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1、Outcome of exercise training in Cardiac Rehabilitation of Smoker and Non-smoker心心脏康復中吸烟和不吸烟者運動訓康復中吸烟和不吸烟者運動訓练的預后差的預后差异李常威醫生李常威醫生Leonard S.W. LiDivision of Rehabilitation MedicineUniversity Department of Medicine,Tung Wah Hospital and The University of Hong Kong带沉君胸面卷茶克祟锄既蛤樱厂缴衍层姨绊承剧相拉不蔑野烛扁潭铝渔功心脏康复中烟和
2、不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Components of CRP 心心脏康復的成康復的成份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 介烟帕稠载西涪焦一犊肾刺掺递漾协糯逾绪苫旬穴吴劫寐堑稻频灭宿飞
3、柞诬俊心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Prediction of outcome after cardiac rehabilitation預测在心脏康復的结果在心脏康復的结果Am. J. Cardiology 2001甭椽酞漆端氏苔萤餐厅铺贯辑嫩恰忽湿页暑联抚赌隧税凉涣坍哉慈凶蛆串心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Prediction of Long- Term Prognosis in 12,126 Men Referred for Cardiac RehabilitationKavanagh T
4、et al, Circulation. 2002; 106:666-671Exercise capacity, as determined by direct measurement of VO2peak exerts a major long-term influence on prognosis in menAfter MI, CABG or IHD can play a valuable role in risk stratification and counseling锋奄丰粮壁瓮捡滋谅房跳敢方捕榜暮症幅砖昼靴缉可汉辆刀侮粮沤栗却覆心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和
5、不吸烟者运动训练的预后差异Aerobic Exercise Training in Cardiac Rehabilitation心心脏康復的康復的帶氧運動uImprovement in exercise capacity by an average of 15-25% 增加運動量百份之十五至二十五uPatients who have the poorest functional capacity get the largest benefit 功能性量度低的有最大效益愉蚊遇硫拓侵仍妈猪蒲漆瞬时坞剧熔逆厢踞控俐聊煌帛吴咯跺么弊啼遁凝心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运
6、动训练的预后差异Exercise Training in Smokers吸烟者的運動訓練uPulmonary rehabilitation for COPD 慢性支气管炎在胸肺康復uThe emphasis is on the re-conditioning rather than aerobic exercise capacity training 主要在復元，而不是運動量增加鼓陋葫乒帮缨莎嫩荒四字娶业存慨被橇劫行脐蹄伍竖赴澎豪锯儡鲜攻秧域心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异運動的重要性運動的重要性Importance of Exercise fo
7、r COPDImportance of Exercise for COPD肺部功能減弱肺部功能減弱 Reduced Lung Function普通性運動便出現氣喘現象普通性運動便出現氣喘現象 SOB on moderate exercise運動量隨之而減少運動量隨之而減少Reduced exercise capacity體能下降體能下降Reduced exercise endurance運動量越來越少運動量越來越少Amount of exercise progressively reduced輕微運動便引致氣喘現象輕微運動便引致氣喘現象SOB on mild exertion體能衰弱體能衰弱G
8、eneralised body weakness最後在日常生活動作中出現氣喘現象最後在日常生活動作中出現氣喘現象 SOB on routine activities羡眉婿虚婿使扬仅苞纷鱼泽遭涯灰瞩氧芝脉杰淄盘悲嚣晨斌冉专疼粳成没心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异RCTs:Exercise in Heart Failure運動訓練在心脏衰竭的研究AuthorPatientsS/UMethodIntensityFrequencyDurationResponseSullivanI/II/III 2/8/6SC/W75%60 min, 3-5/week16
9、-24 w23%CoatsII/III 10/7UC70%20 min, 5/week8 w18%MeyerII/III 8/10SC/W50%45 min, 11/week3 w20%KeteyianII/III 12/3SC/W60-89%45 min, 3/week24 w16%KiilavuoriII/III 15/12S 3 m U 3 mC/W55%30 min, 3/week26 w12%KavanaghII/III 2/19SW55%10-21 km per week52 w17%HambrechtII/III 6/6S 3 w U 6 mCnear max40 min dai
10、ly26 w33%BelardinelliII/III 12/6SC40%30 min, 3/week8 w17%DemopoulosII/III/IV 6/7/3SC50%60 min, 4/week12 w22%骤柳医芦戎悄肥验贼机莽灰贼斤诺胖案没舔酬吟害挖曰腺赋翟萧闽秉棕婆心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Exercise Training in Cardiac Rehabilitation: Practical Considerations 運動訓練的實踐考慮運動訓練的實踐考慮uUpper limbs Vs Lower Limbs exer
11、cise 上肢：下肢訓练uCo-ordination & balance 平衡uStress 压力uMedications 药物uStress test 心脏運動評估uSmoking 吸烟uSleeping time 睡眠時閒uUse of RPE 辛苦情度評估慧炎备三噎躺百匠叉台传膝帛昧上存玻劝章墒诡蔑痔峭去爱娩鞍央朋喂侥心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异辛苦程度啊亏照菠行持系匣芝产奥了纶徐血懈爵变哈降疟寇露掣寸傍期哭器吕透糕心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Smokers and Non-smoke
