有氧運(yùn)動(dòng)對(duì)肥胖青少年心率變異性的影響

李光欣,王占一,呂 薇,趙立君

(1.吉林大學(xué)體育學(xué)院,吉林長(zhǎng)春 130012;2.吉林省長(zhǎng)春市第二實(shí)驗(yàn)中學(xué),吉林長(zhǎng)春 130022; 3.吉林大學(xué)中日聯(lián)誼醫(yī)院藥品管理部,吉林長(zhǎng)春 130033)

有氧運(yùn)動(dòng)對(duì)肥胖青少年心率變異性的影響

李光欣1,王占一2,呂 薇3,趙立君1

(1.吉林大學(xué)體育學(xué)院,吉林長(zhǎng)春 130012;2.吉林省長(zhǎng)春市第二實(shí)驗(yàn)中學(xué),吉林長(zhǎng)春 130022; 3.吉林大學(xué)中日聯(lián)誼醫(yī)院藥品管理部,吉林長(zhǎng)春 130033)

目的:探討有氧運(yùn)動(dòng)對(duì)肥胖青少年心率變異性(HRV)的影響,為制定特異性的運(yùn)動(dòng)處方提供依據(jù)。方法:40名男性肥胖青少年[體質(zhì)量指數(shù)(BMI)≥25 kg·m－2)]隨機(jī)分為運(yùn)動(dòng)組(n＝20)和對(duì)照組(n＝20)。運(yùn)動(dòng)組受試者進(jìn)行有氧運(yùn)動(dòng)干預(yù),每周5次,每次持續(xù)50～60 min,共8周;對(duì)照組受試者保持日常生活習(xí)慣不變。實(shí)驗(yàn)前后分別測(cè)定受試者的身體成分、血液動(dòng)力學(xué)參數(shù)[(心率(HR)和血壓)]和心率變異性(HRV)參數(shù)[總功率(TP)、標(biāo)準(zhǔn)化低頻功率(LFn)、標(biāo)準(zhǔn)化高頻功率(HFn)以及LFn/HFn比值]。結(jié)果:實(shí)驗(yàn)前2組受試者各指標(biāo)比較差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。與實(shí)驗(yàn)前比較,實(shí)驗(yàn)后運(yùn)動(dòng)組受試者脂肪質(zhì)量(FM)、體脂百分比(BF%)、安靜HR、收縮壓(SBP)和舒張壓(DBP)均下降(P＜0.05或P＜0.01),TP和HFn(P＜0.01)升高, LFn和LFn/HFn比值降低(P＜0.01);對(duì)照組受試者各指標(biāo)差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。與對(duì)照組比較,實(shí)驗(yàn)后運(yùn)動(dòng)組受試者FM、BF%、安靜HR、SBP、DBP、LFn和LFn/HFn比值均明顯降低(P＜0.05或P＜0.01),TP和HFn明顯升高(P＜0.01)。結(jié)論:有氧運(yùn)動(dòng)可有效降低肥胖青少年安靜時(shí)的交感神經(jīng)活性,增加迷走神經(jīng)張力。

有氧運(yùn)動(dòng);肥胖;心率變異性;運(yùn)動(dòng)處方;青少年

青少年體質(zhì)量超標(biāo)是成年繼發(fā)性肥胖以及諸多心血管疾病(高血壓、冠心病等)和代謝性疾病(血脂紊亂、糖尿病等)的重要危險(xiǎn)因素。研究[1-3]發(fā)現(xiàn):肥胖可導(dǎo)致自主神經(jīng)功能紊亂,表現(xiàn)為交感神經(jīng)過度興奮而迷走神經(jīng)張力降低,而且自主神經(jīng)功能受損的程度與心血管事件死亡率呈顯著正相關(guān)關(guān)系。規(guī)律的體力活動(dòng)特別是有氧運(yùn)動(dòng)是預(yù)防和治療肥胖的首選非藥物療法,但針對(duì)肥胖青少年的最佳運(yùn)動(dòng)處方仍未確定。有氧運(yùn)動(dòng)是否可改善肥胖青少年自主神經(jīng)功能紊亂狀態(tài)少有報(bào)道。本研究探討8周有氧運(yùn)動(dòng)對(duì)肥胖青少年心率變異性(heart rate variability,HRV)的影響,旨在為制定特異性的運(yùn)動(dòng)處方提供依據(jù)。

