Prof.Dr.B.Bjarnason-WehrensInstituteforCardiologyandSportsMedicine心臟病學和運動醫學研究所GermanSportUniversityCologne德國科隆體育大學Resistanceexerciseincardiacrehabilitation

Implementationofexercisetrainingintocardiacrehabilitationprogramaccordingtotheguidelinebasedontheresultsoftheassessments

-resistancetraining-theoreticalbasicknowledge

基于評估結果指導方針，運動訓練在心臟康復中的應用-力量訓練-基礎理論知識Componentsofexercisebasedtraininginterventions

運動訓練干預成份AerobicendurancetrainingPerceptiontraining,

bodyawareness,

practicalskillsofself-controlResistancetrainingExercisetoimproveflexibility,agilitycoordination,balance,...Modifiedmovementgamesandteamgames...Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne有氧耐力訓練感知訓練、身體意識、自控實際技能改善靈活性、敏捷性、協調性、平衡性...的運動修改過的活動游戲和團體游戲抗阻訓練Exercisetherapieincardiacrehabilitationguidelines

心臟康復指南中的運動療法Pollocketal.Circulation101(2000),828-833

AHAScienceAdvisory.Resistanceexerciseinindividualswithandwithoutcardiovasculardisease:benefits,rationale,safety,andprescription:Fletcheretal.Circulation104(2001),1694-1740ExerciseStandardsforTestingandTraining.AStatementforHealthcareProfessionalsFromtheAmericanHeartAssociation.

Baladyetal.Circulation115(2007),2675-2682CoreComponentsofcardiacRehabilitation/SecondaryPreventionPrograms:2007Update.

Thompsonetal.Circulation107(2003),3109-16

Exerciseandphysicalactivityinthepreventionandtreatmentofatheroscleroticcardiovasculardisease:Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil.2004;11:352-61.Recommendationsforresistanceexerciseincardiacrehabilitation.RecommendationsoftheGermanFederationforCardiovascularPreventionandRehabilitation.

Braithetal.Circulation2006;113;2642-2650ResistanceExerciseTraining:ItsRoleinthePreventionofCardiovascularDiseaseWilliamsetal.Circulation.2007;116:572-84AmericanHeartAssociationCouncilonClinicalCardiology;AmericanHeartAssociationCouncilonNutrition,PhysicalActivity,andMetabolism.Resistanceexerciseinindividualswithandwithoutcardiovasculardisease:2007update:ascientificstatementfromtheAmericanHeartAssociationCouncilonClinicalCardiologyandCouncilonNutrition,PhysicalActivity,andMetabolism.

Bjarnason-WehrensB,etal.ClinicalResearchinCardiology2009;4:1-44

Leitliniek?rperlicheAktivit?tzurSekund?rpr?ventionundTherapiekardiovaskul?rerErkrankungen.Vanheesetal.EJPC,2012DOI10.1177/2047487312437063Importanceofcharacteristicsandmodalitiesofphysicalactivityandexerciseinthemanagementofcardiovascularhealthinindividualswithcardiovasculardisease(PartIII)…

Giannuzzietal.EJCPR10(2003),319-27

Physicalactivityforprimaryandsecondaryprevention.PositionpaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology.Giannuzzietal.EurHeartJ24(2003),1273-8

Secondarypreventionthroughcardiacrehabilitation:positionpaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology.

Corraetal.EJCPR12(2005),321-2

ExecutivesummaryofthePositionPaperoftheWorkingGrouponCardiacRehabilitationandExercisePhysiologyoftheEuropeanSocietyofCardiology(ESC)corecomponentsofcardiac

rehabilitationinchronicheartfailure.Piepolietal.EJCPR(2010),Secondarypreventionthroughcardiacrehabilitation.2009Update;FromKnowledgetoImplementation.APositionpaperfromtheCardiacRehabilitationNucleusoftheEuropeanAssociationofCardiacRehabilitationandPreventionSmithetal.JAmCollCardiol.2011;58:2432-46.

