锻炼和慢性病 ppt课件

ExerciseandChronicDisease MarkA Patterson M Ed RCEPClinicalExercisePhysiologist KaiserPermanentePresident ElectRockyMountainACSM Hippocrates Eatingalonewillnotkeepamanwell hemustalsotakeexercise Forfoodandexercise whilepossessingoppositequalities yetworktogethertoproducehealth Hippocrates Regimen 5thCenturyB C SlideborrowedfromRussPateandRobertSalis www exerciseismedicine org CommonChronicDiseases CardiovasculardiseaseHeartAttack Stroke PADPulmonarydiseaseAsthma COPD EmphysemaDiabetesNeuropathies CADNeuromusculardisordersMultipleSclerosis ParkinsonsMusculoskeletalconditionsArthritisCancerBreast Prostate LeukemiaRenaldiseaseKidneyFailure CADImmunologicalAIDSObesityAlloftheabove Cardiovasculardisease 79million 2007CDCWebsite Pulmonarydisease 35million 2007AmericanLungAssociation Diabetes 14 6Million 2005CDCWebsite Neuromusculardisorders MS 2 5millionnationalmssociety Parkinson s1 5million NationalParkinsonFoundation Musculoskeletalconditions Rheumatoid2 1million osteo21million juvenile300 000 nationalarthritisfoundation Obesity 99Million BasedoffCDCandCensusBureauSites Cancer 10 1Million2002 AmericanCancerSocietyWebsite Renaldisease 20 million AmericanKidneyFund Immunological AIDS36 1MillionAIDS org ChronicDiseases BenefitsofExercise IncreasedVO2ImprovedBPControlIncreasedHDLDecreasedBodyFatImprovedWeightControlImprovedBSControlImprovedStrengthLessFatigueImprovedBalance HeartDiseaseLungDiseaseDiabetesNeuromuscularMusculoskeletalObesityCancerKidneyDiseaseAIDs WhoisBesttoCareforThesePeople Me InanIdealWorldClinicalExercisePhysiologistsPhysicalTherapistsRespiratoryTherapistsRegisteredNursesPhysiciansPersonalTrainersMassageTherapistsAccupunctureChiropractors WhatisClinicalExercisePhysiology TheRegisteredClinicalExercisePhysiologistisanalliedhealthprofessionalwhoworkswithapparentlyhealthypeopleandpatientswithchronicdiseasesandconditionswhereexercisehasbeenproventoprovidetherapeuticbenefit TheRCEPperformsexerciseassessmentsandprescribesexerciseandphysicalactivity primarilyinhospitals clinicsorotherhealth careprovidersettings TheRCEPassistsindividualsindevelopingself managementskillstopromotegoodhealth TheRCEPisanintegralpartofthehealthcareteamandworkscloselywithotherhealthprofessionalsincluding Physicians Nurses NursePractitioners PhysicianAssistants RespiratoryTherapists PhysicalTherapistsandRegisteredDietitians RCEP saretrainedtoworkwithpatientswithchronicdiseasessuchas Cardiovasculardisease pulmonarydisease diabetes neuromusculardisorders musculoskeletalconditions obesity cancer endstagerenaldisease neoplastic immunological hematologicaldisorders CEPorPT Physicaltherapy whichislimitedtothecareandservicesprovidedbyorunderthedirectionandsupervisionofaphysicaltherapist includes Aerobiccapacity endurance anthropometriccharacteristics arousal attention andcognition assistiveandadaptivedevices circulation arterial venous lymphatic cranialandperipheralnerveintegrity environmental home andwork job school play barriers ergonomicsandbodymechanics gait locomotion andbalance integumentaryintegrity jointintegrityandmobility motorfunction motorcontrolandmotorlearning muscleperformance includingstrength power andendurance neuromotordevelopmentandsensoryintegration orthotic protective andsupportivedevices pain posture prostheticrequirements rangeofmotion includingmusclelength reflexintegrity self careandhomemanagement includingactivitiesofdailylivingandinstrumentalactivitiesofdailyliving sensoryintegrity ventilation andrespiration gasexchange work job school play community leisureintegrationorreintegration includinginstrumentalactivitiesofdailyliving 2 Alleviatingimpairmentandfunctionallimitationbydesigning implementing andmodifyingtherapeuticinterventionsthatinclude butarenotlimitedto Coordination communicationanddocumentation patient client relatedinstruction therapeuticexercise functionaltraininginself careandhomemanagement