1 研究對(duì)象與方法

1.1 研究對(duì)象吉林省長(zhǎng)春市某中學(xué)40名男生自愿參加本實(shí)驗(yàn)。納入標(biāo)準(zhǔn):年齡為13～17歲的單純性肥胖者,即體質(zhì)量指數(shù)(body mass index, BMI)≥25 kg·m－2[4]。排除繼發(fā)性肥胖患者(原發(fā)性甲狀腺功能減退和Cushing綜合征等)、藥物(如糖皮質(zhì)激素等)引起的肥胖患者、患有骨關(guān)節(jié)疾病而不能完成運(yùn)動(dòng)實(shí)驗(yàn)者、急慢性感染者、心血管疾病和代謝性疾病患者以及有長(zhǎng)期吸煙飲酒史者。將受試者隨機(jī)分為運(yùn)動(dòng)組(n＝20)和對(duì)照組(n＝20)。

1.2 整體實(shí)驗(yàn)設(shè)計(jì)受試者于清晨空腹?fàn)顟B(tài)下進(jìn)入標(biāo)準(zhǔn)運(yùn)動(dòng)生理學(xué)實(shí)驗(yàn)室,常規(guī)方法測(cè)定身高、體質(zhì)量、心率(HR)和血壓,利用身體組成分析儀測(cè)定身體成分,最后測(cè)定HRV。測(cè)試結(jié)束后第2天運(yùn)動(dòng)組受試者參加為期8周的有氧運(yùn)動(dòng)計(jì)劃,對(duì)照組受試者在家長(zhǎng)監(jiān)督下保持日常生活習(xí)慣。末次運(yùn)動(dòng)后48 h(消除最后一次訓(xùn)練的影響),受試者返回實(shí)驗(yàn)室,再次進(jìn)行上述指標(biāo)的測(cè)定。

1.3 身體形態(tài)學(xué)參數(shù)測(cè)定體質(zhì)檢測(cè)組件測(cè)量身高和體質(zhì)量后,計(jì)算BMI,BMI＝體質(zhì)量(kg)/身高2(m2);體成分用身體組成分析儀(Inbody 3.0,韓國(guó))測(cè)量,主要觀測(cè)指標(biāo)為脂肪質(zhì)量(fat mass, FM)、去脂體質(zhì)量(fat-free mass,FFM)和體脂百分比(percent of body fat,BF%)。

1.4 血液動(dòng)力學(xué)參數(shù)測(cè)定受試者休息10 min后取端坐位,采用經(jīng)校正后的標(biāo)準(zhǔn)臺(tái)式水銀柱血壓計(jì)測(cè)量右上臂肱動(dòng)脈血壓,每次間隔5 min,連續(xù)測(cè)量3次,取均值,獲得收縮壓(systolic blood pressure,SBP)和舒張壓(diastolic blood pressure, DBP)。同時(shí)計(jì)數(shù)3次(6×10 s)脈搏,取均值作為安靜HR值。

1.5 HRV測(cè)定受試者安靜仰臥位休息10 min 后,用多導(dǎo)生理記錄儀(RM-6000,成都儀器廠)記錄5 min心電,經(jīng)快速傅里葉轉(zhuǎn)換后用自回歸模型頻譜分析法得到心率變異功率譜圖,計(jì)算每個(gè)頻段下的絕對(duì)面積,以ms2為單位。HRV的頻域指標(biāo)包括總功率(total power,TP,0.00～0.40 Hz)、低頻功率(low frequency,LF,0.04～0.15 Hz)和高頻功率(high frequency,HF,0.15～0.40 Hz)。由于HF和LF受TP的影響,因此將其值標(biāo)準(zhǔn)化后再進(jìn)行比較,即標(biāo)準(zhǔn)化低頻功率(normalized low frequency,LFn),LFn＝(LF/TP)×100%;標(biāo)準(zhǔn)化高頻功率(normalized high frequency,HFn), LFn＝(HF/TP)×100%,同時(shí)計(jì)算LFn/HFn比值。

1.6 運(yùn)動(dòng)方案運(yùn)動(dòng)組受試者進(jìn)行8周有氧運(yùn)動(dòng),每周5次,每次50～60 min,運(yùn)動(dòng)方式為健身跑,運(yùn)動(dòng)強(qiáng)度為60%～70%最大預(yù)測(cè)心率(最大預(yù)測(cè)心率＝220－年齡)。每次運(yùn)動(dòng)前先進(jìn)行10～15 min熱身以防止肌肉拉傷,運(yùn)動(dòng)后進(jìn)行5～10 min整理活動(dòng)以減輕延遲性肌肉酸痛。所有受試者均使用遙測(cè)心率表(Polar S800,芬蘭)監(jiān)控運(yùn)動(dòng)強(qiáng)度。受試者在家長(zhǎng)陪同下由經(jīng)驗(yàn)豐富的體育教師和科研人員對(duì)訓(xùn)練過程進(jìn)行嚴(yán)格監(jiān)控并記錄訓(xùn)練日志,同時(shí)每周進(jìn)行1～2次健康教育等方式提高依從性。