AHA/ACCFsecondarypreventionandriskreductiontherapyforpatientswithcoronaryandotheratheroscleroticvasculardisease:2011update:aguidelinefromtheAmericanHeartAssociationandAmericanCollegeofCardiologyFoundationendorsedbytheWorldHeartFederationandthePreventiveCardiovascularNursesAssociation.Flegetal.Circulation.2013;128:2422–2446SecondaryPreventionofAtheroscleroticCardiovascularDiseaseinOlderAdults:AScientificStatementFromtheAmericanHeartAssociation.…

Increaseinmuscularstrengthandendurance

肌肉力量和耐力的增長

-byincreasingmusclemassand/orimprovingcoordination

andmetabolicsituation

通過增加肌肉質量和/或改善協調性和代謝情況

Workagainstlossinskeletalmusclemassandstrength;

reduceandpreventdecreasesinbonemass

針對骨骼肌肉質量和力量的損失；減少并預防骨質下降-

agerelated;postmenopausal

年齡相關；絕經后

-long-termbed-confinementorinactiveduetoillness因為疾病長期臥床或靜止

-catabolismofskeletalmuscles(e.g.CHF)

骨骼肌的分解代謝（比如充血性心力衰竭）

-long-lastingimmunosuppressivetherapy長期免疫抑制療法ResistanceTraininginCardiacRehabilitation心臟康復中的抗阻訓練Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne

increaseexerciseaswellasfunctionalcapacity增加活動力同時增加功能能力

reduceactivitylimitation減少活動受限

improvefunctionalityincarryingouteverydayactivity改善每天執行的日常活動的功能性

preventingfalls摔倒預防

positivelyinfluenceself-confidenceandpsychosocialwell

being,socialre-adaptationandre-integration對自信心，心理健康，社會再適應和再融入有積極影響

improvequalityoflife改善生活質量ResistanceTraininginCardiacRehabilitation心臟康復中的抗阻訓練

Increaseinmuscularstrengthandendurance增加肌力和耐力

Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneImpactofmusclestrengthintheelderly

肌力對老年人的影響Reducedmuscularstrengthinolderpersonshasbeendeterminedtobeamajorcauseofdisability老年人肌力的減少已被認為是殘疾的主要原因之一。Reducedlowerlegstrengthhasbeenassociatedwithreductionin下肢力量減少已被與下列方面變差聯系起來：gaitspeed步態速度balance平衡stair-climbingability上臺階能力abilitytogetupfromaseatedposition從坐位站起的能力ValenzuelaTJAMDA13(2012)418-428MangioneKKetal.PHYSTHER.2010;90:1711-1715.Impactofimprovingmusclestrengthintheelderly…

改善老年人肌力的影響Enhancedmuscularstrength增強肌力可以reducesactivitylimitation減少活動限制improvesfunctionalcapacity改善功能性能力maximizesindependence使自理能力最大化slowstheprogressionofDementia減緩老年癡呆癥的進展promotessleep改善睡眠enhancesqualityoflifeandwell-being提高生活質量和健康狀況reducesriskoffalls降低摔倒風險ValenzuelaTJAMDA13(2012)418-428balancetrainingintheelderly…老年人的平衡訓練

Theexerciseprogramshouldincludeexercisesthatmaintainorimprovebalanceinordertoreducethe

riskofinjuryfromfalls.運動計劃應包含保持或改善平衡性的運動練習，以減少因跌倒而受傷的風險。

Balanceexercisesshouldbeperformeddailyoratleastonthreedaysaweek平衡性練習應每天或至少一周訓練3天Exampleofexercises:運動范例：-walkingbackwards,

向后走-toewalking,

用腳尖走路-standingfromasittingposition…從坐位站起NelsonME.etal.PhysicalActivityandPublicHealthinOlderAdultsRecommendationFromtheAmerican

CollegeofSportsMedicineandtheAmericanHeartAssociation.Circulation.2007;116:1094-1105Elsawyetal.PhysicalactivityguidelinesforOlderAdults;AmericanFamilyPhysician20108155-59

Positiveeffectsoncardiovascularriskfactors

對心血管疾病風險因素的積極影響

enhancementofweightreductionandstabilization

幫助減重和增強穩定性

improvementofinsulinsensitivity,independentfromchangesinbodyweightandendurancecapacity

改善胰島素敏感度，不受體重和耐力變化影響

reductionofbloodpressure

降低血壓ResistanceTraininginCardiacRehabilitation心臟康復中的抗阻訓練Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneInSearchoftheIdealResistanceTrainingProgramtoImproveGlycemicControlanditsIndicationforPatientswithType2DiabetesMellitus:ASystematicReviewandMeta-Analysis.

