间歇及持续有氧运动对高血压患者自主神经系统影响的荟萃分析

Effects of intermittent and continuous aerobic exercise on autonomic nervous system in patients with hypertension: a systematic review and Meta-analysis

    摘要
  • 摘要:
    目的 确定有氧运动对高血压患者交感以及副交感神经系统的影响效能。比较间歇和持续有氧运动对高血压患者自主神经功能的影响，以探究更适合高血压患者实践的运动方式。
    方法 在Web of science、PubMed、Embase、中国知网（CNKI）等数据库中进行搜索，收集评估有氧运动（间歇和持续）对高血压自主神经系统（交感和副交感）干预的随机对照试验。采用Cochrane评价工具和Jadad量表对纳入的文献进行方法学质量评价。采用Revman软件进行统计学分析和敏感性分析，采用Stata软件进行网状分析和评估发表偏倚。
    结果 共纳入17项研究，880例高血压患者。荟萃分析结果显示，有氧运动可有效降低高血压患者的收缩压加权均数差（WMD）=10.22（95%CI 6.38～14.05）mmHg、舒张压WMD=6.13（95%CI 4.45～7.81）mmHg、平均动脉压WMD=3.80（95%CI 1.29～6.31）mmHg以及心率WMD=3.40（95%CI 0.94～5.85）次/min；改善24 h（WMD=1.85%，95%CI 0.38%～3.31%）、日间（WMD=1.46%，95%CI 0.98%～1.94%）以及夜间（WMD=0.48%，95%CI 0.10%～0.85%）舒张压变异系数。对自主神经系统调节呈现选择性，对交感神经系统的作用有统计学意义，包括低频功率WMD=0.50（95%CI 0.02～0.98）ms2和归一化低频功率究WMD=0.15（95%CI 0.08～0.22)，对副交感神经系统影响无统计学意义，包括高频功率、归一化高频功率、相邻RR间期差值的均方根（RMSSD）和相邻RR间期差值大于50 ms的个数占总RR间期个数的百分比（pNN50）。网状分析显示，间歇有氧运动在降低高血压患者心率及改善低频功率、SDNN方面较持续有氧运动更优（P＜0.05）。
    结论 有氧运动对高血压患者自主神经调节以交感神经系统为主要作用靶点。其中，间歇有氧运动对交感神经调控及改善心率的效果更显著，为高血压运动干预提供了更具针对性的方案。

     

    Abstract:
    Objective To determine the effects of aerobic exercise on the sympathetic and parasympathetic nervous systems in hypertensive patients, and to compare and analyze the effects of intermittent and continuous aerobic exercise on the autonomic function of hypertensive patients, in order to explore a more suitable exercise mode for hypertensive patients to practice.
    Methods Databases such as Web of science, PubMed, Embase, and China National Knowledge Infrastructure (CNKI) were searched to collect randomized controlled trials evaluating the intervention ettect of aerobic exercise (intermittent and continuous) on the autonomic nervous system (sympathetic and parasympathetic) in patients with hypertension. The methodological quality of the included literature was evaluated using the Cochrane evaluation tool and the Jadad scale. Statistical and sensitivity analyses were performed using Revman software, and Stata software was used for net analysis and assessment of publication bias.
    Results  A total of 17 studies with 880 hypertensive patients were included. Meta analysis showed that aerobic exercise was effective in reducing systolic blood pressure weighed mean difference (WMD)=10.22 (95%CI 6.38–14.05) mmHg, diastolic blood pressure WMD=6.13 (95%CI 4.45–7.81) mmHg, mean blood pressure WMD=3.80 (95%CI 1.29–6.31) mmHg, and heart rate WMD=3.40 (95%CI 0.94–5.85) beats/min, improved blood pressure variability, including 24-hour WMD=1.85% (95%CI 0.38%–3.31%), daytime WMD=1.46% (95%CI 0.98%–1.94%), and nocturnal WMD=0.48% (95%CI 0.10%–0.85%) diastolic blood pressure variability. The effect of aerobic exercise on the autonomic nervous system showed selective, and the effects on the sympathetic nervous systems was ignificant, including low-frequency power WMD=0.50 (95%CI 0.02–0.98) ms2 and normalized low-frequency power studies WMD=0.15 (95%CI 0.08–0.22), and the effect on the parasympathetic nervous system was not significant, including high-frequency power, normalized high-frequency power, root mean square of successive differences of RR intervals (RMSSD) and percentage of NN intervals with differences greater than 50 ms (pNN50). The network analysis showed that intermittent aerobic exercise was superior to continuous aerobic exercise in reducing the heart rate and improving low-frequency power and SDNN (P＜0.05).
    Conclusion Aerobic exercise mainly targets the sympathetic nervous system in the regulation of autonomic nervous system in hypertensive patients. Among them, intermittent aerobic exercise has a more significant effect on regulating the sympathetic nervous system and improving heart rate, providing a more targeted solution for exercise intervention in hypertension.

     

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