心脏康复中吸烟和不吸烟者运动训练的预后差异.ppt
Outcome of exercise training in Cardiac Rehabilitation of Smoker and Non-smoker 心脏康復中吸烟和不吸烟者運動訓练的預后差异,李常威醫生 Leonard S.W. Li Division of Rehabilitation Medicine University Department of Medicine, Tung Wah Hospital and The University of Hong Kong,Components of CRP 心脏康復的成份,Exercise training 運動訓練 Physical counseling 活動講解 Weight management 控制体重 Lipid management 脂肪控訓 Psychosocial management 心理社會處理 Diabetes management 糖尿控制 HT management 血庄治理 Nutritional counseling 营養講解 Smoking cessation 介烟,Prediction of outcome after cardiac rehabilitation 預测在心脏康復的结果,Am. J. Cardiology 2001,Prediction of Long- Term Prognosis in 12,126 Men Referred for Cardiac Rehabilitation Kavanagh T et al, Circulation. 2002; 106:666-671,Exercise capacity, as determined by direct measurement of VO2peak exerts a major long-term influence on prognosis in men After MI, CABG or IHD can play a valuable role in risk stratification and counseling,Aerobic Exercise Training in Cardiac Rehabilitation 心脏康復的帶氧運動,Improvement in exercise capacity by an average of 15-25% 增加運動量百份之十五至二十五 Patients who have the poorest functional capacity get the largest benefit 功能性量度低的有最大效益,Exercise Training in Smokers 吸烟者的運動訓練,Pulmonary rehabilitation for COPD 慢性支气管炎在胸肺康復 The emphasis is on the re-conditioning rather than aerobic exercise capacity training 主要在復元，而不是運動量增加,運動的重要性 Importance of Exercise for COPD,肺部功能減弱 Reduced Lung Function,普通性運動便出現氣喘現象 SOB on moderate exercise,運動量隨之而減少 Reduced exercise capacity,體能下降 Reduced exercise endurance,運動量越來越少 Amount of exercise progressively reduced,輕微運動便引致氣喘現象 SOB on mild exertion,體能衰弱 Generalised body weakness,最後在日常生活動作中出現氣喘現象 SOB on routine activities,RCTs:Exercise in Heart Failure 運動訓練在心脏衰竭的研究,Exercise Training in Cardiac Rehabilitation: Practical Considerations 運動訓練的實踐考慮,Upper limbs Vs Lower Limbs exercise 上肢：下肢訓练 Co-ordination & balance 平衡 Stress 压力 Medications 药物 Stress test 心脏運動評估 Smoking 吸烟 Sleeping time 睡眠時閒 Use of RPE 辛苦情度評估,辛苦程度,Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復,Smoking risk factor for IHD 吸烟是冠心病的危险因素之一 Not uncommon to see smokers to enter cardiac rehabilitation program 參加心脏康復病人是吸烟者很常見 Used to have no or minimal respiratory symptoms 很少呼吸道的病癥 Any difference after exercise training? 兩者在運動訓練有否分别？,Phases of Cardiac Rehabilitation 心脏康復期,Phase IV,In-patient program 住院,Out-patient supervised program 門診,Community-based program 社区,Life-long program 長期,Phase I,Phase II,Phase III,8 weeks,3 months,Forever,1 2 weeks,Phase II 第二期,Intense exercise after medical clearance 密什式運動 Group exercise 1:5 Exercise 運動 Aerobic exercise帶氧 Flexibility exercise 鬆弛 + Resistance exercise阻力 Aims: 目的 Exercise capacity 增加運動量 Exercise habit 習慣 Exercise Protocol,Exercise Prescription 運動處方,EHR 運動心跳 RHR静止 + (MHR最快 RHR) x *% Or other alternatives 别的 RPE 10 - 15,Dynamic 動態 Rhythmic 節奏 Isotonic 等力,Interval 分隔 Cumulative 積聚,Supervised Home exercise 家中運動,Progression 進度,MONITOR 監察,Resistance Exercise for Cardiac Patients 阻力性運動,Conventional: 0.5 2.0 kg dumbbells, pulley weights, spring pulleys, weight machine 哑铃，舉重器械,Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復,To look into any difference between the training outcome 訓練后是否不同结果 To analysis smokers and non-smokers in terms of exercise capacity 用運動量作分析 Patients entered cardiac rehabilitation at Tung Wah Hospital in last 10 years. 在十年内在东華医院参加心脏康復者,Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復,P 0.001,Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復,Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復,Conclusion 總结,No difference between non-smoker and respiratory asymptomatic smoker in exercise capacity after training 兩组在運動量訓练没有分別 Training methods seem to be tolerated well by both groups 訓练方法在兩组中都能夠接受 Despite being chronic smokers, the impairment of lung function seems to minimal when compared with the non-smoker group 雖然是長期吸烟，肺功能没有太大影響,1st Asian Oceania Conference of Physical and Rehabilitation Medicine 16 -19 May 2008, Nanjing China,www.aocprm2008.com,Thank you,
