بررسی و مقایسه‌ی میزان کاهش ضربان قلب پس از تست ورزش (Heart Rate Recovery) و ظرفیت ورزش (Exercise Capacity) در افراد با و بدون سندرم متابولیک در شهرستان اصفهان

نوع مقاله : مقاله های پژوهشی

نویسندگان

1 دستیار، گروه قلب، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان،

2 دانشیار، مرکز تحقیقات قلب و عروق اصفهان، پژوهشکده‌ی قلب و عروق اصفهان، داتشگاه علوم پزشکی اصفهان، اصفهان، ایران

3 دانشیار، گروه قلب، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

4 دستیار، گروه داخلی، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

5 دستیار، گروه قلب، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران.

6 پزشک عمومی، مرکز تخقیقات قلب و عروق اصفهان، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

7 استاد، مرکز تخقیقات قلب و عروق اصفهان، پژوهشکده‌ی قلب و عروق اصفهان، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

چکیده

مقدمه: مطالعات متعددی در جوامع مختلف دو شاخص تعداد ضربان قلب در دقیقه‌ی اول بعد از پایان تست ورزش (1 Minute Heart Rate Recovery یا HRR) و ظرفیت ورزش (Exercise Capacity یا EC) را به عنوان پیش‌گویی کننده‌های بروز حوادث قلبی نشان داده است. مطالعه‌ی حاضر جهت مقایسه‌ی این دو شاخص در افراد با و بدون سندرم متابولیک در شهرستان اصفهان انجام گرفت.روش‌ها: این مطالعه بر روی 254 نفر از افراد غیر مبتلا و 216 فرد مبتلا به سندرم متابولیک از مطالعه هم‌گروهی اصفهان انجام شد. اطلاعات دموگرافیک، دور شکم، فشار خون، قد و وزن افراد ثبت شد. تری‌گلیسرید سرم و قند خون ناشتا، کلسترول تام، HDL و LDL افراد نیز اندازه گیری شد. تست ورزش بر اساس پروتکل استاندارد  Bruceانجام گردید و تعداد ضربان قلب در دقیقه‌ی اول و ظرفیت ورزش تعیین و ثبت شد. داده‌ها به کمک نرم‌افزار آماری 15SPSS و بااستفاده از روش Generalized linear model با تعدیل بر اساس سن تجزیه و تحلیل شد.یافته‌ها: تعداد ضربان قلب در دقیقه‌ی اول در گروه غیر مبتلا بیشتر از گروه مبتلا به سندرم متابولیک بود (007/0 = P) اما در هر دو گروه میزان تعداد ضربان قلب در دقیقه‌ی اول طبیعی بود (بیشتر از 18 ضربان در دقیقه). میزان ظرفیت ورزش در گروه مبتلا به سندرم متابولیک به طور معنی‌داری کمتر از گروه غیر مبتلا بود (022/0 = P).نتیجه‌گیری: با توجه به یافته‌ها، این مطالعه توجه پزشکان و برنامه‌ریزان بهداشتی جامعه‌ی ما را به ارتباط قوی‌تر ظرفیت ورزش با سندرم متابولیک در مقایسه با تعداد ضربان قلب در دقیقه‌ی اول معطوف می‌دارد؛ نیاز به تعیین نقطه‌ی معیار جدید جهت تعداد طبیعی ضربان قلب در دقیقه‌ی اول نیز وجود دارد.

کلیدواژه‌ها

عنوان مقاله [English]

Evaluation of Heart Rate Recovery and Exercise Capacity in Individuals with and without Metabolic Syndrome

نویسندگان [English]

  • Davood Shafie 1
  • Masoumeh Sadeghi 2
  • Mohammad Hashemi 3
  • Maryam Heydarpour 4
  • Esmail Aghababaei 5
  • Mohammad Tallaei 6
  • Nizal Sarrafzadegan 7
1 Resident, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Associate Proffesor of Cardiology,Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Associate Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
4 Resident, Department of Internal Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
5 Resident, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
6 Isfahan Cardiovascular Research Center,Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
7 Professor, Isfahan Cardiovascular Research Center, Isfahan Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
چکیده [English]

