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学科主题: 内科学
题名:
运动对健康中年女性心肺功能和血管内皮功能的影响
作者: 杨洋
答辩日期: 2016-11-24
导师: 郭丽君
专业: 内科学
授予单位: 北京大学
授予地点: 北京大学第三临床医学院
学位: 博士
关键词: 间歇性高强度运动 ; 持续中等强度运动 ; 中年女性 ; 运动耐量 ; 血管内皮功能
其他题名: Effects of Exercise on Cardiopulmonary Function and Vascular Endothelial Function in Healthy Middle-aged Women
分类号: R541
摘要:

【背景】CVD是当今导致女性死亡的首位原因。运动量减少是女性CVD发生率增加的主要因素之一,运动缺乏在中年女性中非常普遍。合理运动是中年女性CVD预防的一个重要措施。然而,运动对健康中年女性各项心肺功能指标及血管内皮功能的影响尚缺乏全面的研究。在相同的总运动量下,间歇性高强度运动与持续性中等强度运动相比能否为中年女性带来更多的心血管获益,还存在争议。

【目的】分析运动对健康中年女性心肺功能、血管内皮功能、自主神经功能以及体重、血糖、血脂代谢的影响;寻找运动耐量的影响因素;对比在相同的运动量下,间歇性高强度运动与持续性中等强度运动对运动耐量等心肺功能指标的影响是否存在差异。

【方法】前瞻性纳入60名无疾病史和未接受规律运动运动训练的中年女性志愿者,平均年龄50.2±5.57岁。分为3组进行前瞻性队列研究,其中中等强度运动组(MICT组)22名、间歇高强度运动组(HIIT组)17名,分别进行12周规律功率车运动,每周3次,两组保持每次运动总能量消耗均为4Kcal/kg。对照组(CG组)21名不做运动干预。观测指标包括12周前后的体重、血糖、血脂;心肺运动试验评价的VO2peak等多种心肺功能学指标、超声心动图评价的心脏功能指标、ELISA法测定血清eNOS与ADMA水平。应用SPSS 23.0软件对数据进行分析。

【结果】1. 三组在基线时年龄、身高、体重、空腹血糖、血脂、体重指数、各种心肺运动试验和超声心动图指标、内皮功能指标无统计学差异。2. 12周后,MICT组与HIIT组各项心肺功能指标,包括VO2peak、OUES、O2pulse peak、VE peak、VT均有显著提高,与基线比较统计学差异显著(P<0.05);斑点追踪超声心动图评价的GLS也与基线比较出现有统计学意义的降低(P<0.05);血清eNOS升高、而ADMA下降(P<0.05)。对照组心肺功能指标、超声指标及血管内皮功能指标均无显著变化。各组运动前后血糖及血脂均无显著变化。仅HIIT组运动后BMI下降,与基线比较有统计学意义(P<0.05)。3. 12周后,HIIT组VO2peak的变化值大于MICT组(3.18±3.03 ml/min/kg与1.09±1.59 ml/min/kg,P<0.05),两组GLS、eNOS与ADMA的变化值无显著差异。4. 相关性分析提示VO2peak的变化值与OUES、O2pulse peak、VE peak、VT、GLS、eNOS及ADMA的变化值均显著相关,但多元线性回归分析结果仅有GLS、O2pulse peak和VE peak的变化值是VO2peak的变化值的独立影响因素子(β值分别为-0.380、0.433和0.310,P值均<0.05)。5. 12周前后各组的HRR值均无显著变化。6. 氧脉搏的显著增加无论是在HIIT组还是在MICT组均仅出现在75%VCO2或以上高能量消耗状态下。

【结论】 1. 运动可以提高健康中年女性以VO2peak等反映的心肺功能及血管内皮功能状态。2. 运动训练提高VO2peak的作用可能主要与心肌收缩力增强、每搏输出量增加和肺通气功能的提升有关,即运动在健康中年女性发挥了提升心肺功能储备的作用,而血管内皮功能的改善并不是运动提高VO2peak的独立预测因素。3. 在相同的能量消耗下,接受间歇高强度运动的健康的中年女性可能比接受持续中等强度运动得到更多的心血管获益。4. 单纯通过运动不能显著改变健康中年女性的自主神经功能。5. 运动在较高耗氧状态时才可诱发脉搏氧,即心脏搏出量的增加。

英文摘要:

【Background】 Cardiovascular diseases is the leading cause of death for adult females, and physical inactivity is a major risk factor for cardiovascular diseases in dle-aged females, the population in which lack of exercise is common. Keeping proper amount of exercise is important for preventing cardiovascular disease in dle-aged women. However, the effect of exercise on cardiopulmonary function and vascular endothelial function in healthy dle-aged women is largely understudied. There is still a debate about whether intermittent high-intensity exercises can bring more cardiovascular benefits to dle-aged women than continuous moderate-intensity exercises.The cardiovascular disease is the leading cause of death for women, and lacking of physical activity is one of the major cardiovascular risk factors for dle-aged women. Physical exercise is an important part in cardiovascular disease prevention. However, there is no comprehensive study on the effect of exercise training on cardiopulmonary fitness and vascular endothelial function in healthy dle-aged women. And there is still a controversy over that can intermittent h !E ing more cardiovascular benefits than continuous moderate-intensity exercises to healthy dle-aged women.

