当前，心血管疾病已成为危害人类健康的主要疾病，其中冠心病已成为导致人类死亡的首要原因。如何防治心血管疾病的发生，提高患者的生活质量，已成为一项重大的公共卫生任务。随着全民健身与国民健康的深度融合，太极拳在健身和医疗康复中发挥了不可替代的作用。因此如何将太极拳与现代心脏康复理念相结合，充分发挥中国传统体育养生功法的优势，构建其安全、有效且独具中国特色的太极心康方案就具有十分重要的现实意义和理论价值。

研究目的：

       本研究以体医融合为视角，根据现代康复医学运动处方模式和基本要求，按照寻求循证医学证据、研发干预方案以及临床科学实证的研究路径开展研究。本研究的主要目的是研发太极心康方案，探讨其在冠心病人群中应用的有效性，为提出心脏康复运动处方体系的“中国方案”提供科学依据。

研究方法：

（1）太极心康方案研发部分主要运用文献资料法与实验法。通过全面、系统的检索国内外数据库，查阅建库至2020年6月相关文献资料并进行Meta分析。运用Revman 5.3软件绘制森林图，Stata15.1软件进行敏感性分析，发表偏倚采用Egger法。通过MateMax3B便携式心肺功能测试仪对太极心康方案的核心内容进行能量消耗评估。

（2）太极心康方案实证研究部分主要运用实验法。采用多中心、随机对照实验研究方案，运用组别×时间的双因素混合实验设计。共招募冠心病患者56例，按照1:1比例随机分为两组，每组各28例，实验组采取太极心康方案干预；对照组采取常规运动康复方案干预，两组患者均给予药物治疗。干预周期共计11个月，其中包括2个月的院内康复与9个月的居家康复，居家康复采用腾讯会议远程监控形式。数据分析采用SPSS21.0统计软件，不同时间节点指标比较采用重复测量方差分析。本研究以生活质量（SF-36）作为主要结局指标，以心肺功能、超声心动图、运动能力、身体成分、血脂代谢、焦虑抑郁情绪及运动依从性作为次要结局指标。

研究结果：

（1）构建了以太极（八法五步）为核心内容的太极心康方案，其动作内容简单易学，动作结构严谨合理；在习练太极心康方案核心内容过程中能量消耗强度呈循序渐进“阶梯式”增长；太极心康方案核心内容运动强度小于24式简化太极拳（2.21±0.44 VS 3.2±0.14METs），是中小强度的有氧运动；系统化的太极心康方案由拳境导入、太极（八法五步）、太极运劲功及太极松静功四部分构成。

（2）①经检验，两组被试在一般人口学信息、患病情况及基础用药等方面无显著性差异，P＞0.05，说明基线水平均衡具有可比性。②主要结局指标组内比较：太极心康方案干预后生活质量总分（Tol）提高88.00，P＜0.01，生理健康（PHC）层面提高33.11，P＜0.05，心理健康（MHC）层面提高63.770，P＜0.01，其中生理职能（RP）、一般健康状况（GH）、社会功能（SF）以及情感职能（RE）显著性提高，且具有远期疗效，P＜0.01。③主要结局指标组间比较，干预后太极心康方案在RE维度及MHC层面显著性高于常规运动康复方案，且具有远期疗效，P＜0.05。④次要结局指标组内比较，太极心康方案干预后心肺功能指标6分钟步行距离（6MWT）显著性提高，P＜0.05；运动能力指标体前屈、闭眼单脚站、闭目原地踏步非常显著性提高，P＜0.01；焦虑（GAD-7）、抑郁（PHQ-9）情绪非常显著性降低，P＜0.01；常规运动康复方案干预后心肺功能指标峰值摄氧量、无氧阈摄氧量、峰值梅脱值、最大自主通气量显著性提高，P＜0.05；身体成分指标内脏脂肪含量以及PHQ-9显著性下降，P＜0.05。⑤次要结局指标组间比较，干预后太极心康方案在PHQ-9方面显著性低于常规运动康复方案，P＜0.05；运动依从性显著性高于常规运动康复方案，P＜0.05。常规运动康复方案在身体质量指数（BMI）、内脏脂肪含量方面显著性低于太极心康方案，P＜0.05。两组患者均未出现不良反应及不良事件。

研究结论及建议：

（1）由拳境导入、太极（八法五步）、太极运劲功及太极松静功四部分构成的系统化的太极心康方案对冠心病患者具有一定的科学性、合理性及安全性，是与常规运动康复方案互补的“中国方案”。

（2）临床实验研究发现，太极心康方案在提高冠心病患者生活质量、增强运动能力、改善焦虑抑郁情绪等方面取得了显著性疗效，而常规运动康复方案在改善冠心病患者心肺功能、身体成分两方面具有显著性疗效。两种运动康复方案均具有较高的安全性，但太极心康方案的运动依从性相对较高。

（3）建议今后可将太极心康方案更多地应用于临床实践中，不断完善心脏康复运动处方体系，为国际心脏康复发展贡献“中国方案”。

At present, cardiovascular disease has become a major disease endangering human health, and coronary heart disease (CHD) has become the leading cause of human death. How to prevent the occurrence of cardiovascular diseases and improve the quality of life of patients has become a major public health task. With the deep integration of national fitness and national health, Tai Chi has played an irreplaceable role in fitness and medical rehabilitation. Therefore, how to combine Taijiquan with modern heart rehabilitation concepts, give full play to the advantages of traditional Chinese sports health methods, and construct a safe, effective and unique Tai Chi cardiac rehabilitation programme(TCCRP) with Chinese characteristics has very important practical significance and theoretical value.

