管内皮機能と運動耐容能に与える影響を検討した。【方法】対象をICD あるいはCRT-D が植え込まれた運動習慣のないCHF 患者32 名（男性27 例，平均年齢69 ± 9 歳）とし，ストレッチング体操を実施するストレッチング群と対照群に無作為に分類した。4 週間の介入前後の反応性充血指数（以下，RHI）と6 分間歩行距離（以下，6MWD）を評価した。【結果】ストレッチング群のRHI と6MWD は，介入前と比較して...
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| Published in | 理学療法学 Vol. 45; no. 3; pp. 175 - 182 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本理学療法士学会
2018
日本理学療法士協会 Japanese Society of Physical Therapy |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0289-3770 2189-602X |
| DOI | 10.15063/rigaku.11375 |
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| Abstract | 【目的】植込み型除細動器（以下，ICD）あるいは両心室ペーシング機能つき植込み型除細動器（以下，CRT-D）を装着した慢性心不全（以下，CHF）患者に対するストレッチング体操が，血管内皮機能と運動耐容能に与える影響を検討した。【方法】対象をICD あるいはCRT-D が植え込まれた運動習慣のないCHF 患者32 名（男性27 例，平均年齢69 ± 9 歳）とし，ストレッチング体操を実施するストレッチング群と対照群に無作為に分類した。4 週間の介入前後の反応性充血指数（以下，RHI）と6 分間歩行距離（以下，6MWD）を評価した。【結果】ストレッチング群のRHI と6MWD は，介入前と比較して介入後に有意に増加した（P ＜0.01，P ＜0.01）。介入前後のRHI と6MWD の変化量は，有意に正相関（r ＝0.53，P ＜ 0.05）を示した。【結論】ICD あるいはCRT-D 患者に対するストレッチング体操の効果として，血管内皮機能障害と運動耐容能の改善が考えられた。 |
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| AbstractList | 「要旨」【目的】植込み型除細動器(以下, ICD)あるいは両心室ペーシング機能つき植込み型除細動器(以下, CRT-D)を装着した慢性心不全(以下, CHF)患者に対するストレッチング体操が, 血管内皮機能と運動耐容能に与える影響を検討した. 【方法】対象をICDあるいはCRT-Dが植え込まれた運動習慣のないCHF患者32名(男性27例, 平均年齢69±9歳)とし, ストレッチング体操を実施するストレッチング群と対照群に無作為に分類した. 4週間の介入前後の反応性充血指数(以下, RHI)と6分間歩行距離(以下, 6MWD)を評価した. 【結果】ストレッチング群のRHIと6MWDは, 介入前と比較して介入後に有意に増加した(P<0.01, P<0.01). 介入前後のRHIと6MWDの変化量は, 有意に正相関(r=0.53, P<0.05)を示した. 【結論】ICDあるいはCRT-D患者に対するストレッチング体操の効果として, 血管内皮機能障害と運動耐容能の改善が考えられた. 【目的】植込み型除細動器（以下，ICD）あるいは両心室ペーシング機能つき植込み型除細動器（以下，CRT-D）を装着した慢性心不全（以下，CHF）患者に対するストレッチング体操が，血管内皮機能と運動耐容能に与える影響を検討した。【方法】対象をICD あるいはCRT-D が植え込まれた運動習慣のないCHF 患者32 名（男性27 例，平均年齢69 ± 9 歳）とし，ストレッチング体操を実施するストレッチング群と対照群に無作為に分類した。4 週間の介入前後の反応性充血指数（以下，RHI）と6 分間歩行距離（以下，6MWD）を評価した。【結果】ストレッチング群のRHI と6MWD は，介入前と比較して介入後に有意に増加した（P ＜0.01，P ＜0.01）。介入前後のRHI と6MWD の変化量は，有意に正相関（r ＝0.53，P ＜ 0.05）を示した。【結論】ICD あるいはCRT-D 患者に対するストレッチング体操の効果として，血管内皮機能障害と運動耐容能の改善が考えられた。 Purpose: Endurance training improves vascular endothelial dysfunction and exercise capacity in patients with chronic heart failure (CHF). However, CHF patients with an implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy-defibrillator (CRT-D) often avoid endurance training for fear of ICD shock. Recent studies have shown that stretching exercises enhance antioxidant activity and improve vascular responses. We aimed to assess the effects of four weeks of stretching exercises on oxidative stress and vascular endothelial function in CHF patients with an ICD or CRT-D.Methods: Thirty-two sedentary CHF patients (men, 83%; mean age, 69 ± 9 years; left ventricular ejection fraction, 30 ± 9%) with an ICD or CRT-D were randomly divided into a group that performed four-week stretching exercises (stretching group), and a group that continued a sedentary lifestyle (control group). We compared the reactive hyperemia peripheral arterial tonometry index (RHI) and 6 minute walk distance (6MWD), and sit-and –reach test (SR), between the two groups before and after the four-week study period.Results: In the stretching group, a significant increase in the RHI, 6MWD, and SR were observed after the study period compared to before (p<0.01, p<0.05, and p<0.01). No significant changes were observed in the control group.Conclusion: Four weeks of stretching exercises may increase exercise capacity through improve of vascular endothelial dysfunction in sedentary CHF patients with an ICD or CRT-D. 