尋找理想的抗阻訓練計劃，以改善2型糖尿病患者的血糖控制及其適應癥:一個系統回顧和薈萃分析。

Ishiguroetal.SportsMed.2016;46:67-77.ResistancetrainingisassociatedwithHbA1creduction

-0,34%(p<0,001).抗阻訓練與糖化血紅蛋白減少0.34%有關。（p<0,001)Exercisetrainingforbloodpressure:asystematicreviewandmeta-analysis.

血壓運動訓練：一個系統性回顧和薈萃分析

Cornelissen&SmartJAmHeartAssoc.2013;2:e004473.Metaanalysesincluding29RCSresistanceexercise薈萃分析包含29項回顧性群組研究，抗阻訓練Meanbloodpressure平均血壓

resistanceexercise抗阻訓練-1,8/-3,2mmHgnormalbloodpressure正常血壓

-0,59/-3,4mmHgprehypertension高血壓前期-4,0/-3,8mmHgHypertension高血壓+0,47/-1,0mmHgComparisonoftheEffectsofAerobicTrainingtoResistanceTrainingonHealthandFitnessVariables有氧訓練和抗阻訓練對健康變量影響的對比Variable變量 AerobicExercise ResistanceExerciseBonemineraldensity骨礦物質密度

↑ ↑↑↑

Bodycomposition身體成分Fatmass脂肪質量

↓↓ ↓ Musclemass肌肉質量 ? ↑↑

Strength肌力

Glucosemetabolism葡萄糖代謝Insulinresponsetoglucosechallenge胰島素反應↓↓ ↓↓Basalinsulinlevels基礎胰島素水平

↓ ↓Insulinsensitivity胰島素敏感度

↑↑ ↑↑Serumlipids血清脂質High-densitylipoprotein高密度脂蛋白

↑? ↑?Low-densitylipoprotein低密度脂蛋白

↓? ↓?Restingheartrate靜息心率

↓↓ ↓Bloodpressureatrest靜息血壓Systolic收縮壓

↓↓ ↓Diastolic舒張壓

↓↓ ↓Physicalendurance身體耐力

↑↑↑ ↑↑Basalmetabolism基礎代謝 ↑ ↑↑

↑indicatesincreased;↓,decreased;and?negligibleeffect↑表明升高;↓,降低;而?表明可以忽略的影響(Randyetal.Circulation2006;113;2642-2650)Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneEffectofcombinedaerobicandresistancetrainingversusaerobictrainingaloneinindividualswithcoronaryarterydisease:ameta-analysis

對比有氧抗阻綜合訓練與單獨有氧訓練對冠狀動脈疾病患者的影響：一個薈萃分析

Marzolinietal.EJPC(2012);19;81-94Aim:Tocomparetheeffectofaerobictrainingaloneversuscombinedaerobicandresistancetrainingonbodycomposition,cardiovascularfitness(VO2peak),strength,andquality-of-life(QOL)incoronaryarterydisease(CAD).目標：比較單獨有氧訓練和有氧抗阻綜合訓練對冠狀動脈疾病患者身體成份、心血管健康（耗氧量峰值）、力量和生活質量的影響。Metaanalyses:12studiesN=504;CAD-Patient薈萃分析：12項研究N=504；冠狀動脈疾病患者

n:229aerobictrainingpatients

229名有氧訓練患者n:275combinedaerobicandresistancetrainingpatients

275名有氧抗阻綜合訓練患者

Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneExerciseCapacity運動能力

Differencecombinedvs.Aerobicexercieonly綜合訓練與單獨有氧訓練的對比

a)+0.41mL/min/kgV02peak(ns)+0.41毫升/分鐘/千克

耗氧量峰值(未明確)

b)+0.88watt/exercisetime(p<0.01)+0.88瓦特/運動時間(p<0.01)

