训练前对心血管的筛查

本文由亚洲杯2019年02月19日转载报道： 训练前对心血管的筛查

训练前对心血管的筛查

Getting to the Heart of Pre-Exercise Screening

教你如何避免掉进心血管疾病风险评估的陷阱

Here’s how to avoid the pitfalls of assessing clients’ risk of cardiovascular disease。

通过进行运动前的健康筛查，教练与潜在健身客户们能够安全地实施训练计划。但在三年前，美国运动医学会（ACSM）更新了该机构的运动前健康筛查指导方案，其中一项主要的变化是：ACSM不再推荐使用工具去评估客户产生心血管疾病的风险。

A preparticipation health screening helps trainers and prospective clients safely launch into an exercise program。 When the American College of Sports Medicine updated its pre-exercise screening guidelines 3 years ago， it made one major shift： It stopped recommending the use of a toolto assess cardiovascular disease risk。

考虑到运动对于减少心血管疾病风险的重要性，这一变化似乎有些令人费解。为何教练不再使用工具去评估客户患心脏病的概率呢？ACSM之所以做出这样的变化，是想让人们更好地参与运动、坚持运动。

This may seem like an odd choice， given that exercise is so central to reducing CVD risk。 Why wouldn’t trainers want to use a tool to help people understand their likelihood of developing heart disease？ It turns out that ACSM’s rationale for the change underscores a critical insight regarding exercise participation and adherence。

ACSM变化产生的源头

The Roots of ACSM’s Shift

2015年，ACSM的专家组制定了新版的运动前筛查指南，这些专家具有实践、临床、教育与科研等多领域的工作经验（Riebe et al。 2015）。专家组基于运动者的预期运动强度、当前运动量、代谢疾病、心血管疾病、肾脏疾病的潜在症状，制订了一套运动前健康筛查的模型。

In 2015， ACSM introduced new prescreening guidelines developed by a roundtable of ACSM pros with practitioner， clinical， educational and scientific experience in physical activity and exercise （Riebe et al。 2015）。 These professionals introduced a new model of pre-exercise health-screening recommendations based on the exerciser’s desired intensity； how much physical activity the person currently does； and any symptoms of known metabolic， cardiovascular or kidney diseases。

专家组肯定了辨别客户心血管疾病的风险信号的重要性，其可预防或监控客户的心脏疾病。但专家组明确指出，运动前健康筛查需要被重新定义，以便客户明确自己患心脏病的风险。ACSM这么做，是想让人们通过运动去维持自身健康水平。

The professional panel affirmed that it’s important to identify CVD risk factors to help clients prevent or manage heart disease。 But the panel made a point of redefining the recommendations for telling people about their risk of developing heart disease。 ACSM did this because it wanted to remove some barriers that might prevent people from using exercise to stay healthy。

为何ACSM要更新健康筛查指南？

Why ACSM Updated Its Health-Screening Guidelines

Riebe和他的同事（专家小组成员）解释道：心血管风险分析也可能有其弊端：分析结果会给医疗检查机构提供不必要的冗杂信息，会对于客户的正常运动参与存在影响。这些医疗检查可能会呈现出假阳性的检查结果，这可能增大客户的心理压力，导致客户接受更多的治疗，并造成不必要的个人经济负担，挫伤客户养成良好运动习惯的积极性。

Riebe and colleagues （the panel） explain that CVD risk-factor profiling can have a downside： unnecessary referrals to a healthcare provider for clearance to start an exercise program。 Unfortunately， these doctors’ visits may result in false-positive test results， which can trigger personal stress in clients and lead to more treatments that impose unnecessary financial and personal burdens。 These disadvantages can discourage the adoption of a physically active lifestyle。

Riebe等人注意到，激励人们养成规律的运动习惯很有挑战性；因此，运动前筛查指南不应该去阻止人们增加活动量。

Riebe et al。 note that motivating people to adopt a lifestyle of regular physical activity is a considerable challenge； therefore， pre-exercise health-screening guidelines should not unnecessarily deter people from becoming more active。

