| Chronic heart failure(CHF)is the ultimate battlefield for many chronic cardiovascular diseases.After decades of exploration and development,more and more evidence-based medical evidence shows that exercise can bring benefits to CHF patients by improving endurance of exercise and quality of life.Therefore,exercise is listed as class IA recommendation in international guidelines.However,the initiation and development of cardiac rehabilitation(CR)in China is behind that of Western countries for nearly 50 years.The integrative of Chinese and Western medicine in CR has become characteristics and advantages of China.Traditional exercise of traditional Chinese medicine(TCM)is developed with the long-lasting Chinese culture and is widely accepted by Chinese people.The characteristics of traditional exercise of TCM is both elegant and soft,both static and dynamic,which is quite suitable for CHF patients who are often fragile and with weak physical endurance.How to make full use of the advantage of traditional exercise of TCM and provide more and suitable exercise programs for CHF patients in the fast developing stage of CR has received great attention at home and abroad.This article mainly includes three parts:A systematic review,clinical research and proposal for standard report of clinical research on traditional exercise of TCM.Part Ⅰ:Exercise Rehabilitation for Patients with Chronic Heart Failure:A Systematic Review and Meta-analysisObjective:To systematically evaluate the clinical curative effect and safety of exercise rehabilitation for CHF patients.Methods:We have searched 6 databases in both English and Chinese and 2 clinical trial registration systems for researches studying exercise rehabilation for CHF patients.Search time is from Jan 1,2008 to Jan 1,2018.SPSS 20.0 and RevMan 5.3 software were used to summarize and analyze the eligible studies.Results:Our review finally included 99 articles(43 in English and 56 in Chinese).The results show that studies on exercise rehabilitation for CHF increased graduallly in recent years.The types of exercises studied were in various forms,including common popular sports:running,walking,swimming,and traditional exercise of TCM,such as Tai Chi and Baduanjin,etc.And the time,frequency,and intensity of exercise according to different cardiac function in patients with CHF also varied.The study outcomes mainly included 6-minute walk test(6MWT),left ventricular ejection fraction(LVEF),and peak oxygen uptake(V02 peak)monitored by cardiopulmonary exercise test.Results of meta analyses:1.1 V02 peak and the 6MWT walking distance increased by 2.85 ml/kg/min and 47.57 m separately in aerobic exercise group compared with conventional drug therapy.1.2 Compared with control intervention,traditional exercise of TCM significantly increased V02 peak(1.23ml/kg/min,P<0.05),6MWT walking distance(64.52m,P<0.05)and LVEF(2.49%,P<0.05),and MLHFQ score decreased by 9.52(P<0.05).The results show that traditional exercise of TCM are basically as effective as aerobic exercise for CHF patients on exercise tolerance and quality of life.Conclusion:In recent years,studies on exercises rehabilitation for CHF have are gradually increasing.There are various forms of exercises,but there is a lack of uniform standard for exercise prescriptions.The number of related studies in traditional exercise of TCM is relatively small and the research quality is low.High-quality research is needed to confirm efficacy of traditional exercise of TCM for CHF patients.Part II:Baduanjin Exercise for Patients with Ischemic Heart Failure on Cardiac RehabilitationObjective:To evaluate the clinical efficacy and safety of improved version of Baduanjin for the CHF patients on cardiac rehabilitation.Methods:In our study,CHF patients with coronary heart disease were the target population of our study.Exercise prescription was made according to exercise tolerance and cardiopulmonary function of enrolled patients.The soft and soothing modified version of Baduanjin combined with routine rehabilitation are adopted as the second phase of rehabilitation intervention in the treatment groupsince CHF patients complicated with coronary heart disease is characterized by poor exercise tolerance,while patients in the control group only received conventional rehabilitation exercise.The main outcomes were 6MWT walking distance,VO2 peak,the oxygen uptake under anaerobic threshold(V02 AT),LVEF,MLHFQ scores,major symptoms of TCM.Results:120 patients diagnosed with CHF were enrolled and randomized from April 2017 to February 2018 at two study centers(the Chinese Academy of Medical Sciences Fuwai Hospital and the Xiyuan Hospital of the Chinese Academy of Traditional Chinese Medicine).Finally,109 patients completed the study with 8 patients lost to follow-up and 3 patients excluded,of which 54 