【Objective】 To study the effects of exercise on cardiopulmonary function, vascular endothelial function, autonomic nerve function, body weight, blood glucose,  and blood lipid metabolism in healthy dle-aged women. To find factors that can affect cardiopulmonary fitness. To compare the changes of cardiopulmonary fitness between continuous moderate-intensity exercise and intermittent high-intensity exercise under the same amount of exercise.The aims of this study were to investigate the impact of physical exercise on healthy dle-aged women, and find factors that can influence  cardiopulmonary fitness, compare the effects of two different exercise regimens differing in intensity on fitness improvements.

【Method】60 healthy dle-aged females (age, 50.2±5.57 years) who have no cardiovascular disease history and no regular exercise training habit were enrolled in this prospective cohort study. Subjects were divided into three groups: the continuous moderate-intensity exercise group (MICT, N=22), the intermittent high-intensity exercise group (HIIT, N=17), and the control group (CG, N=21). Both MICT group and HIIT group received regular exercise training using power bicycle for 12 weeks, 3 times per week. The energy expenditure during the exercise was equally controlled as 4Kcal / kg for both exercise groups. The control group(CG) received no exercise intervention. Measurements included body weight, blood glucose, blood lipid, variables of cardiopulmonary function like VO2peak acquired by cardiopulmonary exercise test, the cardiac function variables measured by echocardiography, and the serum level of eNOS and ADMA measured by ELISA to evaluate the changes of vascular endothelial function. All data were analyzed by SPSS 23.0. 60 healthy dle-aged women (age50.2±5.57 years) with no disease history or regular exercise training habits were enrolled in this prospective cohort study, and were divided into three groups: the continuous moderate-intensity exercise group (MICT, N=22), the intermittent high-intensity exercise group (HIIT, N=17) and the control group (CG, N=21). Both MICT group and HIIT group received regular exercise training using power bicycle for 12 weeks, 3 times per week. The energy expenditure during the training was equally controlled as 4Kcal / kg each time in both exercise groups. The control group (CG) received no exercise intervention. The observed indexes including: body weight, blood glucose, blood lipid, variables of cardiopulmonary function acquired by cardiopulmonary exercise test, the cardiac function variables recorded by echocardiography, and the serum eNOS and ADMA measured by ELISA to evaluate the changes of vascular endothelial function. All data were analyzed by SPSS 23.0.

【Results】 1. There are no statistical differences in age, height, weight, blood glucose, blood lipids, BMI, cardiopulmonary function, echocardiography variables and endothelial function among three groups in baseline. 2. All the cardiopulmonary function variables, such as VO2peak, OUES, O2pulse peak, VE peak and VT , were increased after 12-week exercise training in both exercise groups compared to baseline (P<0.05). GLS measured by speckle tracking echocardiogram decreased significantly in both exercise groups (P<0.05). The levels of serium eNOS increased significantly after exercise while ADMA decreased significantly in both exercise groups (P<0.05). GLS measured by speckle tracking echocardiogram decreased in both exercise groups with statistical differences (P<0.05). The blood plasma levels of eNOS were increased while the plasma levels of ADMA decreased in both exercise groups (P<0.05). All the indexes above were not changed in CG. The blood glucose and blood lipid level were not changed in all three groups. Slight decreases of BMI only observed in HIIT group (P<0.05). 3. The increases of VO2peak and O2pulse peak were more dramatic in HIIT group than in MICT group (3.18±3.03 ml/min/kg and 1.09±1.59 ml/min/kg,P<0.05). But the levels of eNOS, ADMA and GLS changes were not significant between the two groups.The improvements of VO2peak and O2pulse peak were greater in HIIT group compared to MICT group (3.18±3.03 ml/min/kg and 1.09±1.59 ml/min/kg,P<0.05). But the changes in eNOS, ADMA and GLS had no significant differences between the two groups. 4. The correlation analysis showed that the changes of VO2peak was closely correlated with that of O2pulse peak, GLS, VEpeak, OUES, VT, eNOS and ADMA. But multiple linear regression analysis suggests that only the improvements of GLS ,O2pulse peak and VEpeak were independent predictors independent influence factors for that of VO2peak (β= -0.380、0.433 and 0.310, all three P<0.05). 5. All three groups showed no significant changes in HRR. 6. O2pulse peak only increased during higher energy consumption in both HIIT group and MICT group.

【Conclusion】 1. Physical exercise could improve cardiopulmonary function and vascular endothelial function in healthy dle-aged women. 2. The improvement of VO2peak was could be was determined by enhanced cardiac systolic function, improved cardiac output and increased ventilation volume. Exercise can elevate the cardiopulmonary reserve in healthy dle-aged women. The improvement of vascular endothelial function is not an independent predictorinfluence factor for that of VO2peak. 3. The intermittent high-intensity exercise could bring more cardiac benefits to healthy dle-aged women than continuous moderate-intensity exercise at the same consumption of energy. in the same energy consumption level. 4. The autonomic nervous function of healthy dle-aged women may not be changed by exercise alone. The autonomic nervous function of healthy dle-aged women could not be changed purely by exercise. 5. The increase of cardiac output can only be induced by higher energy consumption.

语种: 中文
相关网址: 查看原文
内容类型: 学位论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/124742
Appears in Collections:北京大学第三临床医学院_学位论文

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作者单位: 北京大学第三临床医学院

Recommended Citation:
杨洋. 运动对健康中年女性心肺功能和血管内皮功能的影响[D]. 北京大学第三临床医学院. 北京大学. 2016.
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