为何教练不使用工具去评估客户们产生心脏病的几率呢？这是因为ACSM这一变化背后，其实强调了参与运动、坚持运动的重要性。

Why wouldn’t trainers want to use a tool to help people understand their likelihood of developing heart disease？ It turns out that ACSM’s rationale for the change underscores a critical insight regarding exercise participation and adherence。

锻炼到底有多安全？

How Safe Is Exercise？

Riebe等人在他们的综述中承认，急性的剧烈运动可能会增加两种潜在急性心脏病的发病风险：

In their review， Riebe et al。 concede that sudden vigorous physical exertion can elevate the acute risk of two potentially fatal heart problems：

心脏猝死（SCD），当心电系统机能失常以及心跳过快时会发生这种情况

sudden cardiac death （SCD），when the heart’s electrical system malfunctions and the heart beats dangerously fast

急性心肌梗死（AMI），通常称为心脏病，当一个或多个冠状动脉产生堵塞时会发生这种情

acute myocardial infarction （AMI）， better known as a heart attack， when one or more coronary arteries have a blockage

研究人员注意到在男性人群中，每进行150万次剧烈运动中才会发生一例心脏猝死（SCD）。而在女性人群中，每进行3650万小时的中度或剧烈运动中才会发生一例心脏猝死（SCD）。研究人员表示，所有关于运动中心脏猝死（SCD）和急性心肌梗死（AMI）的公开数据都表明，这些病发案例都非常罕见，因此运动对大多数人来说是都安全的。研究人员补充到，不运动的人突发心脏病（所有心肌损伤的病变）的风险几率要比运动人群高。

However， the researchers note that SCD occurs once in every 1.5 million episodes of vigorous physical exertion in men and once in 36.5 million hours of moderate-to-vigorous exertion in women。 All of the published data on SCD and AMI during exercise says these events are very rare， suggesting that exercise is safe for most people， the researchers say。 They add that physically inactive people face a greater total risk for an abrupt cardiac event （any incident that damages heart muscle） than their physically active counterparts。

尽管年龄的增长是影响心血管疾病的一个重要因素，但还没有证据表明年龄因素可以完全准确有效地预测心脏猝死（SCD）或急性心肌梗死（AMI）的发病率。（Riebe et al。 2015）研究人员还补充道，关于抗阻训练中引发心血管疾病风险的数据还很少，但这种风险似乎很低。最重要的是，进行规律的体育锻炼与心脏猝死（SCD）和急性心肌梗死（AMI）的发生概率呈反比关系。也就是说，人们越常锻炼，发生致命心脏病的可能性越低。

Even though increasing age is a CVD risk factor， there is no evidence that age is a strong predictor of SCD or AMI （Riebe et al。 2015）。 The researchers add that there’s little data on cardiovascular risk during resistance training， but that risk appears to be low。 Most importantly， regular physical activity shows an inverse relationship with SCD and AMI， meaning the more people exercise consistently， the less likely they are to have a life-threatening heart complication。

健身专家是否还应该评估客户心血管疾病的风险？

Should Fitness Pros Still Assess for CVD Risk？

Riebe等人指出心血管风险评估并不能作为客户进行运动训练的医学证明。因为这些评估不能准确预测心脏病或其他心血管疾病发作的可能性。尽管如此，专家组成员仍然鼓励教练们对客户心血管疾病的风险因素进行评估（见表1），预防与控制心血管和代谢疾病。

Riebe et al。 state that CVD risk assessments should not be part of the process of providing medical clearance for exercise because these assessments cannot accurately predict the likelihood of a heart attack or other CVD issues。 However， the panelists still encourage exercise pros to assess clients’ CVD risk factors （see Table 1） to help prevent or manage cardiovascular and metabolic diseases。

