中国传统体育项目的传播和推广在加速“体育强国”和“健康中国”建设方面扮演着重要的角色。太极拳，作为中国卓越传统文化的珍贵代表，具备让世界了解中国、将中国融入世界的重要桥梁作用。同时，太极拳在医疗和保健领域的价值也引起了学界和太极拳爱好者的广泛关注。因此，提供可信的科学证据，以支持太极拳对健康的促进作用，对于推动中国传统体育项目的国际传播和国内推广，以及实现“体育强国”和“健康中国”的目标，都具有极其重要的意义。

在“体卫融合”的背景下，太极拳的核心拳理和中医理念，为其在现行运动康复体系中发挥促进冠心病患者康复的作用提供了可行性。冠心病的流行病学、人口学和病理学特征，以及运动康复项目开展不足等现状都表明，太极拳是冠心病治疗中的重要一环。然而，目前太极拳在冠心病运动康复中的应用还处于探索阶段，相关研究存在一些限制，例如方案内容的不完整，运动处方的混乱，组别设置的不合理性，测试指标的权威性不足，以及作用机制研究的不充分。现有的研究证据还不足以推动相关循证医学决策的制定和实施，需要进行大量实证研究来深入探讨太极拳与冠心病患者的健康获益之间的内在联系。因此，按照国际标准，进行规范化和科学化的太极拳健康干预研究变得非常必要。

在借鉴已有相关研究的基础上，本研究充分发挥太极拳在康复和养生方面的功效，聚焦于冠心病患者的主要健康问题，进行太极拳健康干预研究，并分为三个层面：太极拳运动方案的研发，太极拳运动方案的效果验证，以及太极拳运动方案的作用机制探索。本研究旨在通过太极拳健康干预研究，探讨“体卫融合”的实际实施途径，为中国传统功法如八段锦、五禽戏等融入现行运动康复体系提供可复制、可移植、可推广的实际范例和方法，以促进中国传统体育项目在国际上的传播和在国内的推广，进一步加速实现“体育强国”和“健康中国”的建设目标。

本研究遵循“提取-构建-完善-验证-探索”的研究进路，首先，循证医学方法被用来检索中英文数据库中的相关信息，包括国内外近10年的冠心病运动康复的权威指南和专家共识。这些文献经过筛选和质量评价后，有关运动方案的主要内容被提取出来。接下来，采用了多种研究方法，如专家会议法、参与式观察法、预试验法和访谈法，从方案的实施主体、实施过程以及具体受众三个层面，构建和完善了太极拳运动方案。其次，实验法被用于分析12周太极拳运动方案和常规运动方案干预后，48名符合纳入排除标准的冠心病患者的各项指标变化，即心肺耐力、心功能、血脂代谢、焦虑及抑郁状态。最后，将理论研究和实践研究相结合，基于“心与小肠相表里”的中医理论，考虑到血管内皮功能在冠心病发病机制中的重要性，肠道菌群与冠心病的血管内皮功能的关联，以及运动可能通过调节肠道菌群来改善冠心病患者的血管内皮功能等研究背景，血管内皮功能被用于评估冠心病患者的康复效果，采用实验法研究太极拳运动方案促进冠心病患者康复的作用机制，解释了太极拳运动方案干预后冠心病患者的血管内皮功能和肠道菌群的变化趋势，基于肠道菌群的角度，探讨了太极拳运动方案改善冠心病患者的血管内皮功能的可能作用机制。

通过上述研究，得出以下结论：

1．本研究研发的太极拳运动方案具有科学性、可行性和有效性

本研究研发的太极拳运动方案包括运动耐量评估、运动程序、运动形式、运动处方（运动周期、运动强度、运动频率、运动时间）、运动进阶、运动执行模式、运动监控方式、运动干预形式等11项核心内容。其中，运动耐量评估：依据心肺运动试验和6分钟步行试验结果，并结合病史评估及一般功能评估结果进行危险分层，制定运动处方。运动程序和运动形式：拳境导入（热身活动）、太极（八法五步）（有氧运动）、太极运劲功（抗阻运动）、太极松静功（整理活动+柔韧练习）。运动处方包括12周的运动周期、55-65%VO₂max的运动强度、3次/周的运动频率、75min的单次运动时间。运动进阶：遵循运动量递增原则，在第5周和第9周上调运动量。运动执行模式包含两个阶段，即1个月的院内运动和2个月居家运动。运动监控方式：运动全程佩戴心率监测智能手环（院内运动阶段）监测心率，运动前中后测试即刻心率、血压、血氧含量及主观运动疲劳感觉等级（院内运动阶段+居家运动阶段）。运动干预形式：团体干预。

