Telesna dejavnost in vadba pri bolnikih s sindromom takotsubo

Skubic, Urša (author), Kambič, Tim (mentor), Jug, Borut (comentor)

Sindrom takotsubo, znan tudi kot sindrom zlomljenega srca, se kaže kot akutno srčno popuščanje z značilnim vzorcem motenj krčenja levega prekata in s sorazmerno hitrim okrevanjem krčljivosti srčne mišice, ki posnema akutni koronarni sindrom, vendar ni posledica akutne koronarne zapore. Prevalenca je med 2 in 3 % vseh bolnikov s klinično sliko akutnega koronarnega sindroma, najpogosteje prizadene ženske, stare med 60 in 80 let. Ključnega pomena je celostna oskrba bolnikov, ki vključuje farmakološko in nefarmakološko obravnavo. Pri slednji je nepogrešljiva ambulantna kardiološka rehabilitacija, v sklopu katere so bolniki deležni psihosocialne obravnave, izvajajo telesno vadbo in prejmejo napotke za telesno dejavnost. Ker je napotitev bolnikov s sindromom takotsubo v kardiološko rehabilitacijo slaba, obenem pa so tudi smernice za telesno dejavnost in vadbo pomanjkljive, sta bila cilja naloge izvesti pregled objavljene literature o zadevni temi ter pripraviti primer programa telesne dejavnosti in vadbe. Izvedli smo sistematični pregled literature po smernicah PRISMA, iskali smo po bazah PubMed, Science Direct in Web of Science. Uporabili smo ključnike za “sindrom takotsubo,” “telesno dejavnost”, “vadbo” in “kardiološko rehabilitacijo”. V končni pregled smo izmed 511 zadetkov vključili štiri raziskave, med katerimi sta bili dve retrospektivni, ena randomizirana in ena raziskava primera. Vse raziskave so v sklopu vadbene intervencije vsebovale aerobno vadbo, tri so dodale še vadbo za moč, bolniki pa so intervencijo izvajali od treh mesecev do treh let. Telesna vadba se je izvajala dvakrat do trikrat tedensko in trajala med 20 in 60 minut. Aerobno vadbo so izvajali na tekalni stezi ali kolesarskem ergometru, v posamezni vadbeni enoti je trajala med 20 in 50 minut pri intenzivnosti 65–75 % največje frekvence srca ali 40–59 % rezerve srčne frekvence, medtem ko se je vadba za moč kot dopolnilno sredstvo izvajala za zgornje in spodnje okončine, trajala je približno 15 minut pri intenzivnosti 40–60 % največjega premaganega bremena. Telesna vadba je vplivala na izboljšanje v hemodinamiki, aerobni zmogljivosti, mišični moči, kakovosti življenja in prispevala k nižji stopnji ponovne hospitalizacije. Na podlagi pregleda razpoložljivih raziskav sta telesna dejavnost in vadba varni, izvedljivi in učinkoviti, vendar primanjkuje randomiziranih kontroliranih raziskav, ki bi predstavljale glavni dokaz o njuni učinkovitosti ter vplivale na dokončen zapis smernic optimalne rehabilitacije pri bolnikih s sindromom takotsubo.

• Language: Slovenian
• Keywords: sindrom takotsubo, telesna dejavnost, vadba, kardiološka rehabilitacija
• Work type: Master's thesis/paper
• Organization: FŠ - Faculty of Sport
• Year: 2025
• PID: 20.500.12556/RUL-176694
• Publication date in RUL: 09.12.2025

Secondary language

• Language: English
• Title: Physical activity and exercise training of patients with takotsubo syndrome

Abstract

Takotsubo syndrome, also known as broken-heart syndrome, presents as acute heart failure with a charasteristic abnormality of left ventricular wall motion and relatively rapid recovery of myocardial contractility. It mimics acute coronary syndrome but occurs without acute coronary occlusion. Its prevalence is between 2 % and 3 % among all patients presenting with clinical features of acute coronary syndrome. The syndrome most commonly affects women between 60 and 80 years of age. Optimal care requires a comprehensive approach that integrates pharmacological and non-pharmacological management, with outpatient cardiac rehabilitation playing a crucial role. This includes psychosocial counselling, supervised exercise training, and counseling on habitual physical activity. However, referral of patients with takotsubo syndrome to cardiac rehabilitation remains low due to limited evidence on the safety and efficancy of physical activity and exercise training. This thesis aimed to conduct a systematic review on this topic and to propose a comprehensive exercise training program for physical activity and exercise training. A systematic literature review was conducted according to PRISMA guidelines in PubMed, Science Direct and Web of Science using the keywords “takotsubo syndrome”, “physical activity”, “exercise”, and “cardiac rehabilitation”. Of 511 records screened, four studies met the inclusion criteria: two retrospective studies, one randomised study, and one case report. All interventions included aerobic training; three also included resistance training. The duration of exercise training interventions ranged from three months to three years. Exercise frequency was 2–3 sessions per week, with 20–60 minutes per session. Aerobic training was performed on a treadmill or cycle ergometer for 20–50 minutes at 65–75 % of maximal heart rate or 40–59 % of heart rate reserve. Resistance training for upper and lower limbs was performed as an adjunct exercise modality for 15 minutes per session at 40–60 % of one-repetition maximum (1-RM). Reported outcomes included changes in hemodynamics, aerobic capacity, muscle strength, and quality of life, along with lower rehospitalisation rates. Current evidence suggest that physical activity and structured exercise are safe, feasible, and effective for patients with takotsubo syndrome. However, there is still a lack of randomized controlled trials, which limits the quality of the evidence nedded to form a disease-specific guidelines for optimal cardiac rehabilitation in patients with takotsubo syndrome.

• Keywords: takotsubo syndrome, physical activity, exercise training, cardiac rehabilitation