Background: Many studies showed that heart rate recovery (1 min) and exercise capacity at exercise test are both strong predictors of cardiovascular events in various populations. This study compared heart rate recovery (1min) and exercise capacity in individuals with and without metabolic syndrome in Iranian community.Methods: This cross-sectional study was performed on 470 individuals aged ≥ 35 years who followed in Isfahan Cohort Study. A questionnaire including questions on demographic and lifestyle information as well as weight, height, blood pressure, and waist circumference was completed. Triglyceride, fasting blood glucose (FBS), total cholesterol, HDL, and LDL levels were measured as well. All subjects performed a symptom limited exercise test under the standard Bruce protocol. Heart rate recovery (1 min) and exercise capacity were calculated. Data were analyzed by generalized linear model SPSS15 software.Finding: The prevalence of diabetes mellitus, hypertension, and dyslipidemia were higher in individuals with metabolic syndrome (P = 0.001). Heart rate recovery (1 min) was in normal range in individuals with and without metabolic syndrome (> 18 bpm) but in subjects without metabolic syndrome it was higher (41.48 versus 37.07; P = 0.007). There was no difference between men and women in individuals with and without metabolic syndrome (P = 0.645 and 0.39 respectively). Exercise capacity was lower in individuals without metabolic syndrome (P = 0.022).Conclusion: Our findings suggested that among exercise capacity and heart rate recovery, this is exercise capacity which has a stronger relationship with metabolic syndrome in our community. Also, it seems that there is a need for reconsideration on heart rate recovery threshold.

کلیدواژه‌ها [English]

