제 1장 심호흡계 재활치료 개관
(Cardiopulmonary Rehabilitation: Overview )
심 호 흡 계 물 리 치 료
부산가톨릭대학교 물리치료학과
김 난 수
1. 심장재활 개관
(Cardiac Rehabilitation: Overview)
History and Evolution of Cardiac Rehabilitation
• In the 1930s, patients with myocardial infarction were advised to observe 6 weeks of bed rest.
• Physical activities, while sitting in a chair, were introduced in the 1940s.
• In the 1950s, 5 minutes of daily walking was advocated after 4 weeks of convalescence.
• Inpatient cardiac rehabilitation programs were first eveloped in the 1960s when clinicians gradually began to recognize that early ambulation avoided many of the complications of bed rest.
History and Evolution of Cardiac Rehabilitation
• At this time(1960s), a methodology for a more comprehensive, multidisciplinary approach to the rehabilitation of patients recovering from an acute cardiac event was first proposed.
• Contemporary cardiac rehabilitation began in the early 1970s, when exercise programs were extended beyond hospital discharge to highly structured, physician supervised, electrocardiographic-monitored, exercise programs. The focus of cardiac rehabilitation programs was almost entirely on exercise training to reverse the physical decline that resulted from extended bed rest
History and Evolution of Cardiac Rehabilitation
• During the 1980s cardiac rehabilitation evolved from a singular exercise intervention to a more comprehensive, multifaceted, medical and lifestyle modification model.
• In 1994, the American Heart Association (AHA) declared that cardiac rehabilitation should not be limited to an exercise training program but also should include multifaceted strategies aimed at reducing modifiable risk factors for CHD.
History and Evolution of Cardiac Rehabilitation
• Based on a comprehensive, systematic review of the scientific evidence, the first Clinical Practice Guidelines for Cardiac Rehabilitation broadened the scope of cardiac rehabilitation programs to include the assessment and modification of risk factors.
• As such, the aims of CR programs are to optimize cardiovascular risk reduction, promote adoption and adherence to healthy behaviors, enhance emotional well-being, reduce disability, and promote an active lifestyle for patients with CHD.
History and Evolution of Cardiac Rehabilitation
• In the 1970s, participation in outpatient CR/SP programs was essentially limited to males under 65 years of age with a diagnosis of an uncomplicated myocardial infarction or coronary bypass surgery
• Ideally, for all patients, the care-continuum approach includes comprehensive CR/SP services that begin during hospitalization and transition to the outpatient setting.
• Present day CR/SP services are multifaceted and multidisciplinary and include, but are not limited to: exercise training, counseling, education, risk factor modification, and psychosocial and nutritional interventions.
Core Components of Care and Measuring Patient Outcomes
• The AHA and American Association of Cardiovascular and Pulmonary Rehabilitation(AACVPR) recognize that all CR/SP programs should contain specific core components that aim to optimize cardiovascular risk reduction, foster and encourage compliance with healthy behaviors, reduce disability, and promote an active lifestyle for patients with CHD.
• Core components include: (1) patient assessment, (2) nutritional counseling, (3) weight management, (4) blood pressure
management, (5) lipid management, (6) diabetes management,
• (7) tobacco cessation, (8) psychosocial management,
• (9) physical activity counseling, and (10) exercise training.
2. 호흡재활 개관
(Pulmonary Rehabilitation: Overview )
HISTORICAL ASPECTS
• As for coronary artery disease patients, rest was considered
essential part of the treatment for respiratory patients during the first half of the last century.
• In 1952, Barach suggested that in chronic respiratory patients, the progressive improvement in ability to walk without dyspnea might be a physiological response similar to a training program in athletes.
• In 1960s, Petty established a standardized out-patient program of pulmonary rehabilitation.
HISTORICAL ASPECTS
• In 1980, the American Thoracic Society acknowledged benefits of pulmonary rehabilitation notably and included exercise conditioning as an important constituent in treatment program.
However, during this period, some trials showed no significant benefit. The failure to show benefit was probably because these studies looked for effect in only an individual variable related to exercise.
• After the mid 1980s, important and more comprehensive work in rehabilitative research established the role of pulmonary rehabilitation for patients with chronic respiratory diseases.
DEFINITION
• by American College of Chest Physicians (ACCP) and the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) as follows: “Pulmonary rehabilitation is an evidence-based, multidisciplinary and comprehensive intervention for patients with chronic lung disorders who are symptomatic and have some disability. Pulmonary rehabilitation is aimed to decrease symptoms, optimize functional state, increase participation, and reduce health- care costs through stabilizing or reversing systemic manifestations of the disease”.
AIMS OF REHABILITATION
• The basic goals of pulmonary rehabilitation are to (1) improve symptoms, (2) restore functional capabilities, and (3) enhance overall quality of life.
• Thus, an ideal pulmonary rehabilitation program should be structured to bring about specific changes in underlying pathophysiology to improve functional capabilities, leading to symptomatic improvement and reduction in handicap, thereby refining quality of life in a cost-effective and individualized manner. With the help of education, the rehabilitation also aims to relieve fears and anxiety associated with program and lung condition, thereby ensuring long-term commitment to exercise.
TYPES OF PULMONARY REHABILITATION PROGRAMS
• Out-patient, in-patient and home-based programs are three basic types of pulmonary rehabilitation.
• Each patient is prescribed a customized program that is most appropriate for his needs.
Reference
• Savage et al., Clinical Research in Cardiac Rehabilitation and Secondary Prevention: Looking Back and Moving Forward. J Cardiopulm Rehabil Prev. 2011 November ; 31(6): 333–341.
• Sharma & Signh, Pulmonary rehabilitation: An overview . Lung India. 2011 Oct-Dec; 28(4): 276–284..