指南的另一项修改中，ACSM不再默认肺病患者接受医疗检查。这是因为肺部疾病不会增加运动期间或运动后发生致命心血管疾病的风险。

In another guideline change， people with pulmonary disease are no longer automatically referred for medical clearance。 Pulmonary disease does not increase the risk of fatal cardiovascular events during or immediately after exercise。

新版ACSM运动前健康筛查算法

New ACSM Pre-Exercise Health-Screening Algorithm

算法是可以用来解决问题的程序化步骤。新版的运动前健康筛查算法（Riebe et al。 2015）显示了运动者（表2）和非运动者（表3）应遵循的运动步骤。对锻炼者的定义是在过去3个月里，每周至少3天，每天进行至少30分钟、中等强度、有计划的身体活动的人（Riebe et al。 2015）。低强度运动被定义为可引起心率和呼吸小幅度增加的运动（30% 40%的心率储备，9-11级RPE）。相比而言，中等强度运动能引起心率和呼吸频率的显著增加（40% 60%的心率储备，12 - 13 RPE），剧烈运动能引起心率和呼吸频率的大幅度增加（心率储备≥60%，≥14 RPE）。

An algorithm is a set of steps that can be followed to solve a problem。 The new pre-exercise health-screening algorithm （Riebe et al。 2015） shows the steps to follow for exercisers （Table 2） and nonexercisers （Table 3）。 Exercisers are described as persons who have engaged in planned， structured activity of moderate intensity for at least 30 minutes on at least 3 days per week for at least the past 3 months （Riebe et al。 2015）。 Light-intensity exercise is defined as exercise that causes a slight increase in heart rate and breathing （30% 40% of heart rate reserve， 9–11 rating of perceived exertion）。 By comparison， moderate-intensity exercise causes a noticeable increase in heart rate and breathing （40% 60% of heart rate reserve， 12–13 RPE）， and vigorous exercise causes a substantial increase in heart rate and breathing （≥60% heart rate reserve， ≥14 RPE）。

了解更多

Find Out More

为了降低运动相关心血管疾病的产生风险，健身专业人士应始终确保客户遵循个性化与安全有效的运动计划，并逐步转换运动频率、强度、时间、运动类型、运动量以及进阶（训练计划中的FITT-VP原则）。想要了解更多信息，请参阅《ACSM运动测试和处方指南》（第10版），在训练指南板块，你可以找到运动测试或训练计划的最新专业信息。（ACSM 2018）

To reduce the risk of exercise-related cardiovascular health complications， fitness pros should always ensure that clients follow an individualized， safe and effective exercise design that progressively transitions frequency， intensity， time， exercise type， volume and progression （known as the FITT-VP principle of exercise program design）。 To learn more， seeACSM’s Guidelines for Exercise Testing and Prescription（10th ed。）， which has the most up-to-date information on exercise guidelines for fitness pros who do exercise tests and design exercise programs （ACSM 2018）。

Len Kravitz博士是CSCS体能训练师，是新墨西哥大学（University of New Mexico）运动科学项目的协调员，在校内获得了“年度杰出教师”和“总统杰出贡献奖”的奖项。在2016年，除了入选国家健身名人堂之外，Len Kravitz还获得了“训练专家贡献奖”。

Len Kravitz， PhD， CSCS， is the program coordinator of exercise science at the University of New Mexico， where he has received the Outstanding Teacher of the Year and Presidential Award of Distinction。 In 2016， in addition to being inducted into the National Fitness Hall of Fame， he received the canfitpro Specialty Presenter Award。

表1：

TABLE 1：

当前引发心脏病的高危因素

CURRENT HEART DISEASE RISK FACTORS

可改变的风险因素

Modifiable Risk Factors

可改变的风险因素

缺少体育活动

lack of physical activity

smoking

high blood cholesterol

超重或肥胖

overweight or obesity

high blood pressure

糖尿病及前驱糖尿病

diabetes and prediabetes

不良的饮食习惯

unhealthy diet

影响心脏病的因素

Factors That Boost Heart Disease Risk

压力：压力过大的人可能会吸烟或暴饮暴食，提高心脏病发病风险。

Stress：People under stress may start smoking or overeat， contributing to heart disease risk。