1.7 統(tǒng)計(jì)學(xué)分析應(yīng)用SPSS 15.0軟件包對(duì)數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)處理。2組受試者基線變量、形態(tài)學(xué)參數(shù)、血液動(dòng)力學(xué)參數(shù)和HRV參數(shù)以±s表示,組內(nèi)實(shí)驗(yàn)前后各指標(biāo)比較采用配對(duì)t檢驗(yàn),組間各指標(biāo)比較采用獨(dú)立樣本t檢驗(yàn)。

2 結(jié)果

2.1 受試者的基線特征所有受試者均完成了實(shí)驗(yàn)室測(cè)試與運(yùn)動(dòng)干預(yù),無失訪者。受試者的基本特征見表1。2組受試者年齡、身高、體質(zhì)量、BMI、FM、FFM、BF%、HR、SBP和DBP等基線變量比較差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05),具有可比性。

表1 2組受試者的基線特征Tab.1 Baseline characteristics of subjects in two groups(n＝20,±s)

表1 2組受試者的基線特征Tab.1 Baseline characteristics of subjects in two groups(n＝20,±s)

Age(year)Height(l/m)Weight(m/kg)BMI(kg·m－2)FM(m/kg) Group Exercise 15.4±2.6 1.69±0.06 80.4±9.4 28.4±4.2 22.1±3.7 Control 14.6±3.5 1.70±0.08 84.5±9.9 29.3±4.4 21.7±3.4 Group FFM(m/kg)BF%(η/%)HR(beat·min－1)SBP(P/mm Hg)DBP(P/mm Hg) Exercise 58.3±11.5 28.1±7.1 76±5 118±7 75±5 Control 62.7±9.2 25.9±4.3 74±4 115±9 76±4

2.2 2組受試者形態(tài)學(xué)參數(shù)實(shí)驗(yàn)前,2組受試者形態(tài)學(xué)參數(shù)比較差異無統(tǒng)計(jì)學(xué)意義(P＞0.05)。與實(shí)驗(yàn)前比較,實(shí)驗(yàn)后運(yùn)動(dòng)組受試者FM和BF%降低(P＜0.01),實(shí)驗(yàn)后對(duì)照組受試者各形態(tài)學(xué)參數(shù)差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。實(shí)驗(yàn)后運(yùn)動(dòng)組FM和BF%均低于對(duì)照組(P＜0.01)。見表2。

表2 2組受試者形態(tài)學(xué)參數(shù)的變化Tab.2 Changes of morphological parameters of subjects in two groups(n＝20,±s)

表2 2組受試者形態(tài)學(xué)參數(shù)的變化Tab.2 Changes of morphological parameters of subjects in two groups(n＝20,±s)

?P＜0.01 compared with pre-test;△P＜0.01 compared with control group.

Group Weight(m/kg)BMI(kg·m－2)FM(m/kg)FFM(m/kg)BF%(η/%) Exercise Pre-test 80.4±9.4 28.4±4.2 22.1±3.7 58.3±11.5 28.1±7.1 Post-test 77.5±8.4 27.9±4.0 17.2±3.0?△60.3±12.6 22.6±6.5?△Control Pre-test 84.5±9.9 29.3±4.4 21.7±3.4 62.7±9.2 25.9±4.3 Post-test 83.2±10.4 29.2±4.3 23.4±4.1 59.8±10.1 28.5±5.8

2.3 2組受試者血液動(dòng)力學(xué)參數(shù)實(shí)驗(yàn)前,2組受試者血液動(dòng)力學(xué)各參數(shù)比較差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。與實(shí)驗(yàn)前比較,實(shí)驗(yàn)后運(yùn)動(dòng)組受試者HR、SBP和DBP降低(P＜0.05),對(duì)照組受試者血液動(dòng)力學(xué)各參數(shù)差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。實(shí)驗(yàn)后運(yùn)動(dòng)組受試者HR、SBP和DBP均低于對(duì)照組(P＜0.05)。見表3。

表3 2組受試者血液動(dòng)力學(xué)參數(shù)的變化Tab.3 Changes of hemodynamic parameters of subjects in two groups(n＝20,±s)

表3 2組受試者血液動(dòng)力學(xué)參數(shù)的變化Tab.3 Changes of hemodynamic parameters of subjects in two groups(n＝20,±s)

?P＜0.05 compared with pre-test;△P＜0.05 compared with control group.