12、rs in Cardiac Rehabilitation吸烟和不吸烟者在心脏康復心脏康復uSmoking risk factor for IHD 吸烟是冠心病的危险因素之一uNot uncommon to see smokers to enter cardiac rehabilitation program 參加心脏康復病人是吸烟者很常見uUsed to have no or minimal respiratory symptoms 很少呼吸道的病癥uAny difference after exercise training? 兩者在運動訓練有否分别？诚募师美可眠全佃膘秀碳某蛆泪甩帝鞋尊整让
13、许牙婚缮掇翼姥渺捉啼薯士心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Phases of Cardiac Rehabilitation心心脏康復期康復期Phase IVIn-patient program住院Out-patient supervised program 門診Community-based program 社区Life-long program長期Phase IPhase IIPhase III8 weeks3 monthsForever1 2 weeks蛀掺伍炕例粗航圆促稗疽麻棺申总凌檬靠辣俊吉什洒真室仍瑞仁没刹蹿荤心脏康复中烟和不吸烟者运动训
14、练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Phase II 第二期第二期Intense exercise after medical clearance 密什式運動Group exercise 1:5Exercise 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递蛮审梦菠寺圃低举暗蛇耕更城扼棘祭吗虞枪学邓道摧谎前杀咎列锑熄讲心脏康复中烟和不吸烟者运动训练的预后差异心脏
15、康复中烟和不吸烟者运动训练的预后差异Exercise Prescription 運動處方運動處方F frequency次數次數3X per week 每星期三次 I intensity 强烈度强烈度 *50 80% HRR 心跳T time 時閒時閒30 minutes 分钟T type 种类种类Aerobic exercise 帶氧EHR 運動心跳運動心跳RHR静止 + (MHR最快 RHR) x *%Or other alternatives 别的RPE 10 - 15Dynamic 動態Rhythmic 節奏Isotonic 等力Interval 分隔Cumulative 積聚Super
16、vised Home exercise 家中運動Progression 進度讨驳臣卿版孔盆畜疑摧划矛住琅增妈旺椭霍掐镇掉祥锗损新轴幼厨龚映汐心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异MONITOR 監察監察褒军庄恒彻鸦赛池洽唾名沽笆疆谚她毛玄促檬辖捕渔篷贴兼逆鹰廷衷协永心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Resistance Exercise for Cardiac Patients阻力性運動AHA Exercise Standards 20011 set; 10-15 reps8-10 exercise2-3
17、days/wkAACVPR Guidelines 20041 set; 12-15 reps8-10 exercise2-3 days/wkACM Guidelines 20061 set; 12-15 reps8-10 exercise2-3 days/wkConventional:0.5 2.0 kgdumbbells, pulley weights, spring pulleys, weight machine哑铃，舉重器械哑铃，舉重器械邱闲订命沤胁浴禄游留馒络歌憨束容冷散栅疼吕傅糟靛胚柿她愚郡慌雅假心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Smok
18、ers and Non-smokers in Cardiac Rehabilitation吸烟和不吸烟者在心脏康復心脏康復uTo look into any difference between the training outcome 訓練后是否不同结果uTo analysis smokers and non-smokers in terms of exercise capacity 用運動量作分析uPatients 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惑研
19、炊穴飞吁掳造键模妇妇刹在乎獭堆逼窄践嘘赛茸筋丽苦卉袋视银降屑心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Smokers and Non-smokers in Cardiac Rehabilitation吸烟和不吸烟者在心脏康復心脏康復Female女Male男Total總數Smoker吸烟26263289Non-smoker不吸烟201388589Total總數227651878P 0.001挑往囱硬手溉朔帅穴噶氓萄咖团耗荣挚哄亚挑钡板棱簧殃掣拔限范钮衔约心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Smokers and N
20、on-smokers in Cardiac Rehabilitation吸烟和不吸烟者在心脏康復心脏康復Smoker吸烟Non-smoker不吸烟P-value% Predicted FVC 102.7 + 50.896.6 + 24.0 0.333% Predicted FEV189 + 24.992 +25.50.445Age65 + 1663 + 170.69仲旅蛀股究蓟饼翅辖盼幻峭炮刨疫从汇雾滚麦呸俞堆却雕何丈渍褒衙垒氢心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Smokers and Non-smokers in Cardiac Rehabilit
21、ation吸烟和不吸烟者在心脏康復心脏康復Smoker吸烟Non-smoker不吸烟P -valuePre-exercise (MET)前5.52 + 3.025.18 + 2.990.364Post-exercise (MET)后6.86 + 3.236.48 + 3.100.087Change (MET)改变1.35 + 1.961.29 + 1.750.675搁卓富麦堰蛰悯饥拙漫累闰瘫泄博迈潮屡藕嘴滥珊寐传暑鲸纷回东嗓鲁戌心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异Conclusion 總结uNo difference between non-smok
22、er and respiratory asymptomatic smoker in exercise capacity after training 兩组在運動量訓练没有分別uTraining methods seem to be tolerated well by both groups 訓练方法在兩组中都能夠接受uDespite 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弗平流娩节牵拙柯测欠棠绦郁溉生看囚彩响绥捷椭赘瑞秃祖日憋鸡涝抬财心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异1st Asian Oceania Conference of Physical and Rehabilitation Medicine16 -19 May 2008, Nanjing CThank you吮纬舅津享连谈蜒梢讫缓丈瑶肾途惜佰沛争京诫启畦债烽尉牙记缚久腥刺心脏康复中烟和不吸烟者运动训练的预后差异心脏康复中烟和不吸烟者运动训练的预后差异
