Effects Of Exercise Rehabilitation On Autonomic Nervous Function,Cardiopulmonary Fitness And Sleep Quality In Patients With Chronic Heart Failure

Objective:To investigate the effects of 12-week phase II outpatient exercise rehabilitation on the recovery of various physical functions in patients with chronic heart failure.To explore the changes of cardiac autonomic nervous function,cardiopulmonary fitness,cardiac function and sleep quality in patients with chronic heart failure based on routine treatment combined with exercise rehabilitation,and to explore the correlation between cardiac autonomic nervous function indexes and cardiopulmonary fitness,cardiac function and sleep quality.Methods:A total of 104 CHF patients who met the inclusion criteria were selected from the cardiovascular Department outpatient Department of the Second Hospital of Shanxi Medical University from June 2021 to June 2022.They were randomly divided into rehabilitation group(drug therapy + patient education + phase II exercise rehabilitation)and control group(drug therapy + patient education).A total of 98 CHF patients,including 48 in the rehabilitation group and 50 in the control group,completed and collected 12-week follow-up data.Baseline data,blood test indexes,echocardiogram results and Pittsburgh Sleep Quality index were collected.Complete cardiopulmonary exercise test and obtain cardiopulmonary data report.During the12-week intervention,both groups received standardized drug therapy and health education.On the basis of this,patients in the rehabilitation group were required to receive the related content guidance of phase II outpatient exercise rehabilitation,which was carried out 3 times a week.Patients with stable heart failure may add simple resistance training after 4 weeks of aerobic exercise.After 12 weeks,the two groups underwent blood test,cardiac ultrasound,CPET and sleep quality score again,and the data were recorded.Results:1.There were no significant differences between the rehabilitation group and the control group in gender,age,BMI,creatinine value,four items of blood lipid,blood pressure,drug use,history of hypertension,diabetes,smoking and drinking history,cardiac function grading and other baseline data,P > 0.05.2.CPET parameters,heart rate reserve,Peak heart rate,resting heart rate,VO2 Peak,VO2 AT,VE/VCO2 slope,AT,MET,Brog scores and cardiac autonomic nervous function indexes HRR1 and CI before and after treatment were compared in the rehabilitation group,and there were statistical differences(P < 0.05).Cardiac function index NT-Pro BNP,left ventricular end-diastolic diameter and left ventricular ejection fraction were also different before and after rehabilitation(P < 0.05).Sleep quality was significantly improved after exercise rehabilitation(P < 0.05).Peak heart rate,resting heart rate,VO2 Peak,VO2 at AT,VE/VCO2 slope,AT,MET,Brog scores and cardiac autonomic nervous function indexes HRR1 and CI before and after treatment were compared in the control group,and the differences were statistically significant(P < 0.05).Heart rate reserve and resting heart rate were not significantly different from those before(P > 0.05).Cardiac function indexes NT-Pro BNP,left ventricular end-diastolic diameter,left ventricular ejection fraction before and after treatment had significant statistical differences(P < 0.05),only drug therapy and health education did not improve sleep quality significantly(P > 0.05).3.Patients in the rehabilitation group and the control group were compared in pairs before treatment.There were no significant differences in CPET parameters such as central rate reserve,Peak heart rate,resting heart rate,VO2 Peak,VO2 AT,VE/VCO2 slope,AT,MET,Brog scores,and cardiac autonomic nervous function indexes HRR1 and CI(P > 0.05).There was no significant difference in cardiac function index NT-Pro BNP,left ventricular end-diastolic diameter,left ventricular ejection fraction(P > 0.05),and no significant difference in sleep quality between the two groups(P > 0.05).After 12 weeks of intervention according to the corresponding treatment measures,the comparison between the rehabilitation group and the control group,Heart rate reserve,Peak heart rate,resting heart rate,VO2 Peak,VO2 at AT,VE/VCO2 slope,AT,MET,Brog scores and cardiac autonomic nervous function indexes HRR1 and CI in rehabilitation group were significantly improved compared with control group(P < 0.05).Cardiac function indexes NT-Pro BNP,left ventricular end-diastolic diameter and left ventricular ejection fraction were improved more significantly in the rehabilitation group(P < 0.05),and the sleep quality of patients in the rehabilitation group was improved more significantly(P < 0.05).4.After correlation analysis,it was found that HRR1 was positively correlated with CPET parameter center rate reserve(r=0.518,P<0.05),peak heart rate(r=0.296,P<0.05),VO2 Peak(r=0.475,P<0.05),AT(r=0.512,P<0.05),MET(r=0.492,P<0.05),CI(r=0.248,P<0.05),and negatively correlated with Brog score(r=-0.427,P<0.05),but not with resting heart rate,VO2 at AT,VE/VCO2 slope(P>0.05);HRR1was positively correlated with left ventricular ejection fraction(r=0.227,P<0.05),but not with NT-Pro BNP(r=0.016,P>0.05)and left ventricular end-diastolic diameter(r=0.125,P>0.05);There was no correlation between HRR1 and sleep quality score(r=-0.109,P>0.05).CI and CPET parameters: central rate reserve(r=0.585,P<0.05),peak heart rate(r=0.875,P<0.05),VO2 Peak(r=0.584,P<0.05),VO2 at AT(r=0.294,P<0.05),AT(r=0.575,P<0.05),MET(r=0.630,P<0.05)were positively correlated,and negatively correlated with the Brog score(r=-0.522,P<0.05),but not with resting heart rate,VE/VCO2 slope(P>0.05);CI was positively correlated with left ventricular ejection fraction(r=0.262,P<0.05),but not with NT-Pro BNP and left ventricular end-diastolic diameter(P>0.05);There was no correlation between CI and sleep quality score(r=0.040,P>0.05).Conclusion:1.Exercise rehabilitation can improve the cardiopulmonary exercise ability of patients with chronic heart failure,improve the cardiac autonomic nervous regulation function,improve the sleep quality of patients,and help patients better return to society and life.2.There is a certain correlation between cardiac autonomic nerve function indexes HRR1 and cardiac chronotropy and cardiac function and exercise tolerance indexes in patients with heart failure.HRR1 and cardiac chronotropy can preliminarily and simply evaluate cardiac function and exercise tolerance in patients with chronic heart failure,which has certain clinical application value.