Group HR(beat·min－1)SBP(P/mm Hg)DBP(P/mm Hg) Exercise Pre-test 76±5 118±7 75±5 Post-test 71±4?△112±6?△72±3?△Control Pre-test 74±4 115±976±4 Post-test 76±5 117±6 78±4

2.4 2組受試者HRV參數(shù)實(shí)驗(yàn)前,2組受試者各HRV參數(shù)比較差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。與實(shí)驗(yàn)前比較,實(shí)驗(yàn)后運(yùn)動(dòng)組受試者TP 和HFn升高(P＜0.01),LFn和LFn/HFn比值下降(P＜0.01);對(duì)照組受試者HRV各參數(shù)差異均無統(tǒng)計(jì)學(xué)意義(P＞0.05)。實(shí)驗(yàn)后運(yùn)動(dòng)組TP 和HFn高于對(duì)照組(P＜0.01),LFn和LFn/ HFn比值低于對(duì)照組(P＜0.01)。見表4。

表4 2組受試者HRV參數(shù)的變化Tab.4 Changes of HRV parameters of subjects in two groups(n＝20,±s)

表4 2組受試者HRV參數(shù)的變化Tab.4 Changes of HRV parameters of subjects in two groups(n＝20,±s)

?P＜0.05 compared with pre-test;△P＜0.05 compared with control group.

Group TP(ms2)LFn(η/%)HFn(η/%)LFn/HFn Exercise Pre-test 2 106±478 52.3±6.8 33.5±4.3 4.23±0.61 Post-test 3 087±574?△41.5±5.2?△45.1±5.0?△3.35±0.56?△Control Pre-test 2 355±512 48.7±7.0 35.8±5.2 3.88±0.81 Post-test 2 209±423 50.6±6.1 32.6±4.4 3.97±0.71

3 討論

有氧運(yùn)動(dòng)可改善心血管機(jī)能和肌肉適能,降低脂肪含量并改善胰島素敏感性,是預(yù)防和治療肥胖的重要非藥物療法[3]。本研究運(yùn)動(dòng)組受試者實(shí)驗(yàn)后體質(zhì)量、BMI、FM和BF%下降,同時(shí)安靜時(shí)HR和血壓降低,提示8周有氧運(yùn)動(dòng)可對(duì)肥胖青少年身體形態(tài)和血液動(dòng)力學(xué)產(chǎn)生積極的作用,降低心血管不良事件的發(fā)生率。有報(bào)道[5]指出:停訓(xùn)4～6周后,通過運(yùn)動(dòng)獲得的良性效應(yīng)逐漸消退,因此建議肥胖青少年應(yīng)長(zhǎng)期堅(jiān)持規(guī)律的有氧運(yùn)動(dòng)訓(xùn)練。

HRV是評(píng)估心臟自主神經(jīng)功能的無創(chuàng)指標(biāo),可間接反映心臟自主神經(jīng)即交感和迷走神經(jīng)的緊張性以及交感-迷走神經(jīng)的均衡性等信息。在HRV指標(biāo)中,TP反映HRV的大小,LFn代表心臟交感調(diào)制,HFn代表心臟迷走調(diào)制,LFn/HFn代表交感-迷走均衡性[6]。研究[1]證實(shí):肥胖者常常伴有自主神經(jīng)紊亂狀態(tài),表現(xiàn)為心交感神經(jīng)過度興奮而迷走神經(jīng)功能減退,交感-迷走平衡呈現(xiàn)交感優(yōu)勢(shì)。交感神經(jīng)過度活化可造成胰島素抵抗并加重肥胖,而肥胖患者脂肪組織分泌的脂聯(lián)素、瘦素和腫瘤壞死因子α等細(xì)胞因子可誘導(dǎo)交感神經(jīng)過度激活[7]。因此,交感活化與肥胖互為因果、相互影響,改善自主神經(jīng)功能將對(duì)肥胖者的心血管系統(tǒng)產(chǎn)生積極的保護(hù)效應(yīng)。

