锻炼和慢性病课件.ppt

1、 Cardiovascular disease Heart Attack,Stroke,PAD Pulmonary disease Asthma,COPD,Emphysema Diabetes Neuropathies,CAD Neuromuscular disorders Multiple Sclerosis,Parkinsons Musculoskeletal conditions Arthritis Cancer Breast,Prostate,Leukemia Renal disease Kidney Failure,CAD Immunological AIDS Obesity All

2、 of the above?Cardiovascular disease 79 million(2007 CDC Website)Pulmonary disease 35 million(2007 American Lung Association),Diabetes 14.6 Million(2005 CDC Website)Neuromuscular disorders(MS,2.5 million national ms society/Parkinsons 1.5 million+,National Parkinson Foundation)Musculoskeletal condit

3、ions(Rheumatoid 2.1 million,osteo 21 million,juvenile 300,000,national arthritis foundation)Obesity 99 Million(Based off CDC and Census Bureau Sites)Cancer 10.1 Million 2002(American Cancer Society Website)Renal disease 20+million(American Kidney Fund)Immunological(AIDS 36.1 Million AIDS.orgIncrease

4、d VO2Improved BP ControlIncreased HDLDecreased Body FatImproved Weight ControlImproved BS ControlImproved StrengthLess FatigueImproved BalanceHeart DiseaseLung DiseaseDiabetesNeuromuscularMusculoskeletalObesityCancerKidney DiseaseAIDs Me!In an Ideal World Clinical Exercise Physiologists Physical The

5、rapists Respiratory Therapists Registered Nurses Physicians Personal Trainers Massage Therapists Accupuncture ChiropractorsThe Registered Clinical Exercise Physiologist is an allied health professional who works with apparently healthy people and patients with chronic diseases and conditions where e

6、xercise has been proven to provide therapeutic benefit.The RCEP performs exercise assessments and prescribes exercise and physical activity,primarily in hospitals,clinics or other health-care provider settings.The RCEP assists individuals in developing self-management skills to promote good health.T

7、he RCEP is an integral part of the health care team and works closely with other health professionals including:Physicians,Nurses,Nurse Practitioners,Physician Assistants,Respiratory Therapists,Physical Therapists and Registered Dietitians.RCEPs are trained to work with patients with chronic disease

8、s such as:Cardiovascular disease,pulmonary disease,diabetes,neuromuscular disorders,musculoskeletal conditions,obesity,cancer,end stage renal disease,neoplastic/immunological/hematological disordersPhysical therapy,which is limited to the care and services provided by or under the direction and supe

9、rvision of a physical therapist,includes:1.Examining(history,system review and tests and measures)individuals with impairment,functional limitation,and disability or other health-related conditions in order to determine a diagnosis,prognosis,and intervention;tests and measures may include the follow

10、ing:Aerobic capacity/endurance,anthropometric characteristics,arousal,attention,and cognition,assistive and adaptive devices,circulation(arterial,venous,lymphatic),cranial and peripheral nerve integrity,environmental,home,and work(job/school/play)barriers,ergonomics and body mechanics,gait,locomotio

11、n,and balance,integumentary integrity,joint integrity and mobility,motor function(motor control and motor learning),muscle performance(including strength,power,and endurance),neuromotor development and sensory integration,orthotic,protective,and supportive devices,pain,posture,prosthetic requirement

12、s,range of motion(including muscle length),reflex integrity,self-care and home management(including activities of daily living and instrumental activities of daily living),sensory integrity,ventilation,and respiration/gas exchange,work(job/school/play),community,leisure integration or reintegration(

13、including instrumental activities of daily living)2.Alleviating impairment and functional limitation by designing,implementing,and modifying therapeutic interventions that include,but are not limited toCoordination,communication and documentation,patient/client-related instruction,therapeutic exerci

14、se,functional training in self-care and home management (including activities of daily living and instrumental activities of daily living),functional training in work(job/school/play)and community and leisure integration or reintegration activities (including instrumental activities of daily living,

15、work hardening,and work conditioning),manual therapy techniques(including mobilization/manipulation)prescription,application,and,as appropriate,fabrication of devices and equipment(assistive,adaptive,orthotic,protective,supportive,and prosthetic),airwayclearance techniques,integumentary repair and p

16、rotection techniques,electrotherapeutic modalities,physical agents and mechanical modalities3.Preventing injury,impairment,functional limitation,and disability,including the promotion and maintenance of health,wellness,fitness,and quality of life in all age populations4.Engaging in consultation,educ

17、ation,and researchMonitored rehab?Personal training?Case management?Doctors Advice/Guidance?Physical Therapy?Community Resources?Support Groups?Recreation Center Memberships?MI/ACS/PCI/CABGCase ManagerMonitored CRCEPCPCRS Dietician Cardiologist PCP Other ResourcesClinical Exercise PhysiologistExerci

18、se Rx/Consult(One-on-One)Monitored Sub-Max Exercise TestingROM/Flexibility EvaluationStrength EvaluationBehavior Change CounselingMonitored Rehab Cardiologist PCP Other Resources What is a functional exercise?Exercise that is specific to and closely mimics task to be completed.Walking lunge better t