includingactivitiesofdailylivingandinstrumentalactivitiesofdailyliving functionaltraininginwork job school play andcommunityandleisureintegrationorreintegrationactivities includinginstrumentalactivitiesofdailyliving workhardening andworkconditioning manualtherapytechniques includingmobilization manipulation prescription application and asappropriate fabricationofdevicesandequipment assistive adaptive orthotic protective supportive andprosthetic airwayclearancetechniques integumentaryrepairandprotectiontechniques electrotherapeuticmodalities physicalagentsandmechanicalmodalities 3 Preventinginjury impairment functionallimitation anddisability includingthepromotionandmaintenanceofhealth wellness fitness andqualityoflifeinallagepopulations 4 Engaginginconsultation education andresearch ExerciseandDeath Men ExerciseandDeath Women WhatistheBestWaytoIncreasePhysicalActivity Monitoredrehab Personaltraining Casemanagement Doctor sAdvice Guidance PhysicalTherapy CommunityResources SupportGroups RecreationCenterMemberships ComprehensiveRiskFactorModificationKaiserPermanenteColoradoCardiacRehabilitationModelofIntegratedDeliveryofHealthCare MI ACS PCI CABGCaseManagerMonitoredCRCEPCPCRSDieticianCardiologistPCPOtherResources ClinicalExercisePhysiologistRoleKaiserPermanenteColoradoCardiacRehabilitationModelofIntegratedDeliveryofHealthCare ClinicalExercisePhysiologistExerciseRx Consult One on One MonitoredSub MaxExerciseTestingROM FlexibilityEvaluationStrengthEvaluationBehaviorChangeCounselingMonitoredRehabCardiologistPCPOtherResources FunctionalExercises Whatisafunctionalexercise Exercisethatisspecifictoandcloselymimicstasktobecompleted Walkinglungebettertostrengthenmusclestoassistinincreasingefficiencyofwalking runningthanlegextensions INDIVIDUALIZE Eachpatientisadelicatesnowflake Makesuretogetdetailedhistoryofdisease co morbidities checkthatriskfactorsareincontrol priorexercisehistory checkforcurrentsymptomsandreviewsupportteamandresourcesforexercise WhatistheRiskofExercise ExercisePrescriptionTips CardiovascularMedications HRandBP Symptoms CAD CHF PAD F I T PrincipleConsiderationsImportanceofWarmUpandCoolDownDonotholdyourbreath Whencantheystart AssumingPatientisMedicallyStable Allpatientsshouldstartwithslowprogressionofwalking stationarybike etc PCIwithoutMI exercisetestingandmoremoderateexerciseafterabout4weeksofconsistentlowintensityaerobicexercise MIwithorwithoutPCI exercisetestingandmoremoderateexerciseafterabout4 6weeksofconsistentlowintensityaerobicexercise CABG exercisetestingandmoremoderateaerobicexerciseabout4weekspostsurgery moderatestrengthtrainingabout12weekspostsurgery CHF Asymptomaticpatientsincreaseaerobicexerciseveryconservativelyascantolerate ifEFisbelow30 strengthtrainingmaybecontraindicated ExercisePrescriptionTipsPeripheralVascularDisease ClaudicationWalkingisamust Specificity2MostImportantMeasures1 Onsetofsymptoms2 MaximumwalktimeIntermittentWalkingtoModeratePainHighRiskofHeartDisease CAD AddothermodesofaerobicexercisetoincreasetotalconditioningtimeRoleofStrengthTraining Non ClaudicantCanprescribeexerciselikepeoplewithheartdisease orathighriskforheartdisease ClaudicationandStrengthTraining HiattWR etal PeripheralArterialandAorticDiseases SuperiorityofTreadmillWalkingExerciseVersusStrengthTrainingforPatientswithPeripheralArterialDisease ImplicationsfortheMechanismoftheTrainingResponse Circulation 90 4 October1994 1866 1874 ExercisePrescriptionTipsLungDisease PerceivedExertionvs ShortnessofBreathReliabilityofHR AerobicWalking Partofmostactivitiesofdailyliving StationaryBikeArmErgometerImportanceofStrengthConditioning1 Improveefficiencyofmuscles conservationofenergy ExercisePrescriptionTipsDiabetes MonitorBloodSugarBeforeandAfter 250withKetones 100 PostExerciseHypoglycemiaMealsandMedicationsAutonomicNeuropothyandHRPeripheralNeuropothyandWoundCare ExercisePrescriptionTipsDiabetes AutonomicNeuropathySilentischemiaandinfarction tachycardiaatrestandearlyinexercise