Purpose: 

This research is based on the perspective of the integration of sports and medicine, according to the modern rehabilitation medicine exercise prescription model and basic requirements, according to the research path of seeking evidence-based medical evidence, researching and developing intervention programs, and clinical scientific evidence. The main purpose of this research is to develop the TCCRP, explore its effectiveness in the CHD population, and provide a scientific basis for proposing the “China's programme” of the cardiac rehabilitation exercise prescription system.

Methods: 

(1) The research and development part of the TCCRP mainly uses the literature method and the experimental method. Through a comprehensive and systematic search of domestic and foreign databases, the relevant literature and materials of the database until June 2020 are consulted and meta-analysis is carried out. Revman 5.3 software was used to draw forest maps, Stata 15.1 software was used for sensitivity analysis, and Egger method was used for publication bias. Evaluate the core content of the TCCRP through the MateMax3B portable cardiopulmonary function tester.

(2) The empirical research part of the TCCRP mainly uses experimental methods. A multi-center, randomized controlled experimental research protocol was adopted, and a mixed experimental design of group×time was used. A total of 56 patients with CHD were recruited and randomly divided into two groups according to a 1:1 ratio, with 28 cases in each group. The experimental group was treated with TCCRP; the control group was treated with conventional exercise cardiac rehabilitation program(RECRP), and both groups were given medication . The total intervention period is 11 months, including 2 months of in-hospital rehabilitation and 9 months of home rehabilitation. The home rehabilitation adopts the form of Tencent conference remote monitoring. Data analysis uses SPSS21.0 statistical software, and the comparison of indicators at different time nodes uses repeated measurement analysis of variance. In this study, quality of life was used as the main outcome index, and cardiopulmonary function, echocardiography, exercise capacity, body composition, lipid metabolism, anxiety, depression, and exercise compliance were used as secondary outcome indicators.

Results: 

(1) With Bafa Wubu of Tai Chi as the core content of the TCCRP, its action content is simple and easy to learn, and the action structure is rigorous and reasonable. In the process of practicing the core content of the TCCRP, the energy consumption intensity increased gradually “step-wise” manner. The core content of TCCRP is the exercise intensity less than 24 forms simplified Taijiquan (2.21 ± 0.44 VS 3.2±0.14METs), which is a small and medium intensity aerobic exercise. The systematic TCCRP is composed of four parts: Quanjing Daoru, Bafa Wubu of Tai Chi, Tai Chi Yunjingong and Tai Chi Songjinggong.

(2) ① After testing, there is no significant difference between the two groups of participants in general demographic information, prevalence and basic medications, P>0.05, indicating that the baseline level is balanced and comparable. ②Comparison of the main outcome indicators within the group: The total score (Tol) of quality of life increased by 88.00 after the intervention of TCCRP, P<0.01, the level of physical health (PH) increased by 33.11, P<0.05, and the level of mental health (MH) increased by 63.770. P<0.01, among which physiological function (PF), general health (GH), social function (SF) and role emotional (RE) are significantly improved, and have long-term curative effects, P<0.01. ③Comparing the main outcome indicators between groups, the TCCRP after intervention was significantly higher than the CECRP at the RE dimension and MH level, and it had a long-term effect, P<0.05. ④Comparing the secondary outcome indicators within the group, the 6-minute walking distance (6MWT) of the cardiopulmonary function index increased significantly after the intervention of the TCCRP, P<0.05; the exercise ability index bends forward, stands on one foot with eyes closed, and keep eyes closed and keep moving increased significantly, P<0.01; anxiety and depression were significantly reduced, P<0.01; peak oxygen uptake, oxygen intake by anaerobic threshold, peak Metre value, and maximum voluntary ventilation after the CECRP increased significantly, P<0.05; body composition index visceral fat content and depression decreased significantly, P<0.05. ⑤Comparing the secondary outcome indicators between groups, the TCCRP after intervention was significantly lower than the conventional exercise rehabilitation program in depression, P<0.05; the exercise compliance was significantly higher than that of the CECRP, P<0.05. The CECRP was significantly lower than the TCCRP in terms of body mass index (BMI) and visceral fat content, P<0.05. There were no adverse reactions and adverse events in the two groups of patients.

Conclusions and recommendations:

(1) The systematic TCCRP composed of Quanjing Daoru, Bafa Wubu of Tai Chi, Tai Chi Yunjingong and Tai Chi Songjinggong is scientific, reasonable and safe for patients with CHD, and is a “China's programme” complementary to the CECRP.

(2) Clinical experimental studies have found that the TCCRP has achieved significant effects in improving the quality of life of patients with CHD, enhancing exercise capacity, and improving anxiety and depression, while CECRP can improve the cardiopulmonary function and body composition of patients with CHD and has a significant effect. Both exercise rehabilitation programs have high safety, but the TCCRP has relatively high exercise compliance.

(3) It is suggested that the TCCRP can be used more in clinical practice in the future to continuously improve the cardiac exercise rehabilitation system and contribute China's programme to the development of international cardiac rehabilitation.