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physioscience 2016; 12(01): 11-16
DOI: 10.1055/s-0035-1567063
Originalarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Pulsfrequenzgesteuertes Ausdauertraining bei Patienten nach Schlaganfall

Randomisierte kontrollierte Pilotstudie zur HerzratenvariabilitätPulse Frequency Controlled Endurance Training in Patients after StrokeRandomised Controlled Pilot Study on Heart Rate Variability
M. Glaser
1   Landesklinikum, Allentsteig, Österreich
,
S. Ring-Dimitriou
2   Universität Salzburg, Interfakultärer Fachbereich Sport- und Bewegungswissenschaften/USI, Salzburg, Österreich
,
C. Bancher
1   Landesklinikum, Allentsteig, Österreich
,
M. Pinter
1   Landesklinikum, Allentsteig, Österreich
› Author Affiliations
Further Information

Publication History

21 April 2015

27 October 2015

Publication Date:
04 March 2016 (online)

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Zusammenfassung

Hintergrund: Nach einem Schlaganfall zeigen sich neben den typischen neurologischen Defiziten oftmals auch Einschränkungen des kardiovaskulären und autonomen (vegetativen) Systems. Moderates Ausdauertraining verbessert die kardiovaskuläre Kapazität und die Herzratenvariabilität (HRV) bei gesunden, älteren und Herzerkrankten. Bei Patienten nach Schlaganfall wurde es jedoch bislang nicht ausreichend untersucht. Eine hohe HRV ist ein Indikator für ein ausgewogenes autonomes Nervensystem.

Ziel: Die randomisierte kontrollierte Pilotstudie mit patientenverblindetem Design untersuchte, ob ein 3-wöchiges pulsfrequenzgesteuertes Ausdauertraining die HRV bei Patienten nach Schlaganfall verbessern kann.

Methode: Subakute Patienten nach Schlaganfall wurden den Einschlusskriterien entsprechend selektiert und in 2 Trainingsgruppen (Gruppe A: pulsfrequenzkontrolliert, Gruppe B: keine Intensitätsregulierung) randomisiert. In dem 3-wöchigen Interventionszeitraum trainierten alle Teilnehmer 4-mal pro Woche 20 – 30 Minuten lang am Ergometer. Das autonome Nervensystem wurde mithilfe der 24-Stunden-HRV-Messung untersucht und die funktionelle Gehleistung mit dem 6-Minuten-Gehtest (6-Minutes Walk Test, 6-MWT) bestimmt.

Ergebnisse: Für die Haupt- (HRV) und Nebenzielgröße (6-MWT) ergaben sich keine statistisch bedeutsamen Gruppenunterschiede. Zeit- und Frequenzbereiche der HRV veränderten sich in beiden Gruppen nicht ausreichend, um das Signifikanzniveau von p < 0,05 zu erreichen. In beiden Gruppen verbesserte sich die funktionelle Gehleistung im 6-MWT signifikant (Gruppe A: 21,5 %, p = 0,002; Gruppe B: 14,4 %, p = 0,04). Die Leistung am Ergometer erhöhte sich in Gruppe A signifikant um 28,1 % (p = 0,02) und in Gruppe B um 13,9 % (p = 0,4).

Schlussfolgerungen: In dem 3-wöchigen Untersuchungszeitraum ergaben sich bei Patienten nach Schlaganfall keine HRV-Verbesserungen durch individuelles pulsfrequenzgesteuertes Ausdauertraining. Bei Patienten nach subakutem Schlaganfall verbesserte jedoch Physiotherapie kombiniert mit Ausdauertraining signifikant die funktionelle Gehleistung.

Abstract

Background: Along with the characteristic neurological deficits in patients after stroke often cardiovascular functional capacity and autonomic (vegetative) nervous system’s constraints become apparent. Moderate endurance training improves cardiovascular capacity and heart rate variability (HRV) in healthy, elderly and cardiac subjects. In patients after stroke it has, however, not yet been investigated sufficiently. A high HRV can be considered as an indicator of a well-balanced autonomic nervous system.

Objective: This randomised controlled pilot study with patient-blinded design investigated whether a three week’s pulse frequency controlled endurance can improve HRV in patients after stroke.

Method: Patients after subacute stroke were selected according to the inclusion criteria and randomised into 2 exercise groups (group A: pulse frequency controlled, group B: no intensity modulation). During the intervention period all subjects performed ergometer training 4 times per week for 20 – 30 minutes. The autonomic nervous system was investigated using the 24 hours’ HRV measurement and the functional walking ability was assessed using the 6-minutes walk test (6-MWT).

Results: There were no statistically significant group differences to be found for primary (HRV) and secondary (6 MWT) outcomes. The time and frequency ranges of HRV did not change sufficiently in neither group, in order to attain the significance level of p < 0.05. In both groups the functional walking ability during 6 MWT improved significantly (group A: 21.5 %, p = 0.002); group B. 14.4 %, p = 0.04). In group A the ergometer performance grew significantly by 28.1 % (p = 0.02) and in group B by 13.9 % (p = 0.4).

Conclusions: In patients after stroke no HRV improvements were to be found during the three weeks’ investigation period using individual pulse frequency controlled endurance training. However, in patients after subacute stroke physiotherapy accompanied by endurance training improved significantly the functional walking ability.

Schlüsselwörter

Schlaganfall - Ausdauertraining - autonomes Nervensystem - Herzratenvariabilität - funktionelle Gehfähigkeit

Key words

stroke - endurance training - autonomic nervous system - heart rate variability - functional walking ability
 

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