reducedmaxHR exerciseintolerance exerciseinducedhypotension thermoregulatorydysfunction pronetodehydrationandhypoglycemiaunawareness PeripheralNeuropathyLossofperipheralsensation poorhealingofwounds overstretchingcancausemusculoskeletalinjury lossofbalance falling ExercisePrescriptionTipsDiabetes AerobicFrequency3 7daysperweekIntensity40 60 Moderate 60 VigorousTime 150minutes weekmoderate 90minutes weekvigorousResistanceTrainingFrequency 3daysperweekIntensity8 10repetitionsVolumeofExercise 8exercisesUpto3setsperexercise AerobicExerciseModesChooseexercisessuchasstationarybikeandelipticaltrainers helpwithbalance lesschanceoffallingWalkingalsoagoodchoiceasinvolvedinmostactivitiesofdailyliving specificityResistanceTrainingModesMachineweightsarepreferredatstartsincetheycanhelpwithbalance ExercisePrescriptionTipsMultipleSclerosis AerobicExercise1 PerceptualScalebetterforExerciseIntensity2 Adjustdailyaccordingtosymptomsandenergylevels3 Avoidexerciseinheat exerciseearlyindaybetterforsymptomsoffatigue4 BladderissuescancausepatientstonothydrateproperlyStrengthTraining1 Optimizeinunaffectedmusclegroups2 Functionalexercisesbest Emphasizecoregroups3 Increaserestperiodtime4 Duringtimesincreasedsymptoms focusstretching ROM5 Weightmachinespreferred ExercisePrescriptionTipsParkinson sDisease AerobicSafety walkingispreferred butmayneedtousebikeergometer eliptical armergometerorothersifsymptomswarrant Balancedevices harness walkingpolesStrengthWarmupimportantFocusonexercisesthatextendthetrunkFunctionalexercisesbestAuditorycuesmaybeneededtohelpwithtimingofrepetitionsEnsuregoodposture ExercisePrescriptionTipsOsteoarthritis WeightBearing AerobicExerciseContinuousweightbearingaerobicexercisecanbedifficultCarefulwiththosewhohavesevereosteoporosisWaterWalkingagainstcurrentmaybeagoodoptionExercisestoimprovebalanceMinimizeforwardflexionandtwistingmovementsCanstartwithstrengthtrainingCandocombinationofshortboutsofaerobictrainingwithstrengthtrainingdoneduringrestperiods ExercisePrescriptionTipsRheumatoidArthritis CanfollowsamebasicguidelinesaswithosteoarthritisAvoidexerciseduring inflamatoryphase ExercisePrescriptionTipsFibromyalgia MustcustomizetoindividualCarefultoavoidoverexertionProgressslowly watertolandwalking ExercisePrescriptionTipsObesity WalkingimportantasisinvolvedinmostaspectsofactivitiesofdailylivingIfbalanceisanissuethenstationarybikesandelipticaltrainersaregoodoptionWaterwalkingandwateraerobicsidealforthosewithproblematicjointsWatchcarefullyforsignsofcardiopulmonaryandmetabolicdisease ExercisePrescriptionTipsObesity StrengthTrainingMachineweightsmayhelpwithbalanceandhelptoensureproperformLightweightsrecommendedwithmoderatetohighrepetitionsMaybebestoptiontoconcentrateonearlyasde conditioningandjointissuemaylimitabilitytoperformaerobicexerciseatonsetofnewprogram ExercisePrescriptionTipsAIDS HIVExerciseRxmustbeadaptedperstageofdiseaseAsymptomatic usualgeneralACSMguidelinesarefineSymptomatic needtoadjustdaytoday shouldnotexercisewithfeverabove100 orifhavingnausea vomiting uncontrolleddiarrheaordehydration ExercisePrescriptionTipsAIDS Moderatebetter overtrainingincreaseslikelihoodofinfectionsEnvironmentAbrasions tissueinjuriesCrossinfection sharingofwaterbottlesOverseastravel ExercisePrescriptionTipsAIDS ExerciseandSicknessCommoncoldMildtomoderateexerciseOKIntenseexerciseOKafewdaysaftersymptomsresolveFever extremefatigue muscleaches besttowait2 4weeksbeforeresumingintenseexercise ExerciseandDialysis EffectsofKidneyDiseaseandLongTermDialysisbonedisease fatigue coronaryarterydiseaseandrhythmdisturbances ExerciseandDialysis Becauseofthereductionincardiovascularriskfactorsthatresultsfromexercisetraining andbecauseoftheneedtopreventprogressivedeconditioning dialysispatientsmayactuallybeplacedatagreaterriskforcardiaceventsandadversemusculoskeletaloutcomesinthearenotparticipatinginregularphysicalactivity AdvRenReplTher Vol6 No2 1999 pp165 171 Exercisea