| ObjectiveIn view of the lack of experimental evidence and data support in setting intensity load of traditional Chinese medicine exercise(TCME)when formulating the exercise prescription of cardiac rehabilitation(CR)at present,this paper measured the real-time cardiopulmonary physiological stress response of Baduanjin to the population with CR indication represented by hypertension(HBP)and coronary heart disease(CHD)through experiments,quantitatively evaluated the intensity load characteristics of Baduanjin to the target population,and explored and verified the appropriate scheme to enhance its intensity load.The effect of Baduanjin on the cardiorespiratory function of the target population was preliminarily observed to provide evidence support for the application of Baduanjin in CR.Methods1.Literature research.Retrieve relevant literature on the application of TCME,represented by Baduanjin,to the CR population for review,systematic evaluation,and metaanalysis.According to the PICOS principles,develop search terms and search for Chinese or English literature from the PubMed,Elsevier All Medical Database(ClinicalKey),EMBASE(OVID platform),China National Knowledge Infrastructure(CNKI),China Science and Technology Journal Database(CQVIP),and Wanfang Database from its establishment to August 15,2022.Screening of original literature,followed by data extraction,literature quality evaluation,statistical analysis,and data synthesis.2.Study on basic exercise cardiorespiratory function of CR population.Cardiopulmonary exercise test(CPET)was conducted in cases of HBP group,CHD group and healthy people(HeP)who met the inclusion and exclusion criteria.The exercise cardiorespiratory function indexes and safety indexes such as exercise power,respiratory metabolism,circulatory system and ventilation function were observed,and the basic exercise cardiorespiratory function characteristics of the target population were studied.3.Quantification and regulation of intensity load of Baduanjin in CR population.Finished Baduanjin teaching and passed the evaluation,the subjects that included in the second part performed Regular Baduanjin Exercise(RBE)under the real-time detection of CPET tester,observed the immediate respiratory metabolism,circulatory system,ventilation function,energy metabolism and other cardiopulmonary physiological stress response indicators,to quantify the intensity load characteristics of Baduanjin on the target population.Then,by increasing the limb impedance of the subject(weight bearing Baduanjin,WBE)and extending the exercise time(Long-range Baduanjin Exercise,LBE),under the real-time detection of the CPET exercise tester,to observe the changes of the above cardiopulmonary physiological stress response indicators during the exercise of the subject,in order to explore the adjustment method of Baduanjin intensity load.4.A preliminary study on the effect of Baduanjin on cardiorespiratory function in CR population.A prospective cohort design was used.Health education and guidance on daily home exercise management and Baduanjin movement teaching and assessment was conducted for the CR population who met the inclusion and exclusion criteria.After passing the Baduanjin assessment,they entered a 48-weeks follow-up observation period.Taking whether to adhere to Baduanjin daily exercise during the observation period as the exposure factor,the patients who completed the observation were divided into Baduanjin group and control group.Through CPET,the changes of exercise cardiorespiratory function indexes at peak exercise point or anaerobic threshold(AT)such as exercise oxygen uptake(VO2),exercise heart rate(HR),oxygen pulse(O2pulse),metabolic equivalent(METS),exercise load(WR)were observed.The change of the main traditional Chinese medicine(TCM)syndrome scores,body weight,body mass index(BMI),left ventricular ejection fraction(LVEF)were also observed.Results1.Literature research and meta-analysisThe database was searched and 40 articles were finally included(26 in English and 14 in Chinese).The results showed that all the studies were based on the comparison of the eff-ects before and after the exercise treatment.The intervention measures were mainly Taijiquan and Baduanjin.The observation indicators included the indexes of exercise cardiopulmonary function,resting circulatory system and quality of life.The overall methodological quality of the study was low,and there were certain risks in allocation hiding,blind method,data integrity and selective reporting.The research suggests that compared with ordinary daily exercise management methods,TCME can improve the peak VO2,increase the peak METS by 0.95mets,increase the peak O2pulse by 1.19ml/beat,increase the walking distance of 6-minute walk test by 19.59m,and reduce the basic resting HR by 5.24 times/minute,It can reduce systolic blood pressure,diastolic blood pressure and MLHFQ score.Baduanjin can increase VO2 at AT by 1.94ml/kg/min.2.Study on basic exercise cardiorespiratory function in CR population.A.Baseline.The final number of cases included was 30 in the HBP group,30 in the CHD group,and 26 in the HeP group.There was no significant difference in the baseline static cardiorespiratory function status of the subjects before the exercise test(P>0.05).B.AT point.There were statistically significant differences in VO2/kg,METS,HR and blood pressure among the three groups(P<0.05).There was no statistically significant difference between the groups in the measured value/predicted maximum value of each index of exercise cardiorespiratory at the AT point(P>0.05).C.Peak exercise point.There were statistically significant