patients(4 patients lost to follow-up and 2 excluded)were in the intervention group and 55 patients(4 patients lost to follow-up and 1 excluded)in the control group.Baseline conditions,such as general information,medical history and clinical medication,were well balanced between the two groups.1 Main outcome measures1.1 Results of cardiopulmonary exercise test(CPET)showed that V02 peak and V02 AT of both the intervention and control groups increased at 3 months.The V02 peak of the intervention group was non-significantly higher than that of the control group(15.54±0.90 ml/kg/min vs.15.43±1.96 ml/kg/min,P>0.05).But the V02 AT was 13.31±1.25 ml/kg/min,which improved more significantly than the control group 11.12±2.10 ml/kg/min.The difference was statistically significant(P<0.05).1.2 Patients in the intervention group had significantly better 6MWT walking distance at 3 months than patients in the control group(419.61 ±26.33 meters vs.397.24±39.10 meters,P<0.05)2 Secondary outcome measures2.1 At 3 months,compared with the control group,the lung function indicators of intervention group showed a significantly better effect on FEV1/FVC(78.37%in the intervention group vs.76.54%in the control group,P<0.05),FEV1/VC(74.26%in the intervention group vs.73.13%in the control group,P<0.05),and MVV(103.68 in the intervention group vs.102.11 in control Group,P<0.05).2.2 At 3 months,Buduanjin showed a nonsignificantly better improvement on cardiac function(LVEF),NT-proBNP,and hs-CRP2.3 At 3 months,standard deviation of normal RR(SDNN)was significantly improved than control group(P<0.05),indicating that Buduanjin can balance function of sympathetic and vagal nerves2.4 Comparison of main TCM symptoms at 3 months between the two groupsshowed that Baduanjin significantly relievedchest tightness,chest pain,fatigue,palpitations,spontaneous perspiration and other symptoms(P<0.05).2.5 Patients in the intervention group had a significantl lower MLHFQ score than patients in the control group(27.44±7.91 points vs.30.56±7.94 points,P<0.05).2.6 There were no adverse events in the two groups during the exercise rehabilitation,and the safety of Baduanjin and routine exercise rehabilitation was good.Conclusion:1 Comparison of CPET and 6MWT indicated that combination of the improved version of Baduanjin and conventional rehabilitation exercise can improve exercise tolerance(V02 AT and 6MWT walking distance)in patients with CHF in exercise rehabilitation.2 Combination of the improved version of Baduanjin and conventional rehabilitation exercise can improve relevant indexes of lung function in CHF patients and exercise rehabilitation.At the same time,it can also regulate the tone and functional balance of sympathetic and vagal nerves in the heart.3 The effect of Baduanjin exercise on LVEF,NT-proBNP,and hs-CRP in CHF patients was not obvious,which may be related to the short course of observation(only 3 months)in this study.4 Combination of the improved version of Baduanjin and conventional rehabilitation exercise can safely improve the main TCM symptoms and quality of life of CHF patients.Part III:Suggestions for Standardized Reports of Clinical Research on theTraditional ExercisesObjective:According to the current status of clinical research on traditional sports,we proposed to construct the " Suggestions for Standardized Reports of Clinical Research on the Application of Traditional Exercises "(hereinafter referred to as "Proposal"),aiming to standardize reports of clinical research on traditional Chinese medicine exercise and guarantee the reliability of research conclusions.Method:Advocated by academy member Keji Chen,the "Proposal" was jointly drafted by experts at home and abroad studying the traditional exercise,evidence-based medicine,and by the Health Qigong Center of the General Administration of Sport of China.Main methods adopted were literature review,logic analysis,expert consultation,and comparative analysis.The "Proposal" was constructed by reviewing literature on traditional Chinese exercise rehabilitation,and systematicly sorting collected data.Result:Referring to the CONSORT statement for clinical trials and interventional research and its related extended version,results of the systematic review of traditional exercise of TCM experimental research literature,and characteristics of traditional Chinese exercise,we drafted the "Proposal" including 7 categories and 17 items.The items of first version of the "Proposal" needs further refinement of the expert consultation or qualitative interview to form the final version.Conclusion:The construction of the "Proposal" is conducive to revealing the advantages of traditional exercise of TCM.It is an important task to improve the quality and standardization of TCM clinical research. |
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