酒精：过量饮酒会使血压升高，增加人们患癌症、中风或其他疾病的几率。建议男性最好一天饮酒量不多于两杯，女性不多于一杯。

Alcohol：Excessive drinking may elevate blood pressure and increase a person’s risk for cancer， stroke and other diseases。 Limiting alcohol consumption to no more than two drinks per day for men and no more than one drink per day for women is recommended。

不可改变的的风险因素

Fixed Risk Factors

年龄：大多数死于心血管疾病的人年龄在65岁以上。

Age：The majority of people who die from CVD are 65 and older。

性别：相对于女性而言，男性通常有更高的心脏病患病风险，且男性患心脏病的年龄更早。

Gender：Men have a higher risk of heart attack than women do。 Men also have heart attacks earlier in life。

家族心脏病史：如果你的母亲或姐妹在65岁之前患心脏病，或你的父亲或兄弟在55岁之前患心脏病，那么你比普通人有更高的患病风险。

Family history of heart disease：If your mother or sister had a heart attack before age 65， or if your father or brother had one before age 55， you are more likely to get heart disease。

更年期：当雌激素分泌下降时，女性更容易患心脏病。

Menopause：When production of estrogen drops， women are more likely to get heart disease。

提前绝经：接受过子宫切除术或提前进入绝经期的女性患心脏病的几率是未绝经的同龄女性的2倍。

Early menopause：Women who have had a hysterectomy or have entered natural menopause early are twice as likely to develop heart disease as women of the same age who have not gone through menopause。

子痫前期：孕期会出现的高血压，这是另一种不可改变的心脏病患病风险因素。

Pre-eclampsia：This pregnancy condition， characterized by high blood pressure， is another nonmodifiable heart disease risk factor。

表2

TABLE 2

规律运动的客户

CLIENT EXERCISES REGULARLY

如果客户无心血管、代谢或肾脏疾病，且无上述症状，那么则不需要医疗检查。

If the client has no cardiovascular （CV）， metabolic or renal diseaseandno symptoms of these conditions： Medical clearance is not necessary。

可按照ACSM的指导方针，继续进行中强度或高强度的运动。

Continue moderate- or vigorous-intensity exercise， progressing by ACSM guidelines。

如客户患有已知的心血管、代谢或肾脏疾病，但无症状：

If the client has known CV， metabolic or renal diseaseandshows no symptoms：

那么进行中等强度的运动则不需要体检。但在进行高强度运动之前建议进行体检（如果体征或症状在过去12个月内没有变化）。

Medical clearance is not necessary for moderate-intensity exercise。 Medical clearance （within the last 12 months if there has been no change in signs/symptoms） is recommended before engaging in vigorous-intensity exercise。

客户继续保持中等强度锻炼，在进行医疗检查后，可根据ACSM的指南，在客户能承受的范围内逐渐加大训练强度。

Continue moderate-intensity exercise。 After medical clearance， client may tolerate gradual progress， following ACSM guidelines。

如果病人出现心血管、代谢或肾脏疾病症状，无论病情如何：

If the client shows any symptoms of CV， metabolic or renal disease， regardless of known disease status：

停止锻炼并寻求医学专家的帮助。

Stop exercise and seek medical clearance。

客户体检合格后可恢复运动。根据ACSM的指南，在客户能承受的范围内逐渐加大训练强度。

Client may resume exercise after medical clearance。 Progress as tolerated， according to ACSM guidelines。

表3

TABLE 3

无规律运动的客户

CLIENT DOES NOT EXERCISE REGULARLY

如果客户无心血管、代谢或肾脏疾病，且无上述症状，那么则不需要医疗检查。

If the client has no CV， metabolic or renal disease and no symptoms of these conditions：

