心脏康复中吸烟和不吸烟者运动训练的预后差异

Outcome of exercise training in Cardiac Rehabilitation of Smoker and Non-smoker 心脏脏康復中吸烟和不吸烟者運動訓练练的預后差异 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 心脏脏康復的帶氧運動 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 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 運動的重要性運動的重要性 Importance of Exercise for COPDImportance 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 AuthorPatientsS/UMethodIntensityFrequencyDurationResponse SullivanI/II/III 2/8/6SC/W75%60 min, 3-5/week16-24 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 daily26 w33% BelardinelliII/III 12/6SC40%30 min, 3/week8 w17% DemopoulosII/III/IV 6/7/3SC50%60 min, 4/week12 w22% Exercise Training in Cardiac Rehabilitation: Practical Considerations 運動訓練的實踐考慮 uUpper limbs Vs Lower Limbs exercise 上肢：下肢訓练 uCo-ordination 10-15 reps 8-10 exercise2-3 days/wk AACVPR Guidelines 2004 1 set; 12-15 reps 8-10 exercise2-3 days/wk ACM Guidelines 2006 1 set; 12-15 reps 8-10 exercise2-3 days/wk 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 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 Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復 Female 女 Male 男 Total 總數 Smoker 吸烟 26263289 Non- smoker 不吸烟 201388589 Total 總數 227651878 P 0.001 Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復 Smoker 吸烟 Non-smoker 不吸烟 P- value % Predicted FVC 102.7 + 50.896.6 + 24.0 0.333 % Predicted FEV1 89 + 24.992 +25.50.445 Age65 + 1663 + 170.69 Smokers and Non-smokers in Cardiac Rehabilitation 吸烟和不吸烟者在心脏康復 Smoker 吸烟 Non-smoker 不吸烟 P -value Pre-exercise (MET)前 5.52 + 3.025.18 + 2.990.364 Post-exercise (MET)后 6.86 + 3.236.48 + 3.100.087 Change (MET)改变 1.35 + 1.961.29 + 1.750.675 Conclusion 總结 uNo 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 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 see