從振興醫院經驗淺談心臟復健

振興醫院心臟醫學中心物理治療長黃心怡

100/04/24

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What is cardiac rehabilitation? 

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A supervised program of progressive exercise, psychological support, and education or training to enable a patient who has had a myocardial infarction to resume the activities of daily living on an independent basis. Special training may be needed to adapt the patient to a new occupation and lifestyle.

Target Populations

Post‐myocardium infarction(MI)coronary artery bypass graft(CABG)PercutaneousTransluminal Coronary Angioplasty (PTCA)Stable angina

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Target Populations

Compensated heart failureControlled dysrhythmiasAICD/pacemakerPost‐valve replacementCardiomyopathyMyocardial aneurysm resectionPre‐ and post‐heart transplantCongenital heart defects

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Target Populations

StrokePeripheral vascular disease Hypertension(HTN)Diabetes(DM) and etc.

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Team Members

12

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45

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Physician Physical Therapist

Nutritionist 

Pharmacist  Psychologist 

Others  Cardiac Rehabilitation

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Physical therapy

Musculoskeletal system managementMuscle spam, Back pain, Spinal dysfunction, and etc.

Functional training Occupation therapy, recreational training, and etc.

Education and consultationExercise behavior change, exercise injury prevention, and etc.

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Nutritionist

Nutritional supplement 營養食品, 配方等

Individual diet planDietary diary, 飲食份量等

Education and consultationDASH 飲食

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Psychological component 

Stress managementRelaxation

Psychotherapy 

Education and consultation

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Education classes

• Smoking Cessation• Medication Usage • Risk Factors Modification

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Phases of cardiac rehabilitation

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Phase I cardiac rehabilitation

• Pre‐operation preparation• CCU stage• Step down stage• Discharge preparation

Phase I cardiac rehabilitation

• Pre‐operation preparation– History – Risk factor– Heart function – Lung function– Musculoskeletal system – Neurological system– Occupation/ADL– Other disease

Phase I cardiac rehabilitation

• CCU stage– lung injury after GA and ventilator 

– prevent deconditioning– prevent complication– early upright – early mobilization

Phase I cardiac rehabilitation

• Step down stage– Maximize ADL function – Early ambulation– Wound care– Correct posture– Musculoskeletal dysfunction– Neurological dysfunction

Phase I cardiac rehabilitation

• Discharge preparation– Energy consumption– Advanced ADL function– Early aerobic training– Self monitor and self record

Phase II cardiac rehabilitation

• Chart review• Individualized evaluation• Functional capacity assessment

– Exercise pulmonary function test– 6‐min walking test

Phase II cardiac rehabilitation

• Aerobic vs. Anaerobic training 

• Risk factor reduction• Musculoskeletal system dysfunction

• Functional activity training / energy consumption

• Return to work preparation

• Education

Phase II cardiac rehabilitation

• Nutritional consult– Coumadin– 健康食品、配方奶粉

• Psychological support – Emotional control – Relaxation technique

• Pharmacy consult• Smoking quick cession

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Phase III cardiac rehabilitation

• Continued aerobic training

• Advanced weight training

• Combined with other leisure activity

• Occupational consultant

• Social support• Psychological support 

Phase III cardiac rehabilitation

99.04 得舒飲食餐會

99.08 病友運動會

99.05 打開心裡那扇窗

99.06 戶外休閒活動守則

從振興醫院經驗淺談心臟復健What is cardiac rehabilitation? Target PopulationsTarget PopulationsTarget PopulationsTeam MembersPhysical therapyNutritionistPsychological component Education classesPhases of cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase I cardiac rehabilitationPhase II cardiac rehabilitationPhase II cardiac rehabilitationPhase II cardiac rehabilitationPhase III cardiac rehabilitationPhase III cardiac rehabilitation

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