Marzolinietal.PrevCardiol2012;19:81-91

bodycomposition(DEXA):

combinedvs.

aerobicexerciseonly:

身體成份（骨密度）：

綜合訓練與單獨有氧訓練的對比：

a)fat-freemass

去脂肪質量

+0.88(p<0.001)

b)percentbodyfat

體脂含量

-2.30(p<0.001)

c)trunkfat

軀干脂肪

-0.56(p<0,001)

Marzolinietal.PrevCardiol

2012;19:81-91Marzolinietal.PrevCardiol

2012;19:81-91Combinedvs.aerobicexerciseonly綜合訓練與單獨有氧訓練的對比

a)upperbodystrength +0.77(p<0.001)

上身力量

b)lowerbodystrength +1.07(p<0,001)

下身力量

Aim:toinvestigatetheeffectsofRTonexercisecapacity,musclestrength,andmobilityinmiddle-agedandelderlypatientswithcoronaryarterydisease(CAD).目標：研究抗阻訓練對中老年冠狀動脈疾病患者運動能力、肌力和活動性的影響Metaanalysis:22RCSN=1095;CAD-Patienten;薈萃分析：22個回顧性群組研究N=1095；冠狀動脈疾病患者7RCS strengthvs.ControlGroup7RCS力量vs.對照組16RCS strengthvs.combinedaerobicandstrengthtraining16RCS力量vs.有氧力量綜合訓練Effectsofresistancetrainingonmusclestrength,exercisecapacity,andmobilityinmiddle-agedandelderlypatientswithcoronaryarterydisease:Ameta-analysis.抗阻訓練對中老年冠狀動脈疾病患者肌力、運動能力和活動性的影響：一個薈萃分析Yamamotoetal.JCardiol2016;68:125-34exercisecapacity運動能力

differencescomparedtocontrol與對照組相比的差異

middle-aged

中年

+0.90mL/min/kgV02peak

elderly 老年

+0.70mL/Min/kgV02peakYamamotoetal.JCardiol2016;68:125-134lowerextremitymusclestrength(kneeextension)下肢肌力

（伸膝）

-differencescomparedtocontrol與對照組相比的差異

middle-aged中年人 SMD+0.65

elderly老年人 SMD+0.63Yamamotoetal.JCardiol2016;68:125-134upperextremitymusclestrength

(chestpress–bicepscurls)

上肢肌力（胸推--二頭肌卷曲）

differencescomparedtocontrol與對照組相比的差異

middle-aged中年人 SMD+0.73

elderly 老年人 SMD+1.18

Yamamotoetal.JCardiol2016;68:125-134mobility(six-mintes-walking-distance)靈活性（6分鐘步行距離）

differencescomparedtocontrole

與對照組相比的差異

middle-aged中年人 SMD+0.13ns.

elderly 老年人 SMD+0.61(p=0,003)Yamamotoetal.JCardiol2016;68:125-134Metaanalysis:27RCS(29exercisegroups)薈萃分析：27個回顧性群組研究（RCS）（29個運動組）N=2321;chronicheartfailureN=2321；慢性心力衰竭6RCSstrengthvs.control6RCS力量訓練vs.對照組18RCScombinedstrengthandaerobicexercisevs.control18RCS有氧力量綜合訓練vs.對照組5RCScombinedstrengthandaerobicexercisevs.aerobicexerciseonly5RCS有氧力量綜合訓練vs.單獨有氧訓練Intensity:

60-80%1RM強度：60-80%1次最大肌力值Programduration:≤6weeks–26weeks項目持續時間：

≤6周–26周OutcomeParameter:結果參數：mortality,hospitalization,peakVO2,peakHR,LVEF%,6MWD,Qual,死亡率、住院、

耗氧量峰值、心率峰值、左心室射血分數、6分鐘步行距離、質量Theeffectofresistancetrainingonclinicaloutcomesinheartfailure:Asystematicreviewandmeta-analysis抗阻訓練對心力衰竭臨床結果的影響：一個系統性回顧和薈萃分析