Medical clearance is not necessary。

客户可进行轻度到中等强度的运动。根据ACSM的指导方针，在客户能承受的范围内逐渐加大训练强度。

Light- to moderate-intensity exercise is recommended。 Client may gradually as tolerated， following ACSM guidelines。

如客户患有已知的心血管、代谢或肾脏疾病，但无病症：

If the client has known CV， metabolic or renal disease and shows no symptoms：

建议客户开具医学证明，征得医生的同意后再进行运动。

Medical clearance for exercise is recommended。

在开具医学证明后，客户可进行轻度到中等强度的运动。根据ACSM的指导方针，在客户能承受的范围内逐渐加大训练强度。

After medical clearance， light- to moderate-intensity exercise is recommended。 Client may gradually progress as tolerated， following ACSM guidelines。

如果病人出现心血管、代谢或肾脏疾病症状，无论病情如何：

If the client has any symptoms of CV， metabolic or renal disease， regardless of disease status：

都需要客户开具医学运动许可证明。

Medical clearance for exercise is recommended。

在开具医学运动证明后，客户可进行轻度到中等强度的运动。根据ACSM的指导方针，在客户能承受的范围内逐渐加大训练强度。

After medical clearance， light- to moderate-intensity exercise is recommended。 Client may gradually progress as tolerated， following ACSM guidelines。

概述

SIDEBAR：FAST FACT

当雌激素分泌下降时，女性更容易患心脏病。在ACSM另一项变动的指导方针里，不再默认肺病患者必须接受医疗检查。肺病并不会增加运动中或运动后即刻心血管疾病发生的风险。

When production of estrogen drops， women are more likely to get heart disease。

In another guideline change， people with pulmonary disease are no longer automatically referred for medical clearance。 Pulmonary disease does not increase the risk of fatal cardiovascular events during or immediately after exercise。

对表2和表3的说明

LEGEND FOR TABLES 2 AND 3

心血管（CV）：心脏外周血管，或脑血管

CV：cardiac peripheral vascular， or cerebrovascular

医学证明：医疗保健人员开具的运动许可证明

medical clearance：a healthcare professional’s approval to engage in exercise

代谢性疾病：1型和2型糖尿病

metabolic disease：type 1 and 2 diabetes mellitus

休息或活动时的病状：颈部、胸部、手臂、下巴或其他部位因缺血（缺氧）而感到疼痛或不适；休息时或轻度用力时呼吸急促；头晕或晕厥（暂时失去意识）；正常活动时产生非正常的疲劳或呼吸急促

symptoms at rest or active：pain and/or discomfort in the neck， chest， arms， jaw， or other areas from ischemia （lack of oxygen）； shortness of breath at rest or with mild exertion； dizziness or syncope （temporary loss of consciousness）； unusual fatigue or shortness of breath with usual activities

表格选自Riebe et al。 2015。

Tables adapted from Riebe et al。 2015。

参考文献

References

ACSM （American College of Sports Medicine）。 2018。ACSM’s Guidelines for Exercise Testing and Prescription（10th ed。） Philadelphia： Wolters Kluwer。

AHA （American Heart Association）。 2018。 Understand your risks to prevent a heart attack。 Accessed July 26， 2018：heart.org/HEARTORG/Conditions/HeartAttack/UnderstandYourRiskstoPreventaHeartAttack/Understand-Your-Risks-to-Prevent-a-Heart-Attack_UCM_002040_Article.jsp# 。W0pdW4V84fo。

NHLBI （National Heart， Lung， and Blood Institute）。 2017。 Lower heart disease risk。 Accessed July 24， 2018：nhlbi.nih.gov/health/educational/hearttruth/lower-risk/risk-factors.htm。

Riebe， D。， et al。 2015。 Updating ACSM’s recommendations for exercise preparticipation health screening。Medicine Science in Sports Exercise， 47（11）， 2473–79。

作者：Len Kravitz， PhD

翻译：王宇晨