  • Metabolic Syndrome X
  • Exercise test
  • Insulin Resistance

مراجع

  1. Reaven GM. Banting lecture 1988. Role of insulin resistance in human disease. Diabetes 1988; 37(12): 1595-607.
  2. Ford ES, Giles WH, Dietz WH. Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 2002; 287(3): 356-9.
  3. Ozanne SE, Hales CN. Early programming of glucose-insulin metabolism. Trends Endocrinol Metab 2002; 13(9): 368-73.
  4. Chaitman BR. Exercise stress testing. In: Libby P, Braunwald E, Editors. Braunwald's heart disease: A textbook of cardiovascular medicine. Philadelphia: Saunders, 2007: 197-205.
  5. Gibbons RJ, Balady GJ, Bricker JT, Chaitman BR, Fletcher GF, Froelicher VF, et al. ACC/AHA 2002 guideline update for exercise testing: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1997 Exercise Testing Guidelines). J Am Coll Cardiol 2002; 40(8): 1531-40.
  6. Vivekananthan DP, Blackstone EH, Pothier CE, Lauer MS. Heart rate recovery after exercise is a predictor of mortality, independent of the angiographic severity of coronary disease. J Am Coll Cardiol 2003; 42(5): 831-8.
  7. Cay S. Heart rate recovery after exercise: an important prognostic criterion. Int J Cardiol 2009; 137(3): 187-8.
  8. Kim ES, Ishwaran H, Blackstone E, Lauer MS. External prognostic validations and comparisons of age- and gender-adjusted exercise capacity predictions. J Am Coll Cardiol 2007; 50(19): 1867-75.
  9. Blair SN, Kohl HW, III, Paffenbarger RS, Jr., Clark DG, Cooper KH, Gibbons LW. Physical fitness and all-cause mortality. A prospective study of healthy men and women. JAMA 1989; 262(17): 2395-401.
  10. Ekelund LG, Haskell WL, Johnson JL, Whaley FS, Criqui MH, Sheps DS. Physical fitness as a predictor of cardiovascular mortality in asymptomatic North American men. The Lipid Research Clinics Mortality Follow-up Study. N Engl J Med 1988; 319(21): 1379-84.
  11. Wei M, Kampert JB, Barlow CE, Nichaman MZ, Gibbons LW, Paffenbarger RS, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999; 282(16): 1547-53.
  12. Mora S, Redberg RF, Cui Y, Whiteman MK, Flaws JA, Sharrett AR, et al. Ability of exercise testing to predict cardiovascular and all-cause death in asymptomatic women: a 20-year follow-up of the lipid research clinics prevalence study. JAMA 2003; 290(12): 1600-7.
  13. Chaitman BR. Abnormal heart rate responses to exercise predict increased long-term mortality regardless of coronary disease extent: the question is why? J Am Coll Cardiol 2003; 42(5): 839-41.
  14. Morise AP. Heart rate recovery: predictor of risk today and target of therapy tomorrow? Circulation 2004; 110(18): 2778-80.
  15. Fletcher GF, Balady GJ, Amsterdam EA, Chaitman B, Eckel R, Fleg J, et al. Exercise standards for testing and training: a statement for healthcare professionals from the American Heart Association. Circulation 2001; 104(14): 1694-740.
  16. Mark DB, Lauer MS. Exercise capacity: the prognostic variable that doesn't get enough re-spect. Circulation 2003; 108(13): 1534-6.
  17. Falcone C, Buzzi MP, Klersy C, Schwartz PJ. Rapid heart rate increase at onset of exercise predicts adverse cardiac events in patients with coronary artery disease. Circulation 2005; 112(13): 1959-64.
  18. Genuth S, Alberti KG, Bennett P, Buse J, De-fronzo R, Kahn R, et al. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care 2003; 26(11): 3160-7.
  19. Singh TP, Evans S. Socioeconomic position and heart rate recovery after maximal exercise in children. Arch Pediatr Adolesc Med 2010; 164(5): 479-84.
  20. Spies C, Otte C, Kanaya A, Pipkin SS, Schiller NB, Whooley MA. Association of metabolic syndrome with exercise capacity and heart rate recovery in patients with coronary heart disease in the heart and soul study. Am J Cardiol 2005; 95(10): 1175-9.
  21. Deniz F, Katircibasi MT, Pamukcu B, Binici S, Sanisoglu SY. Association of metabolic syn-drome with impaired heart rate recovery and low exercise capacity in young male adults. Clin Endocrinol (Oxf) 2007; 66(2): 218-23.
  22. Katzmarzyk PT, Church TS, Janssen I, Ross R, Blair SN. Metabolic syndrome, obesity, and mortality: impact of cardiorespiratory fitness. Diabetes Care 2005; 28(2): 391-7.
  23. Hunt KJ, Resendez RG, Williams K, Haffner SM, Stern MP. National Cholesterol Education Program versus World Health Organization metabolic syndrome in relation to all-cause and cardiovascular mortality in the San Antonio Heart Study. Circulation 2004; 110(10): 1251-7.
  24. McNeill AM, Rosamond WD, Girman CJ, Golden SH, Schmidt MI, East HE, et al. The metabolic syndrome and 11-year risk of incident cardiovascular disease in the atherosclerosis risk in communities study. Diabetes Care 2005; 28(2): 385-90.
  25. Onat A, Ceyhan K, Basar O, Erer B, Toprak S, Sansoy V. Metabolic syndrome: major impact on coronary risk in a population with low cholesterol levels--a prospective and cross-sectional evaluation. Atherosclerosis 2002; 165(2): 285-92.