Jewissetal.IntJCardiol2016;221:674-681

exercisecapacity運動能力

+3.99mL/min/kgV02peak;p<0.001(strengthvs.control)（力量訓練vs.對照組）

+1.43mL/Min/kgV02peak;p=0,002(combinedvs.control)（綜合訓練vs.對照組）

+0.61mL/Min/kgV02peakns.(combinedvs.aerobiconly)（綜合訓練vs.有氧訓練）

Jewissetal.IntJCardiol2016;221:674-681

qualityofLife

(MLwHFQ)

生活質量（心力衰竭問卷）

strengthvs.control-8.31(p<0,001)

力量訓練vs.對照組

-8.31(p<0,001)

Jewissetal.IntJCardiol2016;221:674-681

6minutewalkingdistance

6分鐘步行距離

+41,77m;p<0.001(strengthvs.control)（力量訓練vs.對照組）

+13,49m;p=0,002(combinedvs.control)（綜合訓練vs.對照組）

Jewissetal.IntJCardiol2016;221:674-681Restingheartrate

靜息心率

+5.43;p<0.001(strengthvs.control)（力量訓練vs.對照組）

-0.56;ns.(combinedvs.control)（綜合訓練vs.對照組）Jewissetal.IntJCardiol2016;221:674-68Noadvantageinimproving在改善以下方面并無優勢：Mortality死亡率Re-Hospitalisation再入院治療LVEF%左心室射血分數比率Conclusions:結論：Resistanceonlyorcombinedtrainingimproves：單獨抗阻訓練或綜合訓練能改善：

-peakVO2,

耗氧量峰值-qualityoflifeand

心力衰竭患者的生活質量和

-walkingperformanceinheartfailurepatients.行走能力Theeffectofresistancetrainingonclinicaloutcomesinheartfailure:Asystematicreviewandmeta-analysis抗阻訓練對心力衰竭臨床結果的影響：一個系統性回顧和薈萃分析

Jewissetal.IntJCardiol2016;221:674-681ImplementationofexerciseTrainingincardiacrehabilitation

運動訓練在心臟康復中的應用Carefulclinicalevaluationincluding:riskstratification,

symptomlimitedexercisetestingIndividualobjectivesoftheexerciseprogramIndividualexerciseprescriptionandtrainingprotocolIndividuallydosedandadaptedexercisetrainingControlofefficacy

Modificationandadaptationoftheexerciseprescriptionandtrainingprotocolreferringtothepatientsobjectivemedicalandsubjectivehealthstatus細致的臨床評估，包括：風險分級、非觸發癥狀強度運動測試運動項目的個人目標個人運動處方和訓練方案基于個人設定劑量的適應性運動訓練對療效的控制參考患者的客觀醫學情況和主觀健康情況調整其運動處方和訓練方案Resistancetrainingincardiacrehabilitation

心臟康復中的抗阻訓練Resistancetrainingisprescribedaccordingtodosageparameterssuchas:抗阻訓練應按照如下劑量參數制定：Intensity(resistance)強度（抗阻）Volume訓練量Frequency頻率Duration時長

Rateofprogression訓練逐級進展情況Anumberofmethodsfordeterminingtheintensityforresistancetrainingexist要確定抗阻訓練強度，有一系列方法。

Onemethodisbasedonapercentageoftheonerepetitionmaximum(1RM)其中一個是根據一次最大重復值比率Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine^,GermanSportUniversityCologneImplementationofresistancetrainingincardiacrehabilitation

抗阻訓練在心臟康復中的實施應用pre-training-Implementationofexercise;improvementofselfperceptionandcoordination;

learningtocorrectlyperformexerciseEvaluationofmusclestrength

-onerepetitionmaximummeasurementsImprovementstageI

ImprovementofaerobicenduranceandcoordinationImprovementstageIIincreaseofmusclemass;improvementofcoordinationImprovementstageIIIncreaseinmusclestrength訓練前-運動實施；自我感知和協調能力的改善；學習正確的運動方式肌力評估-