2．太极拳运动方案可有效应用于冠心病运动康复，促进冠心病患者的康复，丰富现行运动康复体系，给冠心病患者更多的运动选择

太极拳运动方案可显著提高冠心病患者的心肺耐力，达到和常规运动方案一样的疗效，且具备安全性。太极拳运动方案可有效改善冠心病患者的焦虑、抑郁状态，效果显著优于常规运动方案。太极拳运动方案有提高冠心病患者心功能的趋势。“太极特色”是太极拳运动方案促进冠心病患者康复的关键。

3．太极拳运动方案对冠心病患者血管内皮功能的改善作用和肠道菌群相关

太极拳运动方案可以有效改善冠心病患者的血管内皮功能，体现在提高血管舒张功能和血管弹性、降低单核细胞向内皮细胞的黏附以及炎症反应程度。太极拳运动方案可增加冠心病患者的肠道菌群的物种多样性，并显著降低致病菌的相对丰度。太极拳运动方案干预后，普雷沃氏菌属109（Prevotella_sp_109）、惰性凝集杆菌（Aggregatibacter segnis）、动物双歧杆菌（Bifidobacterium_animalis）和冠心病患者的血管内皮功能改善密切相关。

本研究采用了创新性的综合方法，融合了体育学、医学、微生物学等多个学科的研究手段。定性研究和定量研究相结合的方法被用于进行太极拳健康干预研究，研发了太极拳运动方案，验证了太极拳运动方案促进冠心病患者康复的效果，以确保太极拳运动方案的安全性、有效性和可行性。最后，基于“心与小肠相表里”，尝试从肠道菌群的角度，解析太极拳运动方案对冠心病患者的血管内皮功能的作用途径，有望推动太极拳健康干预研究朝着科学化和规范化的方向发展，有助于实现更为精确的干预措施，加速该领域的深入研究。

The dissemination and promotion of Chinese traditional sports are important measures to accelerate the construction of ‘sports power’ and ‘healthy China’. Tai Chi is an important part for the world to understand China and China’s excellent traditional Chinese culture to show. The value of medical care of Tai Chi is the first concern for Tai Chi practitioners. Therefore, providing convincing scientific evidence of health promoting by Tai Chi is a big step for the international dissemination and domestic promotion of traditional Chinese sports, as well as the construction of ‘sports power’ and‘healthy China’.

In the context of ‘integration of physical and health’, the situation of insufficient exercise rehabilitation programs of coronary artery disease(CAD) need to change. Tai Chi, a traditional Chinese medicine, maybe a suitable exercise for patients with CAD. However, it still on the beginning stage for the application of Tai Chi to exercise rehabilitation as a method of rehabilitation. There are limitations in relevant research, such as incomplete content of Tai Chi exercise rehabilitation program, chaotic exercise prescriptions, unreasonable group settings, unauthoritative testing indicators, and insufficient research of relative physiological mechanism. The dose effect characteristics between Tai Chi and health benefits indicators for CAD patients still needs to be explored through extensive empirical research, and existing research evidence is difficult to drive the formulation and implementation of relevant evidence-based medicine decisions. Therefore, it is necessary to conduct standardized and scientific research on Tai Chi health interventions in accordance with existing international standards.

This research fully utilizes the rehabilitation and health preserving effects of Tai Chi, and focus on the issue of CAD based on relevant research. Our research included three studies, and the first one is the construction of Tai Chi exercise rehabilitation program. Second one is the validation of the effectiveness of Tai Chi exercise rehabilitation program. The last one is the exploration of physiological mechanism of Tai Chi exercise rehabilitation program. The aims of this research are to take Tai Chi health intervention research as the model for the path of ‘integration of physical and health’, which will help promote the international and domestic dissemination of Chinese traditional sports projects, and accelerate the construction of ‘sports power’ and ‘healthy China’.