【目的】植込み型除細動器（以下，ICD）あるいは両心室ペーシング機能つき植込み型除細動器（以下，CRT-D）を装着した慢性心不全（以下，CHF）患者に対するストレッチング体操が，血管内皮機能と運動耐容能に与える影響を検討した。【方法】対象をICD あるいはCRT-D が植え込まれた運動習慣のないCHF 患者32 名（男性27 例，平均年齢69 ± 9 歳）とし，ストレッチング体操を実施するストレッチング群と対照群に無作為に分類した。4 週間の介入前後の反応性充血指数（以下，RHI）と6 分間歩行距離（以下，6MWD）を評価した。【結果】ストレッチング群のRHI と6MWD は，介入前と比較して介入後に有意に増加した（P ＜0.01，P ＜0.01）。介入前後のRHI と6MWD の変化量は，有意に正相関（r ＝0.53，P ＜ 0.05）を示した。【結論】ICD あるいはCRT-D 患者に対するストレッチング体操の効果として，血管内皮機能障害と運動耐容能の改善が考えられた。 |
| Author | 鬼頭, 和也 光地, 海人 田邊, 潤 角谷, 星那 濱, 貴之 加藤, 倫卓 森, 雄司 小鹿野, 道雄 森本, 大輔 |
| Author_FL | MORI Yuji OGANO Michio TANABE Jun KATO Michitaka KITO Kazuya KOCHI Kaito HAMA Takayuki MORIMOTO Daisuke KADOTANI Seina |
| Author_FL_xml | – sequence: 1 fullname: KATO Michitaka – sequence: 2 fullname: MORI Yuji – sequence: 3 fullname: KOCHI Kaito – sequence: 4 fullname: MORIMOTO Daisuke – sequence: 5 fullname: KADOTANI Seina – sequence: 6 fullname: KITO Kazuya – sequence: 7 fullname: HAMA Takayuki – sequence: 8 fullname: OGANO Michio – sequence: 9 fullname: TANABE Jun |
| Author_xml | – sequence: 1 fullname: 角谷, 星那 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 小鹿野, 道雄 organization: 国立病院機構静岡医療センター循環器科 – sequence: 1 fullname: 森, 雄司 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 田邊, 潤 organization: 国立病院機構静岡医療センター循環器科 – sequence: 1 fullname: 森本, 大輔 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 鬼頭, 和也 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 濱, 貴之 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 光地, 海人 organization: 国立病院機構静岡医療センターリハビリテーション科 – sequence: 1 fullname: 加藤, 倫卓 organization: 常葉大学健康科学部静岡理学療法学科 |
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| References | 2) Freedenberg V, Thomas SA, et al.: Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review. Heart Fail Clin. 2011; 7: 59–68. 14) Axtell AL, Gomari FA, et al.: Assessing endothelial vasodilator function with the Endo-PAT 2000. J Vis Exp. 2010; 15: pii: 2167. 21) Kasanuki H, Hagiwara N, et al.: Angiotensin II receptor blocker-based vs. non-angiotensin II receptor blocker-based therapy in patients with angiographically documented coronary artery disease and hypertension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). Eur Heart J. 2009; 30: 1203–1212. 24) McCall DO, McGartland CP, et al.: The relationship between microvascular endothelial function and carotid-radial pulse wave velocity in patients with mild hypertension. Clin Exp Hypertens. 2010; 32: 474–479. 3) Sears SF, Matchett M, et al.: Effective management of ICD patient psychosocial issues and patient critical events. J Cardiovasc Electrophysiol. 2009; 20: 1297–1304. 5) Alosco ML, Spitznagel MB, et al.: Depression is associated with reduced physical activity in persons with heart failure. Health Psychol. 2012; 31: 754–762. 16) Guazzi M, Dickstein K, et al.: Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail. 2009; 2: 549–555. 