一次最大重復值測量改善階段I有氧耐力和協調性的改善改善階段II肌肉質量的增長；協調性改善

改善階段III肌肉力量的增長Resistancetrainingincardiacrehabilitationrecommendations

心臟康復中的抗阻訓練推薦Intensity強度%onerepetitionmaximum(1RM)一次最大重復值比率30-60%1RM- (70-801RM)Numberofreps重復次數dependingonintensity(8-25reps)根據強度（8-25次重復）Numberofsets組數1-3Restingtimebetweensets/exercises

每組運動后的休息時間>oneminute

1分鐘progression(gradualincrease)進展（逐漸增加）4-8exercises4-8次運動Frequency頻率2-3daysperweek每周2-3天–withrestingdayinbetween

中間有休息日Table2:Implementationofdynamicstrengthtraininginpatientswithcardiovasculardisease(modifiedaccordingtoBjarnason-WehrensBetal.118,WilliamsMAetal.119)Generalrecommendations:ifpossibletrainingshouldincludeallmusclegroups.Trainingshouldchangebetweenagonistandantagonistmusclegroups.Betweentrainingofeachmusclegroupthereshouldbeapauseofmorethan1minute.AimIntensityNumberofrepetitionspermusclegroupTrainingfrequencyInitialstage(pre-training)Implementationofexercise;improvementofselfperceptionandcoordination;learningtocorrectlyperformexercise<30%1-RMRPE≤115-102-3trainingunitsperweek,1-3setseachunitImprovementstageIImprovementofaerobicenduranceandcoordination30-50%1-RMRPE12-1310-152-3trainingunitsperweek;1–3setseachunitImprovementstageIIincreaseofmusclemass;improvementofcoordination40-60%1-RM(>60%inselectedpatients)RPE≤1510-152-3trainingunitsperweek;1–3setseachunitImprovementstageIIIIncreaseinmusclestrength60to80%of1-RM(inselectedpatientsingoodclinicalconditionandwithheavyphysicalemploymentorthosereturningtosport)8-102-3trainingunitsperweek;1–3setseachunit1-RM=onerepetitionmaximum;RPE=rateofperceivedexertionImportanceofcharacteristicsandmodalitiesofphysicalactivityandexerciseinthemanagementofcardiovascularhealthinindividualswithcardiovasculardisease(PartIII)Vanheesetal.EJPC2012Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne表2：動態力量訓練在心血管疾病患者身上的應用（根據Bjarnason-WehrensBetal.118,WilliamsMAetal.119修改）一般建議：如果可能的話，訓練應涉及所有的肌肉群。對主動肌群和拮抗肌群的訓練應該有變化。開始訓練另一個肌肉群前，應有1分鐘以上的停頓。目標

強度每個肌肉群的重復速度訓練頻率最初階段（訓練前）運動實施；自我感知和協調能力的改善；學習正確的運動方式<30%1次最大重復值主觀體力感覺評定≤115-10每周2-3個訓練單元，每單元1-3組訓練改善階段I有氧耐力和協調性的改善30-50%1次最大重復值主觀體力感覺評定12-1310-15每周2-3個訓練單元，每單元1-3組訓練改善階段II肌肉質量的增長；協調性改善40-60%1次最大重復值(入選患者>60%)主觀體力感覺評定≤1510-15每周2-3個訓練單元，每單元1-3組訓練改善階段III肌肉力量的增長60to80%1次最大重復值(臨床狀況好、體力活動程度高或者繼續運動的入選患者)8-10每周2-3個訓練單元，每單元1-3組訓練1-RM=1次最大重復值;RPE=主觀體力感覺評定在心血管疾病患者的心血管健康管理中，體育活動和運動特點及其方式的重要性(第三部分)Vanheesetal.《歐洲預防心臟病學雜志》,2012Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneFamiliarisationpriortoresistanceexercise

抗阻訓練前的熟悉階段Afamiliarisationprocessasabeginoftheresistanceexerciseprogramisessentialtoavoidinjury,toassureaproperliftingtechnique,withoutcompensatorymovementsandwithoutbreathholding將熟悉過程作為抗阻訓練的開端很重要，這樣是為了避免受傷，確保恰當的提拉技巧，沒有代償性運動和憋氣的情況。Teachandpracticecorrectliftingandbreathingtechniqueatverylowload在負荷很低的情況下，教導患者并使其練習正確的提拉和呼吸技巧-onesessioninyoungerandexperiencedindividuals