Our first study follows the research approach which is extraction, construction, improvement, validation, and exploration. Firstly, evidence-based medicine was used to search, screen, and evaluate the authoritative guidelines and expert consensus related to CAD exercise rehabilitation in the past 10 years using Chinese and English databases as data bases. Relevant information was extracted to determine the main content of the cardiac rehabilitation program. Then, we used research methods such as expert meeting, participatory observation, pre-trial, and interview to construct and improve the Tai Chi exercise rehabilitation program. In our second study, 48 CAD patients who met the inclusion and exclusion criteria were randomly divided into experimental group and control group. Both of them received a 12 weeks exercise rehabilitation program. The effects of Tai Chi exercise rehabilitation program were tested by cardiopulmonary endurance, cardiac function, lipid metabolism, anxiety, and depression. The last study was conducted to explore the physiological mechanism of Tai Chi exercise rehabilitation program.

The main conclusions of the present research are as follows:

1. Tai Chi exercise rehabilitation program constructed in this study is scientific, feasible, and effective

Tai Chi exercise rehabilitation program constructed in this study consist of 11 core contents, including exercise tolerance assessment, exercise program, exercise form, exercise prescription (exercise period, exercise intensity, exercise frequency, exercise time), exercise progression, exercise execution mode, and exercise monitoring method. In terms of exercise tolerance assessment, we based on the results of cardiopulmonary exercise test, 6-minute walking test, medical history assessment, general functional assessment and risk stratification to develop exercise prescriptions. In terms of exercise procedures and forms, we included the boxing introduction (warm-up activities), Tai Chi Eight Methods and Five Steps (aerobic exercise), Tai Chi Yunjin Gong (resistance exercise), and Tai Chi Song Jinggong (relax activities, and flexibility exercise). In terms of exercise prescription, we designed a 12 week exercise period, an exercise intensity of 55-65%VO₂max, and a 75 minutes session with a frequency of 3 exercises per week. In terms of exercise progression, we followed the principle of increasing exercise volume, increase the volume of exercise in the 5th and 9th weeks. In terms of exercise execution mode, we included two stages. The first one is a one month hospital-based exercise rehabilitation, and the second one is a two months home-based exercise rehabilitation. For the intervention pattern, a group intervention was applied.

2. Tai Chi exercise rehabilitation program can be effectively applied to CAD exercise rehabilitation for improving the health level of CAD patients, enriching the current exercise rehabilitation system, and providing CAD patients with more choice

Tai Chi exercise rehabilitation program can significantly improve the cardiorespiratory fitness of CAD patients with safely, achieve the same therapeutic effect as conventional exercise rehabilitation. Tai Chi exercise rehabilitation program has a trend of improving left ventricular ejection fraction in CAD patients. Tai Chi exercise rehabilitation program can effectively improve the anxiety and depression status of CAD patients, and the effect is significantly superior to conventional exercise rehabilitation programs.

3. The effect of Tai Chi exercise rehabilitation program on vascular endothelial function in CAD patients may be related to gut microbiota

The improvement of vascular endothelial function in CAD patients induced by Tai Chi exercise rehabilitation program is manifested in the improving of vasodilation function and vascular elasticity, reducing of the monocyte adhesion to endothelial cells, and the degree of inflammatory response. Tai Chi exercise rehabilitation program can increase the Beta diversity, and significantly reduce the relative abundance of pathogenic bacteria in CAD patients. After the intervention of Tai Chi exercise rehabilitation program, the relative abundance of Prevotella 109, Aggregatibacteria segnis, and Bifidobacterium animalis are closely related to the improvement of vascular endothelial function in CAD patients.

This study innovatively utilized multi-disciplinary research methods such as sports, medicine, microbiology. We also combined methods of qualitative and quantitative to conduct the construction of Tai Chi exercise rehabilitation program, the effect of Tai Chi exercise rehabilitation program in patients with coronary artery disease. Our results implies that Tai Chi exercise rehabilitation program is safe, effective, and feasible for CAD patients. Our last study, the physiological mechanism of Tai Chi exercise rehabilitation program indicates that precision intervention is advancing in a deeper direction.