18) Hoeger WW, Hopkins DR: A comparison of the sit and reach and the modified sit and reach in the measurement of flexibility in women. Res Q Exerc Sport. 1992; 63: 191–195. 22) Hedetoft M, Olsen NV: Evaluation of endothelial function by peripheral arterial tonometry and relation with the nitric oxide pathway. Nitric Oxide. 2014; 42: 1–8. 13) Bonetti PO, Pumper GM, et al.: Noninvasive identification of patients with early coronary atherosclerosis by assessment of digital reactive hyperemia. J Am Coll Cardiol. 2004; 44: 2137–2141. 19) McClain JJ, Craig CL, et al.: Comparison of Lifecorder EX and ActiGraph accelerometers under free-living conditions. Appl Physiol Nutr Metab. 2007; 32: 753–761. 10) Hambrecht R, Fiehn E, et al.: Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation. 1998; 98: 2709–2015. 23) Nishiwaki M, Yonemura H, et al.: Four weeks of regular static stretching reduces arterial stiffness in middle-aged men. Springerplus. 2015; 4: 555. 1) Belardinelli R, Capestro F, et al.: Moderate exercise training improves functional capacity, quality of life, and endothelium-dependent vasodilation in chronic heart failure patients with implantable cardioverter defibrillators and cardiac resynchronization therapy. Eur J Cardiovasc Prev Rehabil. 2006; 13: 818–825. 20) Kumahara H, Schutz Y, et al.: The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry. Br J Nutr. 2004; 91: 235–243. 11) Piña IL, Apstein CS, et al.: Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003; 107: 1210–1225. 32) Perera S, Mody SH, et al.: Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006; 54: 743–749. 15) Higashi Y, Oshima T, et al.: Angiotensin-converting enzyme inhibition, but not calcium antagonism, improves a response of the renal vasculature to L-arginine in patients with essential hypertension. Hypertension. 1998; 32: 16–24. 12) Zung WW: A SELF-RATING DEPRESSION SCALE. Arch Gen Psychiatry. 1965; 12: 63–70. 29) Ozasa N, Morimoto T, et al.: Effects of machine-assisted cycling on exercise capacity and endothelial function in elderly patients with heart failure. Circ J. 2012; 76: 1889–1894. 30) Tei C, Imamura T, et al.: Waon Therapy for Managing Chronic Heart Failure -Results From a Multicenter Prospective Randomized WAON-CHF Study. Circ J. 2016; 80: 827–834. 8) Kato M, Masuda T, et al.: Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients with an Implantable Cardioverter Defibrillator. J Cardiopulm Rehabil Prev. 2017; 37: 130–138. 26) Wilson JR, Mancini DM: Factors contributing to the exercise limitation of heart failure. J Am Coll Cardiol. 1993; 22: 93A–98A. 25) Wada O, Asanoi H, et al.: Quantitative evaluation of blood flow distribution to exercising and resting skeletal muscles in patients with cardiac dysfunction using whole-body thallium-201 scintigraphy. Clin Cardiol. 1997; 20: 785–790. 27) Vuckovic KM, Piano MR, et al.: Effects of exercise interventions on peripheral vascular endothelial vasoreactivity in patients with heart failure with reduced ejection fraction. Heart Lung Circ. 2013; 22: 328–340. 17) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166: 111–117. 31) Kihara T, Biro S, et al.: Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. J Am Coll Cardiol. 2002; 39: 754–759. 