differences among the three groups in WR,VO2,VO2/kg,carbon dioxide output(VCO2),kilogram carbon dioxide output(VCO2/kg),METS,HR,systolic pressure and ventilation(P<0.05).The order from high to low was the HeP group,the HBP group,and the CHD group.The measured/predicted values of maximum power,VO2,VO2/kg,VCO2,VCO2/kg,O2pulse and maximum tidal volume(VT)were significantly different among the three groups(P<0.05).D.Safety.All subjects did not have ischemic ECG and other adverse events during the test.3.Quantification and regulation of intensity load of Baduanjin in CR population.A.Quantitative experiment of cardiorespiratory intensity load in RBEa.Absolute intensity load.The average VO2 produced by RBE on human body was 4.49±1.62 ml/kg/min,and the METS was 1.28±0.46 Mets.There were differences in VO2,VO2/kg,exercise HR,blood pressure,energy consumption and other indicators among the three groups.The values in HBP group and CHD group were higher than the HeP group(P<0.05).According to the METS grading method of absolute intensity,the absolute intensity of Baduanjin is low.b.Relative intensity load.① The ratio of measured value to AT point(XBDJ/XAT):the median VO2/kg of HBP group reached 0.47(0.27,0.58)of AT value,and HR was 0.79 ±0.13 of AT value;VO2/kg in CHD group reached 0.38(0.31,0.56)of AT value,and HR was 0.76± 0.1 of AT value.There was a difference between the two groups(P<0.05).②The measured value accounts for the peak exercise value(XBDJ/XMax):VO2/kg in HBP group and CHD group is greater than 20%of VO2/kg max,and VO2/kg in HeP group is less than 20%of VO2/kg max.The HR of Baduanjin in HBP group reached 60±10%of HRmax,the HR of CHD group reached 58 ± 9%of HRmax,and the HR of HeP group reached 45± 6%of HRmax.The difference between groups was statistically significant(P<0.05).The ratio of VO2,VCO2,METS,RER,VE,VT,VD/VT to the maximum value also had inter-group differences(P<0.05).③ The ratio of the measured value to the predicted maximum value(XBDJ/XPrca):the ratio of respiratory metabolic index,HR,VE,respiratory rate to their respective predicted maximum value has inter-group differences,and the ratio of the HeP group is lower(P<0.05).B.Quantitative experiment on the regulation method of cardiorespiratory intensity load of Baduanjina.Increase impedance method-WBE.The maximum load of the upper and lower limb muscle groups was measured,and the load required to load the Baduanjin was converted.The subjects wore sandbags with corresponding weights on both wrists and ankles,and performed the Baduanjin exercise under the real-time detection of the CPET tester.①Absolute intensity load.The average VO2 produced by the stimulation of Baduanjin on human body was 6.86 ± 2.27 ml/kg/min,and the METS was 1.96 ± 0.65 Mets.There was no statistically significant difference in VO2 among the three groups(P>0.05),but there was a difference in HR,BP,respiratory rate,kg/min VT and other indicators among the groups(P<0.05).② Relative intensity load.The average VO2/kg of the three groups was greater than 50%of the AT value.The exercise HR of HBP and CHD groups increased to more than 80%of the AT value.The ratio of VO2/kg to VO2/kg max in HBP group and CHD group was more than 30%,and that in HeP group was close to 30%.The HR of HBP and CHD group was higher than 60%of HRmax,and the HR of HeP group increased to 50%of HRmax.There was still a difference between the groups(P<0.05).There were differences among the three groups in the ratio of HR,respiratory rate and their predicted maximum values(P<0.05).b.Method of prolonging time-LBEThe exercise was performed by the HBP group(n=30)and the CHD group(n=29).The exercise was repeated four times under the real-time detection of the CPET tester.Compare the values at the highest HR point and highest VO2 point in each cycle.Except for HR,there was no significant difference of the cardiorespiratory values between the four times(P>0.05).C.Comparison of Baduanjin’s cardiorespiratory intensity load before and after adjustmenta.Absolute intensity load.The VO2,METS,HR,respiratory rate,tidal volume and energy consumption after weight-bearing adjustment were higher than those of RBE(P<0.05).b.Relative intensity load.The ratio of VO2,METS,O2 pulse,HR,minute ventilation volume,respiratory rate and other indicators to AT value,to peak exercise time value,and to the expected maximum value were increased by load adjustment,which was significantly different from the RBE before adjustment(P<0.05).c.Relative strength load classification.The classification is based on the five-grade strength zoning method of%VO2max and%HRmax.① Inter-group characteristics of relative intensity grading:with VO2max as a reference,the intensity load of the three groups of subjects was "extremely low-low" under the RBE.Under the WBE,the intensity load of some HBP and CHD groups reached "medium intensity".With HRmax as a reference,the intensity load of patients with HBP and CHD reached "medium intensity"under the RBE,and the intensity load increased under the WBE.The intensity load of HeP is "low intensity",and WBE increases its intensity to the critical "medium intensity" level.