1、HM734 Exercise Testing and Prescription: Cardiorespiratory 1 急性冠脈綜合征患者心臟康復治療 的基本概念與進展 The Basic Concepts of and Progress in Cardiac Rehabilitation in Patients with Acute Coronary Syndrome HM734 Exercise Testing and Prescription: Cardiorespiratory 2 Acute Coronary Syndromes(ACS) Anderson, J. L. et al

2、. J Am Coll Cardiol 2007;50:e1-e157 HM734 Exercise Testing and Prescription: Cardiorespiratory 3 HM734 Exercise Testing and Prescription: Cardiorespiratory 4 = HM734 Exercise Testing and Prescription: Cardiorespiratory 5 CR的定義的定義 J. Am. Coll. Cardiol. doi:10.1016/j.jacc.2007.04.033 published online

3、Sep 20, 2007; HM734 Exercise Testing and Prescription: Cardiorespiratory 6 針對ACS的CR綱要 HM734 Exercise Testing and Prescription: Cardiorespiratory 7 針對ACS的CR目標 www.capitalhealth.ca HM734 Exercise Testing and Prescription: Cardiorespiratory 8 CR涉及的人員 Who should be involved? Can J Cardiol 2006, 22(11):

4、905-11 藥劑師（Pharmacist） 護士（Nurse） 咨詢醫師（Consultant） 全科醫師（GP） 營養學家（Dietician） 運動教練（Exercise instructor） 戒煙顧問 （Smoking cessation advisor） 社會服務 （Social Services） 心理學家（Psychologist） 社區護士 （District Nurses） 實習護士（Practice nurses） 保健隨訪人員 （Health Visitor） 二級預防保健（Secondary care） HM734 Exercise Testing and Presc

5、ription: Cardiorespiratory 9 ACS后CR的核心要素 European Journal of Cardiovascular Prevention 17:1-17 Copyright by European Society of Cardiology HM734 Exercise Testing and Prescription: Cardiorespiratory 10 患者評估（Patient assessment） 平板運動最大負荷 European Journal of Cardiovascular Prevention 17:1-17 HM734 Exerc

6、ise Testing and Prescription: Cardiorespiratory 11 患者評估（Patient assessment） 11 HM734 Exercise Testing and Prescription: Cardiorespiratory 12 體力活動咨詢 （Physical activity counselling） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 13 運動訓練

7、 （Exercise training） u抗阻訓練 European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 14 有氧和抗阻運動訓練禁忌癥 HM734 Exercise Testing and Prescription: Cardiorespiratory 15 飲食/營養咨詢 （Diet/nutritional counselling） European Journal of Cardiovascular Preventi

8、on 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 16 血脂管理 （Lipid management） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 17 體重管理 (Weight control management) European Journal of Cardiovascular Prevention 17:1-17

9、HM734 Exercise Testing and Prescription: Cardiorespiratory 18 血壓管理（Blood pressure monitoring） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 19 戒煙（Smoking cessation） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise

10、 Testing and Prescription: Cardiorespiratory 20 心理管理（Psychosocial management） European Journal of Cardiovascular Prevention 17:1-17 HM734 Exercise Testing and Prescription: Cardiorespiratory 21 European Journal of Cardiovascular Prevention 17:1-17 心理管理（Psychosocial management） HM734 Exercise Testing

11、 and Prescription: Cardiorespiratory 22 CR時段分配（時段分配（Structure of CR） JACC Vol. 50, No. 14, 2007:140033 HM734 Exercise Testing and Prescription: Cardiorespiratory 23 第第1階段（階段（住院期間） J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription: Cardiorespiratory 24 J Am Coll Cardiol 2007;5

12、0:140033. 第第2階段（階段（開始于ACS后13周） HM734 Exercise Testing and Prescription: Cardiorespiratory 25 第第3階段階段(ACS后3-4 周) J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription: Cardiorespiratory 26 第第4階段階段(長期而堅持不懈) J Am Coll Cardiol 2007;50:140033. HM734 Exercise Testing and Prescription:

13、Cardiorespiratory 27 J Am Coll Cardiol 2007;50:140033. 對患者及其家庭的挑戰對患者及其家庭的挑戰 HM734 Exercise Testing and Prescription: Cardiorespiratory 28 J Am Coll Cardiol 2007;50:140033. CR的的實施途徑實施途徑 HM734 Exercise Testing and Prescription: Cardiorespiratory 29 ACS后CR獲益的證據 HM734 Exercise Testing and Prescription:

14、Cardiorespiratory 30 Arch Intern Med. 2008;168(20):2194-2204. doi:10.1001/archinte.168.20.2194 HM734 Exercise Testing and Prescription: Cardiorespiratory 31 The ENRICHD Intervention Did Improve Late Survival (6 Months) Late survival depended on whether depression improved over the course of the inte

15、rvention. Carney et al., Psychosom Med 2004;66(4):466-474. HM734 Exercise Testing and Prescription: Cardiorespiratory 32 Actuarial cumulative hazard plot for survival time based on depression status upon completion of cardiac rehabilitation 0 0.05 0.10 0.15 0.20 0.25 0.30 0.35 012345 Depression is Associated with Decreased Survival Milani RV, Am J Med 2007 HM734 Exercise Testin