基于生理参数个体化的运动处方对脑卒中后 偏瘫患者步行功能及心肺健康的影响： 一项随机对照试验

Effects of Individualized Exercise Prescription Based on Physiological Parameters on Walking Function and Cardiopulmonary Health in Hemiplegic Patients after Stroke: A Randomized Controlled Trial

摘要: 目的：探讨心率储备百分比与主观疲劳感知相结合的个体化运动处方对于脑卒中偏瘫患者居家康复步行功能及心肺健康的改善效果及其安全性。方法：采用单盲、随机对照试验设计，选取2024年3月至2025年6月期间在扬中市人民医院康复科进行康复训练后出院的可以进行社区性步行的脑卒中后偏瘫患者82例，采用随机数字表法分为试验组(n = 41)与对照组(n = 41)。试验组进行12周的个体化强度步行训练，通过心率储备百分比(40%~60% HRR)以及主观疲劳量表(RPE 11~13分)进行强度上的调控，并进行监测；对照组接受常规康复健康教育，主要结局指标为10米最快步行速度、6分钟步行距离及峰值摄氧量估算值；次要结局指标包括功能性移动能力、步态参数以及生活质量评分，采用协方差分析比较两组干预后效果。结果：有76例患者完成研究(试验组38例，对照组38例)。干预12周后，试验组10米最快步行速度从(0.78 ± 0.22) m/s提升至(0.99 ± 0.19) m/s，增加了约0.21 m/s，高于对照组的增值0.11 m/s (P < 0.001)；6分钟步行距离从(285.3 ± 66.4) m增加到(340.2 ± 62.5) m，增加54.9 m，与对照组增加的距离26.8 m (P < 0.001)相比，结果更为优秀；峰值摄氧量估算值提高(2.7 ± 0.8) mL∙kg⁻¹∙min⁻¹，也相对高于对照组的(1.2 ± 0.5) mL∙kg⁻¹∙min⁻¹ (P = 0.004)。次要结局指标中，试验组在功能性移动能力、步态对称性以及生活质量多个维度的改善均优于对照组(P < 0.05)。两组不良事件发生率无统计学差异(12.2% vs 9.8%, P = 0.742)，试验组治疗依从性达86.5%。结论：基于心率储备与主观疲劳感知的个体化运动处方可有效改善脑卒中后偏瘫患者的步行功能、心肺适能及生活质量，在家庭环境中这种方案具有较为良好的安全性与可行性，为卒中社区康复提供了可推广的有效干预策略。

Abstract: Objective: To investigate the improvement effect and safety of an individualized exercise prescription combining the percentage of heart rate reserve with subjective fatigue perception on walking function and cardiopulmonary health in stroke patients with hemiplegia during home rehabilitation. Method: A single-blind, randomized controlled trial design was adopted. A total of 82 hemiplegic patients after stroke who could perform community ambulation and were discharged after rehabilitation training in the Rehabilitation Department of Yangzhong People’s Hospital from March 2024 to June 2025 were enrolled. They were divided into an experimental group (n = 41) and a control group (n = 41) using a random number table method. The experimental group received 12 weeks of individualized-intensity walking training, with the intensity regulated and monitored by the percentage of heart rate reserve (40%~60% HRR) and the Rating of Perceived Exertion (RPE) scale (scores 11~13). The control group received routine rehabilitation health education. The primary outcome measures were the 10-meter maximum walking speed, 6-minute walking distance, and estimated peak oxygen uptake. The secondary outcome measures included functional mobility, gait parameters, and quality of life scores. Analysis of covariance was used to compare the post-intervention effects between the two groups. Result: A total of 76 patients completed the study (38 in the experimental group and 38 in the control group). After 12 weeks of intervention, the 10-meter fastest walking speed of the experimental group increased from (0.78 ± 0.22) m/s to (0.99 ± 0.19) m/s, with a mean increase of approximately 0.21 m/s, which was significantly higher than the 0.11 m/s increase observed in the control group (P < 0.001). The 6-minute walking distance rose from (285.3 ± 66.4) m to (340.2 ± 62.5) m, a mean increase of 54.9 m, and the outcome was markedly superior to that of the control group with a mean increase of 26.8 m (P < 0.001). The estimated peak oxygen uptake increased by (2.7 ± 0.8) mL∙kg⁻¹∙min⁻¹ in the experimental group, which was also relatively higher than the (1.2 ± 0.5) mL∙kg⁻¹∙min⁻¹ increase in the control group (P = 0.004). For the secondary outcome measures, the experimental group exhibited significantly better improvements than the control group in multiple dimensions including functional mobility, gait symmetry and quality of life (P < 0.05). There was no statistically significant difference in the incidence of adverse events between the two groups (12.2% vs 9.8%, P = 0.742), and the treatment compliance rate of the experimental group reached 86.5%. Conclusion: Individualized exercise prescriptions based on heart rate reserve and subjective perceived exertion can effectively improve walking function, cardiopulmonary fitness and quality of life in hemiplegic patients after stroke. This regimen demonstrates favorable safety and feasibility when implemented in a home setting, and provides a scalable and effective intervention strategy for community-based post-stroke rehabilitation.