7) JCS Joint Working Group: Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J. 2014; 78: 2022–2093. 6) Abraham WT, Fisher WG, et al.: Cardiac resynchronization in chronic heart failure. N Engl J Med. 2002; 346: 1845–1853. 28) Hornig B, Maier V, et al.: Physical training improves endothelial function in patients with chronic heart failure. Circulation. 1996; 93: 210–214. 9) Hotta K, Kamiya K, et al.: Stretching exercises enhance vascular endothelial function and improve peripheral circulation in patients with acute myocardial infarction. Int Heart J. 2013; 54: 59–63. 4) Suzuki T, Shiga T, et al.: Prevalence and persistence of depression in patients with implantable cardioverter defibrillator: a 2-year longitudinal study. Pacing Clin Electrophysiol. 2010; 33(12): 1455–1461. |
| References_xml | – reference: 14) Axtell AL, Gomari FA, et al.: Assessing endothelial vasodilator function with the Endo-PAT 2000. J Vis Exp. 2010; 15: pii: 2167. – reference: 31) Kihara T, Biro S, et al.: Repeated sauna treatment improves vascular endothelial and cardiac function in patients with chronic heart failure. J Am Coll Cardiol. 2002; 39: 754–759. – reference: 7) JCS Joint Working Group: Guidelines for rehabilitation in patients with cardiovascular disease (JCS 2012). Circ J. 2014; 78: 2022–2093. – reference: 17) ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002; 166: 111–117. – reference: 2) Freedenberg V, Thomas SA, et al.: Anxiety and depression in implanted cardioverter-defibrillator recipients and heart failure: a review. Heart Fail Clin. 2011; 7: 59–68. – reference: 15) Higashi Y, Oshima T, et al.: Angiotensin-converting enzyme inhibition, but not calcium antagonism, improves a response of the renal vasculature to L-arginine in patients with essential hypertension. Hypertension. 1998; 32: 16–24. – reference: 24) McCall DO, McGartland CP, et al.: The relationship between microvascular endothelial function and carotid-radial pulse wave velocity in patients with mild hypertension. Clin Exp Hypertens. 2010; 32: 474–479. – reference: 32) Perera S, Mody SH, et al.: Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006; 54: 743–749. – reference: 20) Kumahara H, Schutz Y, et al.: The use of uniaxial accelerometry for the assessment of physical-activity-related energy expenditure: a validation study against whole-body indirect calorimetry. Br J Nutr. 2004; 91: 235–243. – reference: 10) Hambrecht R, Fiehn E, et al.: Regular physical exercise corrects endothelial dysfunction and improves exercise capacity in patients with chronic heart failure. Circulation. 1998; 98: 2709–2015. – reference: 16) Guazzi M, Dickstein K, et al.: Six-minute walk test and cardiopulmonary exercise testing in patients with chronic heart failure: a comparative analysis on clinical and prognostic insights. Circ Heart Fail. 2009; 2: 549–555. – reference: 23) Nishiwaki M, Yonemura H, et al.: Four weeks of regular static stretching reduces arterial stiffness in middle-aged men. Springerplus. 2015; 4: 555. – reference: 19) McClain JJ, Craig CL, et al.: Comparison of Lifecorder EX and ActiGraph accelerometers under free-living conditions. Appl Physiol Nutr Metab. 