針對(duì)健康人群的研究[8-9]證實(shí):長(zhǎng)期有氧運(yùn)動(dòng)雖然可降低迷走活性,但對(duì)交感活性無顯著影響。對(duì)高血壓[10]、糖尿病[11]以及代謝綜合征患者[12]的研究均顯示:長(zhǎng)期有氧運(yùn)動(dòng)可改善患者的HRV各組分。肥胖者進(jìn)行一次急性運(yùn)動(dòng)后1 h內(nèi),HRV主要表現(xiàn)為抑制,即交感活性增高而且占優(yōu)勢(shì),而迷走活性降低,運(yùn)動(dòng)后2 h交感和迷走活性及平衡度恢復(fù)到運(yùn)動(dòng)前狀態(tài)[13]。但長(zhǎng)期有氧運(yùn)動(dòng)對(duì)肥胖青少年HRV的影響未見報(bào)道。本研究中受試者在末次運(yùn)動(dòng)后48 h進(jìn)行HRV測(cè)量,因此消除了最后一次訓(xùn)練的急性影響,結(jié)果發(fā)現(xiàn):組內(nèi)與實(shí)驗(yàn)前比較,運(yùn)動(dòng)組受試者TP和HFn升高、LFn和LFn/HFn比值降低,對(duì)照組受試者各指標(biāo)均無顯著性差異;組間實(shí)驗(yàn)后比較,運(yùn)動(dòng)組受試者LFn 和LFn/HFn低于對(duì)照組,TP和HFn高于對(duì)照組,提示有氧運(yùn)動(dòng)可顯著改善肥胖青少年心臟自主神經(jīng)功能,即提高迷走神經(jīng)緊張性、降低交感活性,交感-迷走均衡性呈現(xiàn)迷走優(yōu)勢(shì),因此HR和血壓水平下降。其原因可能是有氧運(yùn)動(dòng)通過改善體成分和胰島素敏感性、降低FM和BF%,進(jìn)而下調(diào)脂肪因子釋放[14],此外還可能與心血管自主神經(jīng)中樞(延髓腹外側(cè)區(qū))谷氨酸能神經(jīng)元和γ-氨基丁酸能神經(jīng)元結(jié)構(gòu)與功能重塑有關(guān)[15],具體機(jī)制尚需進(jìn)一步研究。

綜上所述,有氧運(yùn)動(dòng)可有效降低肥胖青少年安靜時(shí)的交感神經(jīng)活性、增加迷走神經(jīng)張力。

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Influence of aerobic exercise in heart rate variability in obese adolescents

LI Guang-xin1,WANG Zhan-yi2,LYU Wei3,ZHAO Li-jun1
(1.School of Physical Education,Jilin University,Changchun 130012,China; 2.Changchun Second Experimental Middle School,Jilin Province,Changchun 130022,China; 3.Department of Drug Administration,China-Japan Union Hospital,Changchun 130033,China)

ObjectiveTo explore the influence of 8-week aerobic exercise in heart rate variability(HRV)in obese adolescents and to provide the evidence for formulating special exercise prescription.MethodsForty male obese adolescents(BMI≥25 kg·m－2)were randomly divided into exercise group(n＝20)and control group(n＝20).The subjects in exercise group conducted a 8-week(five times/week,50－60 min)aerobic exercise while those in control group maintained their routine lifestyle.The body composition,hemodynamic parameters including heart rate(HR)and blood pressure and HRV parameters including total power(TP),normalized low frequency(LFn), normalized high frequency(HFn)and LFn/HFn ratio were measured before and after experiment.ResultsThere were no significant differences of the indicators of the subjects between two groups before experiment(P＞0.05).At the end of experiment,compared before experiment,the fat mass(FM),the percentage of body fat(BF%), the rest HR,SBP and DBP were decreased(P＜0.05 or P＜0.01);the TP and HFn were increased(P＜0.01);the LFn and LFn/HFn ratio were reduced(P＜0.01)in exercise group after experiment;but the indexes of the subjects in control group showed no significant changes(P＞0.05).Compared control group,the FM,the BF%, the rest HR,SBP,DBP,LFn and LFn/HFn ratio were decreased while the TP and HFn were increased(P＜0.01)in exercise group after experiment.ConclusionAerobic exercise may effectively reduce the sympathetic activity and increase the vagal tone in the obese adolescents.

aerobic exercise;obese;heart rate variability;exercise prescription;adolescents

R493;R589.2

B

2014-03-01

國(guó)家社會(huì)科學(xué)基金資助課題(14BTY086)

李光欣(1979－),男,吉林省長(zhǎng)春市人,講師,主要從事運(yùn)動(dòng)醫(yī)學(xué)的研究。

呂 薇(Tel:0431-84995836,E-mail:16909865＠qq.com)趙立君(Tel:0431-85167063,E-mail:zlj＠jlu.edu.cn)

1671-587Ⅹ(2014)05-1093-05

10.13481/j.1671-587x.20140536