慢性心不全に対する筋トレの効果

慢性心不全に対する筋トレの効果をみた論文を紹介します。

Effect of Resistance Training on Physical Disability in Chronic Heart Failure. Medicine & Science in Sports & Exercise: POST ACCEPTANCE, 12 January 2011 doi: 10.1249/MSS.0b013e31820eeea1

18週間のレジスタンストレーニングを慢性心不全患者に実施したことで、身体機能と筋力が実施前と比較して有意に改善したという論文です。

慢性心不全患者の対象群（レジスタンストレーニング以外の何らかの介入など）が設定されていませんので、これで即有効と判断するわけには全くいきません。ただ、慢性心不全患者に対する運動療法として、有酸素運動だけでなくレジスタンストレーニングも選択肢の1つにはなると思います。もちろん有酸素運動を優先しますが。

また、慢性心不全による悪液質が存在しても、重症悪液質（ターミナル）ではなく適切な栄養管理がされていれば、軽度のレジスタンストレーニングを行ってもよいかもしれません。

Abstract

Purpose: Patients with chronic heart failure (CHF) report difficulty performing activities of daily living. To our knowledge, however, no study has directly measured performance in activities of daily living in these patients to systematically assess their level of physical disability. Moreover, the contribution of skeletal muscle weakness to physical disability in CHF remains unclear. Thus, we measured performance in activities of daily living in CHF patients and controls, its relationship to aerobic capacity and muscle strength and the effect of resistance exercise training to improve muscle strength and physical disability.

Methods: Patients and controls were assessed for performance in activities of daily living, self-reported physical function, peak aerobic capacity, body composition and muscle strength before and after an 18-wk resistance training program. To remove the confounding effects of several disease-related factors (muscle disuse, hospitalization, acute illness), we recruited controls with similar activity levels as CHF patients and tested patients >6 months following any disease exacerbation/hospitalization.

Results: Performance in activities of daily living was 30% lower (P<0.05) in CHF patients versus controls and was related to both reduced aerobic capacity (P<0.001) and muscle strength (P<0.01). Moreover, resistance training improved (P<0.05 to <0.001) physical function and muscle strength in patients and controls similarly, without altering aerobic capacity.

Conclusion: CHF patients are characterized by marked physical disability compared to age- and physical activity-matched controls, which is related to reduced aerobic capacity and muscle strength. CHF patients respond to resistance training with normal strength/functional adaptations. Our results support muscle weakness as a determinant of physical disability in CHF and show that interventions that increase muscle strength (resistance training) reduce physical disability.