2007; 32: 753–761. – reference: 27) Vuckovic KM, Piano MR, et al.: Effects of exercise interventions on peripheral vascular endothelial vasoreactivity in patients with heart failure with reduced ejection fraction. Heart Lung Circ. 2013; 22: 328–340. – reference: 8) Kato M, Masuda T, et al.: Stretching Exercises Improve Vascular Endothelial Dysfunction Through Attenuation of Oxidative Stress in Chronic Heart Failure Patients with an Implantable Cardioverter Defibrillator. J Cardiopulm Rehabil Prev. 2017; 37: 130–138. – reference: 30) Tei C, Imamura T, et al.: Waon Therapy for Managing Chronic Heart Failure -Results From a Multicenter Prospective Randomized WAON-CHF Study. Circ J. 2016; 80: 827–834. – reference: 3) Sears SF, Matchett M, et al.: Effective management of ICD patient psychosocial issues and patient critical events. J Cardiovasc Electrophysiol. 2009; 20: 1297–1304. – reference: 11) Piña IL, Apstein CS, et al.: Exercise and heart failure: A statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003; 107: 1210–1225. – reference: 5) Alosco ML, Spitznagel MB, et al.: Depression is associated with reduced physical activity in persons with heart failure. Health Psychol. 2012; 31: 754–762. – reference: 18) Hoeger WW, Hopkins DR: A comparison of the sit and reach and the modified sit and reach in the measurement of flexibility in women. Res Q Exerc Sport. 1992; 63: 191–195. – reference: 12) Zung WW: A SELF-RATING DEPRESSION SCALE. Arch Gen Psychiatry. 1965; 12: 63–70. – reference: 21) Kasanuki H, Hagiwara N, et al.: Angiotensin II receptor blocker-based vs. non-angiotensin II receptor blocker-based therapy in patients with angiographically documented coronary artery disease and hypertension: the Heart Institute of Japan Candesartan Randomized Trial for Evaluation in Coronary Artery Disease (HIJ-CREATE). Eur Heart J. 2009; 30: 1203–1212. – reference: 26) Wilson JR, Mancini DM: Factors contributing to the exercise limitation of heart failure. J Am Coll Cardiol. 1993; 22: 93A–98A. – reference: 9) Hotta K, Kamiya K, et al.: Stretching exercises enhance vascular endothelial function and improve peripheral circulation in patients with acute myocardial infarction. Int Heart J. 2013; 54: 59–63. – reference: 28) Hornig B, Maier V, et al.: Physical training improves endothelial function in patients with chronic heart failure. 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| Snippet | 【目的】植込み型除細動器（以下，ICD）あるいは両心室ペーシング機能つき植込み型除細動器（以下，CRT-D）を装着した慢性心不全（以下，CHF）患者に対するストレッチング体... 「要旨」【目的】植込み型除細動器(以下, ICD)あるいは両心室ペーシング機能つき植込み型除細動器(以下, CRT-D)を装着した慢性心不全(以下, CHF)患者に対するストレッチング体... Purpose: Endurance training improves vascular endothelial dysfunction and exercise capacity in patients with chronic heart failure (CHF). However, CHF patients... |
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| SubjectTerms | Cardiac resynchronization therapy defibrillator Chronic heart failure Endothelial function Exercise capacity Implanted cardioverter defibrillator 両心室ペーシング機能つき植込み型除細動器 慢性心不全 植込み型除細動器 血管内皮機能 運動耐容能 |
| Title | ストレッチング体操が植込み型除細動器あるいは両心室ペーシング機能つき植込み型除細動器を装着した運動習慣のない慢性心不全患者の血管内皮機能と運動耐容能に与える影響 |
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| ispartofPNX | 理学療法学, 2018, Vol.45(3), pp.175-182 |
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