對于年輕的、有經驗的患者，只要一次課就夠了multiplesessionsinolderinexperiencedpatients

對于年老、缺少經驗的患者，要有幾次課Thisfamiliarisationprocessshouldbeperformedpriortostrengthtesting,soitcanbeusedfortestingandtraining這個熟悉過程需要在力量檢測前進行，所以它可以被用來做測試和訓練前的準備工作。Levingeraetal.JournalofScienceandMedicineinSport(2009)12,310—316Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneInitialstage–pre-training–familiarisation最初階段-訓練前-熟悉過程Toimplementtheexercises;learntocorrectlyperformexercise;improveofselfperceptionand

coordination運動實施；學習正確的運動方式；自我感知和協調能力的改善verylowintensity,<30%of1RM,RPE≤11;breathingcontrol很低的強度，低于30%的1次最大重復值負荷，主觀體力感覺評定≤11；呼吸控制fewrepetitions(5–10)

atlowspeedofmovement,在低速運動的情況下重復次數很少（5-10）2-3setswith≥1Minrestbetweenthesets2-3組，每組間休息1分鐘以上2-3trainingunitsperweek,每周2-3個訓練單元Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil11

(2004),352-361Implementationofresistancetrainingincardiacrehabilitation心臟康復中抗阻訓練的實施Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneEvaluationofmusclestrengthcardiacrehabilitationrecommended

onerepetitionmaximummeasurements

心臟康復肌肉力量評估推薦

一次最大重復值測量toprescribeindividualisedsafeandeffectiveresistancetrainingintensities制定安全有效的個人化抗阻訓練強度totracktheprogressofanindividual跟蹤患者的進展toevaluatetheefficacyofresistancetrainingregime評估抗阻訓練計劃的有效性

Williamsetal.Circulation116(2007),572-854)Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne目標耐力力量高強度中等強度低強度Evaluationofmusclestrengthcardiacrehabilitation

onerepetitionmaximum

心臟康復肌肉力量評估

一次最大重復值Theonerepetitionmaximumtesthasbeenshowntobereliableforvariouspopulations–alsoinuntrainedmiddle-agedaswellasoldindividuals一次最大重復值測試被認為對多種人群都有可靠的適用性-包括未經訓練的中老年患者1RMagoldstandardindynamicresistanceexercisetesting一次最大重復值是動態抗阻訓練中的黃金標準The1RMisdefinedasthemaximumamountofweight/resistancethatcanbeperformedforonlyasinglerepetitionforagivenexercise-withaproperliftingtechnique,withoutcompensatorymovementsandwithoutbreathholding一次最大重復值的定義，是某一特定運動單一重復執行時所能使用的最大重量/阻力-有恰當的抬起技巧，沒有代償性動作和屏息的情況。Krameretal.CurrSportsMedRep2002;1(3)165-171;Levingeretal.JSciMedSport2009;12(2)310-316;Schroederetal.JGerontolABiolSciMedSci2007;62(5),543-549;Taylor&FletscherJSciMedSport2012;15,69-73)Evaluationofmusclestrengthcardiacrehabilitation

onerepetitionmaximummeasures

心臟康復肌肉力量評估推薦

一次最大重復值測量

Thismethodiscomparativelysimpleandrequiresrelativelyinexpensivenon-laboratoryequipment這種方法相對簡單，需要的非實驗用設備相對便宜。

The1RMtestcanbeperformedusingthesamepatternsasthoseundertakenbytheexercisingindividualsduringtheirnormaltraining

