文档介绍：心肌梗塞后的运动和康复治疗
浙江医院心内科
这些问题让心梗后患者困惑
■我能不能运动?
■我应该怎么运动?
我什么时候可以回到工作岗位?
■我可以做哪些家务?
■我什么时候可以回到以前正常的生活?
心脏康复的概念和分期
■心脏康复( Cardiac Rerehabilitation,CR)始于
上世纪80年代
■1995年 AHCRP指南提出:
CR由药物治疗、合理运动、危险因素干预、健
康教育、生活习惯干预等多因素构成
旨在
减少心血管疾病带来的身心方面的负面影响
●降低猝死和再梗死风险
Psychological
Secondary
控制症状
Support
Prevention
●减缓疾病进程
C
改善患者生活质量
Education
Exercise
综合的康复治疗方案
运动处方
功能评估
随访
心理干预
营养指导
危险因素
矫正
心脏康复的内容
心脏康复的核心内容
不运动的不利影响
缺少运动
炎症
血脂异常
Age
高血压
糖尿病
Smoking
肥胖
Hypercoagulability
Genetics
动脉硬化
← Novel Risk Factors
Exercise Evidence
Effect on Body Composition
173 sedentary overweight(BMI >24 kg/m2)post-mend
ndomized to moderate intensity exercise vs stretching for 1 year
Exerasers Tertiles
Exercisers (Tertilesp
Control o Low-Active o Intermediately Highly
O Controls o Low-Actme● Intermediately·Hghl
Actlve
Duration
ange in
of Sports
中等度的运动减少肥胖
min/wk; intermediately active, 136-195 min/wk; and highly
active.>
195 min/wk)
ML et :323330
Exercise evidence
运动对血脂的影响
Year and Lipid Level (mg/dL)
Lipids
Baseline
Baseline
214
213
Women
223
209
134
118
15%
Women
120
HDL-C
Women
↑20%
Women
for change in women vs men
tP= for change in women vs men
HDL-C=High density lipoprotein cholesterol, LDL-C=Low density
lipoprotein cholesterol, TG=Triglycerid
Warner JG et al. Circulation 1995: 92: 773-777
Exercise Evidence
运动对肥胖和糖尿病的影响
Nurse’ s Health stud
35%
30%
Risk of obesity
Risk of DM
20%
10%
Reduction
Each hour a day spent Each two hours a day Each two hours a day
walking briskly
spent watching Tv
spent sitting at work
运动降低肥肸和糖尿病的发生率
Hu Fb et al. JAMA 2003: 289: 1785-91
Exercise Evidence
运动对冠心病的影响
Women's Health Initiative observational Study
igorous exercise
Walking
o∝
Quintiles of activit