②Overall relative load grading characteristics:when VO2max is taken as a reference,the RBE generally belongs to low intensity,and some of the subjects in the WBE reach medium intensity.With HRmax as a reference,the median of the overall strength load of the RBE has reached the medium intensity range,and most of the cases under WBE has entered the medium intensity load range.D.Evaluate the medium intensity load of Baduanjin with "target heart rate reaching the standard"a.Taking the HR exceeding the target HR as the standard.When the target HR was set by the maximum HR method,43.3%of the subjects in the HBP group and 20.7%of the subjects in the CHD group met the standard in the RBE.And the rate of reaching the standard in the two groups increased to 63.3%and 65.5%respectively in the WBE.b.Taking HR within±10 range of target HR as the standard.When the target HR range was set by the maximum HR method,43.3%of subjects in the HBP group and 65.5%of subjects in the CHD group met the standard in the RBE.And the rate of reaching the standard in the two groups increased to 56.7%and 89.7%respectively in the WBE.46.2%of the HeP in WBE reached the target HR range of medium intensity.E.Relevant factors and regression analysis of strength performance of BaduanjinThe intensity load of Baduanjin on the body is related to the basic exercise cardiopulmonary function,age and different cardiovascular diseases(P<0.05).Multiple linear regression analysis showed that the maximum HR,the ratio of the maximum HR to the predicted maximum had a statistically significant impact on the percentage of HR reaching HRmax during Baduanjin exercise(P<0.05).The goodness of fit of the RBE regression model was 65%,and that of the WBE regression model was 72%.F.Cardiopulmonary stress response to various movements of BaduanjinThe curves of the main indexes of Cardiorespiratory response with each action time point have their own characteristics.The radar image shows that stable cardiopulmonary feedback can be continuously output during RBE.The second to eighth forms of WBE has the main effect of increasing ventilation and VO2.G.All subjects did not have ischemic electrocardiogram and other adverse events during the experiment.4.A preliminary study on the effect of Baduanjin on cardiorespiratory function in CR population.A.42 cases were ultimately completed,including 20 cases in the Baduanjin group and 22 cases in the control group.There was no statistically significant difference between the two groups in terms of baseline demographic data,medication and disease status,major cardiovascular and pulmonary indicators of exercise,and daily physical activity.During the observation period,the proportion of patients in Baduanjin group who performed Baduanjin exercise to achieve medium intensity load was 30%.B.At the end of observation,the increase rate of VO2peak and HRmax in Baduanjin group was 60%,higher than that in control group;The decline rate of VO2peak and HRmax in the control group was higher than that in the Baduanjin group,and there was no significant difference between the groups(P>0.05).C.At the end of the observation,the VO2peak,HRmax,METS,O2pulse and other indicators of Baduanjin group were higher than those of the baseline,and the percentage of HRmax and the ratio of HRmax and its predicted value had statistical significance(P<0.05).The ratio of VO2AT,HRAT,METSAT and their predicted value in the nonexposed group were higher than the baseline level(P<0.05).The increase of O2pulse and WR in Baduanjin group was higher than that in control group(P<0.05).There was no statistically significant difference between the two groups in the matching of the main indicators after the propensity score matching(P>0.05).D.The integral values of Qi deficiency,phlegm turbidity and blood stasis syndrome in the two groups were significantly lower than the baseline(P<0.05).The decrease of Qi deficiency syndrome score in Baduanjin group was greater than that in control group,and the difference was statistically significant(P<0.05).The total effective rate of Qi deficiency syndrome in Baduanjin group was 75%,and that in control group was 62.6%.The total effective rate of phlegm turbidity syndrome in Baduanjin group was 25%,and that in control group was 9.1%.E.At the end of the observation,the body weight and BMI of the control group decreased from the baseline,and the average level was lower than that of the Baduanjin group(P<0.05).Conclusion1.The CR population(represented by HBP and CHD)showed the decline of cardiorespiratory function during exercise,and had different basic exercise cardiorespiratory function status compared with healthy people.2.The absolute intensity load to cardiorespiratory of Baduanjin on human body belongs to low intensity,and the relative intensity load generated by Baduanjin is different in different populations.The relative intensity of Baduanjin for healthy people is low intensity,and that for CR people is"low to medium" intensity.With the target HR set by the maximum HR method as the standard,Baduanjin produced medium-intensity stimulation on 43.3%of patients with HBP and 65.5%of patients with CHD.3.The intensity load of Baduanjin on the body is negatively correlated with the basic exercise cardiopulmonary function,and positively correlated with age and the degree of cardiovascular disease.The HR relative intensity of Baduanjin’s exercise can be estimated by reference model.4.The WBE can increase the proportion of healthy people and CR people to reach the medium-intensity load by increasing the limb impedance,and cause strong cardio-pulmonary reaction.Its safety is the same as that of the RBE.5.The daily home exercise with Baduanjin as the main form of exercise can improve the maximum HR level in the CPET of the CR population,and its effect on the cardiorespiratory function of the target population is not less than that of the home exercise rehabilitation with walking behavior as the main form,and can improve the score of Qi deficiency syndrome in TCM.Baduanjin has a low proportion of medium-intensity load in daily home exercise and needs to adjust the intensity load to meet the requirements of CR. |