  26. Girman CJ, Rhodes T, Mercuri M, Pyorala K, Kjekshus J, Pedersen TR, et al. The metabolic syndrome and risk of major coronary events in the Scandinavian Simvastatin Survival Study (4S) and the Air Force/Texas Coronary Atherosclerosis Prevention Study (AFCAPS/TexCAPS). Am J Cardiol 2004; 93(2): 136-41.
  27. Brinkworth GD, Noakes M, Buckley JD, Clifton PM. Weight loss improves heart rate recovery in overweight and obese men with features of the metabolic syndrome. Am Heart J 2006; 152(4): 693-6.
  28. Rissanen P, Franssila-Kallunki A, Rissanen A. Cardiac parasympathetic activity is increased by weight loss in healthy obese women. Obes Res 2001; 9(10): 637-43.
  29. Karason K, Molgaard H, Wikstrand J, Sjostrom L. Heart rate variability in obesity and the effect of weight loss. Am J Cardiol 1999; 83(8):1242-7.
  30. Sarraf-Zadegan N, Boshtam M, Malekafzali H, Bashardoost N, Sayed-Tabatabaei FA, Rafiei M et al. Secular trends in cardiovascular mortality in Iran, with special reference to Isfahan. Acta Cardiol 1999; 54(6): 327-33.
  31. Sarraf-Zadegan N, Sayed-Tabatabaei FA, Ba-shardoost N, Maleki A, Totonchi M, Habibi HR et al. The prevalence of coronary artery disease in an urban population in Isfahan, Iran. Acta Cardiol 1999; 54(5): 257-63.
  32. Sarrafzadegan N, Kelishadi R, Baghaei A, Hussein SG, Malekafzali H, Mohammadifard N et al. Metabolic syndrome: an emerging public health problem in Iranian women: Isfahan Healthy Heart Program. Int J Cardiol 2008; 131(1): 90-6.
  33. Sarraf Zadegan N, Baghaei A, Sadri CH, Keli-shadi R, Malekafzali H, Boshtam M, et al. Isfa-han healthy heart program: Evaluation ofcom-prehensive, community-based interventions fornon-communicable disease prevention. Preventionand control 2006; 2(2): 73-84.
  34. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA 2001; 285(19): 2486-97.
  35. World Health Organization. Obesity: preventing and managing the global epidemic. Geneva: WHO; 2000.
  36. Warnick GR, Benderson J, Albers JJ. Dextran sulfate-Mg2+ precipitation procedure for quantitation of high-density-lipoprotein cholesterol. Clin Chem 1982; 28(6): 1379-88.
  37. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem 1972; 18(6): 499-502.
  38. World Health Organization, Cardiovascular Diseases Unit. Monica manual. Geneva: WHO; 2010.
  39. Cole CR, Blackstone EH, Pashkow FJ, Snader CE, Lauer MS. Heart-rate recovery immediately after exercise as a predictor of mortality. N Engl J Med 1999; 341(18): 1351-7.
  40. Cole CR, Foody JM, Blackstone EH, Lauer MS. Heart rate recovery after submaximal exercise testing as a predictor of mortality in a cardiovascularly healthy cohort. Ann Intern Med 2000; 132(7): 552-5.
  41. Nishime EO, Cole CR, Blackstone EH, Pashkow FJ, Lauer MS. Heart rate recovery and treadmill exercise score as predictors of mortality in patients referred for exercise ECG. JAMA 2000; 284(11): 1392-8.
  42. Arena R, Arrowood JA, Fei D, Shelar S, Helm S, Kraft KA. The influence of sex on the relationship between heart rate recovery and other cardiovascular risk factors in apparently healthy subjects. Scand J Med Sci Sports 2010; 20(2): 291-7.
  43. Kizilbash MA, Carnethon MR, Chan C, Jacobs DR, Sidney S, Liu K. The temporal relationship between heart rate recovery immediately after exercise and the metabolic syndrome: the CARDIA study. Europian Heart Journal 2006; 27(13): 1596-7.
  44. Laaksonen DE, Lakka HM, Niskanen LK, Kaplan GA, Salonen JT, Lakka TA. Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study. Am J Epidemiol 2002; 156(11): 1070-7.
  45. Lakka HM, Laaksonen DE, Lakka TA, Niskanen LK, Kumpusalo E, Tuomilehto J, et al. The metabolic syndrome and total and cardiovascular disease mortality in middle-aged men. JAMA 2002; 288(21): 2709-16.
  46. Nilsson G, Hedberg P, Jonason T, Lonnberg I, Ohrvik J. Heart rate recovery is more strongly associated with the metabolic syndrome, waist circumference, and insulin sensitivity in women than in men among the elderly in the general population. Am Heart J 2007; 154(3): 460-7.
  47. Sung J, Choi YH, Park JB. Metabolic syndrome is associated with delayed heart rate recovery after exercise. J Korean Med Sci 2006; 21(4): 621-6.
  48. Mora S, Redberg RF, Sharrett AR, Blumenthal RS. Enhanced risk assessment in asymptomatic individuals with exercise testing and Framingham risk scores. Circulation 2005; 112(11): 1566-72.
  49. Caminiti G, Volterrani M, Marazzi G, Massaro R, Vitale C, Gatta L, et al. Metabolic syndrome predicts lower functional recovery in female but not in male patients after an acute cardiac event. Int J Cardiol 2009; 135(3): 296-301.
  50. Regitz-Zagrosek V, Lehmkuhl E, Mahmoodza-deh S. Gender aspects of the role of the metabolic syndrome as a risk factor for cardiovascular disease. Gend Med 2007; 4(Suppl B): S162-S177.

فایل ها

سابقه مقاله

  • تاریخ دریافت: 23 دی 1389
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

هم رسانی

ارجاع به این مقاله

آمار