一次最大重復值測量可以按照患者正常訓練時的模式進行Numerousstudieshavereportedthatthe1RMmethodtoassessmusclestrengthissafeforpatientswithcardiovasculardisease多項研究報告稱，評估肌肉力量的一次最大重復值測量方法對心血管疾病患者是安全的(Ghilarduccietal.AmJCardiol1989;64:866-70.;Featherstoneetal.AmJCardiol1993;71:287—92).Shaw,etal.JCardiopulmRehabil15:283-287,1995.Barnard,etal.JCardiopulmRehabil19:52-58,1999.Levingeraetal.JournalofScienceandMedicineinSport(2009)12,310—3161.Alightwarm-upof5-10repetitionsat40-60%ofassumed1RM一次輕負荷的熱身，5-10次重復，1次最大重復值的40-60%。

restperiod≥1-min休息時間1分鐘以上2.3-5repetitionsat60-80%ofassumed1RM3-5次重復，1次最大重復值的60-80%restperiodof≥2-3min休息時間2-3分鐘以上3.After3-5attemptstheweightwhichcanbeliftedinasinglerepetitionshallbeidentified

3-5次嘗試后，單詞重復可抬起的重量就可以被確定The1RMvalueisreportedastheweightofthelastsuccessfullycompletedlift1次最大重復值即最后一次成功抬起的重量

Communicationbetweensupervisorandtestpersonisofparticularimportance監督人員和受試者之間的溝通尤為重要Onerepetitionmaximumtestingprescription-standardprotocol-一次最大重復值測量-標準方案-SkinnerExercisetestingandexerciseprescriptionforspecialcases.LippincotWilliams&Wilkins2005)Predictiveonerepetitionmaximum

預測性一次重復最大值

/Calculators/OneRepMax.html

Brzycki′sequationtodeterminemaxload:確定最大負荷的Brzycki公式 Weight÷(1.0278–(0.0278xnumberofrepetitions))

重量÷(1.0278–(0.0278x重復次數))Baechleequationtoderterminemaxload:確定最大負荷的Baechle公式 Weightx(1+(0.033xnumberofrepetitions))Brzycki,M(1993).Strengthtesting-Predictionaone-repmaxfromreps-to-fatique.JOPERD,68p.88-90BaechleTR,EarleRW,WathenD(2000).ResistanceTrainingIn:NaechleTR&EarleRWeds.EssentialsofStrengthTrainingandConditioning,2nded.Champaign,ILHumanKineticsp:395-425./Calculators/OneRepMax.htmlProf.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne/Calculators/OneRepMax.htmlPredictiveOneRep.Max.

預測性一次重復最大值

/Calculators/OneRepMax.html

Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne抬起的重量重復次數一次最大重復值計算重設輸入“抬起的重量”和“重復次數”。重復次數必須在1到10之間。按“計算”鍵，就能得出你一次重復可能抬起的重量。PredictiveOneRep.Max.

預測性一次重復最大值

/Calculators/OneRepMax.html

Prof.Dr.BirnaBjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologne抬起的重量一次最大重復值重復次數計算重設輸入“抬起的重量”和“重復次數”。重復次數必須在1到10之間。按“計算”鍵，就能得出你一次重復可能抬起的重量。ImprovementstageI–muscleendurancetraining改善階段I-肌肉耐力訓練To

improvelocalaerobicenduranceandcoordination改善局部有氧耐力和協調性

dynamic,lowisometriccomponent!

動態的、較少等長對抗！lowtomoderateintensity(30–50%1RM)低到中等強度（30-50%1次最大重復值）numberofrepetitions(10-15)重復次數（10-15次）2-3setswith≥1Minrestbetweenthesets2-3組，每組間休息1分鐘以上

2–3daysperweekfor

每周2-3天

RPE(Borg-scale)12-13主觀體力感覺評定（Borg量表）12-13Implementationofresistancetrainingincardiacrehabilitation心臟康復中抗阻訓練的實施應用Bjarnason-Wehrensetal.EurJCardiovascPrevRehabil11

(2004),352-361Prof.Dr.B.Bjarnason-Wehrens,InstituteforCardiologyandSportsMedicine,GermanSportUniversityCologneImprovementstageII改善階段IITo

increasemusclemassandimprovecoordination增加肌肉質量和協調性

dynamic,lowisometriccomponent!

動態的、較少等長對抗！moderateintensity(40–60%1RM)中等強度（40%-60%1次最大重復值）numberofrepetitions(10-15)重復次數（10-15次）2-3sets