19、o strengthen muscles to assist in increasing efficiency of walking/running than leg extensions.Each patient is a delicate snowflake!Make sure to get detailed history of disease,co-morbidities,check that risk factors are in control,prior exercise history,check for current symptoms and review support

20、team and resources for exerciseCardiovascularMedications(HR and BP)Symptoms(CAD,CHF,PAD)F.I.T.Principle ConsiderationsImportance of Warm Up and Cool DownDo not hold your breath!Assuming Patient is Medically Stable:*All patients should start with slow progression of walking,stationary bike,etc.PCI wi

21、thout MI exercise testing and more moderate exercise after about 4 weeks of consistent low intensity aerobic exercise.MI with or without PCI exercise testing and more moderate exercise after about 4-6 weeks of consistent low intensity aerobic exercise.CABG exercise testing and more moderate aerobic

22、exercise about 4 weeks post surgery,moderate strength training about 12 weeks post surgery.CHF Asymptomatic patients increase aerobic exercise very conservatively as can tolerate,if EF is below 30%strength training may be contraindicated.ClaudicationWalking is a must Specificity2 Most Important Meas

23、ures1.Onset of symptoms2.Maximum walk timeIntermittent Walking to Moderate PainHigh Risk of Heart Disease(CAD)Add other modes of aerobic exercise to increase total conditioning time Role of Strength Training Non-ClaudicantCan prescribe exercise like people with heart disease/or at high risk for hear

24、t diseaseHiatt WR,et al,Peripheral Arterial and Aortic Diseases:Superiority of Treadmill Walking Exercise Versus Strength Training for Patients with Peripheral Arterial Disease:Implications for the Mechanism of the Training Response.Circulation;90(4);October 1994;1866-1874Perceived Exertion vs.Short

25、ness of BreathReliability of HR?Aerobic1.Walking Part of most activities of daily living.2.Stationary Bike3.Arm ErgometerImportance of Strength Conditioning1.Improve efficiency of muscles/conservation of energyMonitor Blood Sugar Before and After*250 with Ketones,60%VigorousTime 150 minutes/week mod

26、erate 90 minutes/week vigorousResistance Training Frequency 3 days per weekIntensity8-10 repetitionsVolume of Exercise 8 exercisesUp to 3 sets per exerciseAerobic Exercise ModesChoose exercises such as stationary bike and eliptical trainers-help with balance-less chance of fallingWalking also a good

27、 choice as involved in most activities of daily living specificityResistance Training ModesMachine weights are preferred at start since they can help with balanceAerobic Exercise1.Perceptual Scale better for Exercise Intensity2.Adjust daily according to symptoms and energy levels3.Avoid exercise in

28、heat,exercise early in day better for symptoms of fatigue4.Bladder issues can cause patients to not hydrate properlyStrength Training1.Optimize in unaffected muscle groups2.Functional exercises best,Emphasize core groups3.Increase rest period time4.During times increased symptoms focus stretching,RO

29、M5.Weight machines preferred.Aerobic Safety walking is preferred,but may need to use bike ergometer,eliptical,arm ergometer or others if symptoms warrant.Balance devices harness,walking polesStrength Warm up important Focus on exercises that extend the trunk Functional exercises best Auditory cues m

30、ay be needed to help with timing of repetitions Ensure good posture“Weight Bearing”Aerobic ExerciseContinuous weight bearing aerobic exercise can be difficultCareful with those who have severe osteoporosisWater Walking against current may be a good optionExercises to improve balanceMinimize forward

31、flexion and twisting movementsCan start with strength trainingCan do combination of short bouts of aerobic training with strength training done during rest periods.Can follow same basic guidelines as with osteoarthritisAvoid exercise during“inflamatory phase”Must customize to individualCareful to av

32、oid overexertionProgress slowly(water to land walking)*Walking important as is involved in most aspects of activities of daily livingIf balance is an issue then stationary bikes and eliptical trainers are good optionWater walking and water aerobics ideal for those with problematic jointsWatch carefu

33、lly for signs of cardiopulmonary and metabolic disease.Strength TrainingMachine weights may help with balance and help to ensure proper formLight weights recommended with moderate to high repetitionsMay be best option to concentrate on early as de-conditioning and joint issue may limit ability to pe

34、rform aerobic exercise at onset of new programHIV Exercise Rx must be adapted per stage of disease Asymptomatic usual general ACSM guidelines are fine Symptomatic need to adjust day to day,should not exercise with fever above 100,or if having nausea,vomiting,uncontrolled diarrhea or dehydrationModer

35、ate better,overtraining increases likelihood of infectionsEnvironment Abrasions,tissue injuries Cross infection,sharing of water bottles Overseas travel Exercise and Sickness Common cold Mild to moderate exercise OK Intense exercise OK a few days after symptoms resolve Fever,extreme fatigue,muscle a

36、ches best to wait 2-4 weeks before resuming intense exerciseEffects of Kidney Disease and Long Term Dialysis bone disease,fatigue,coronary artery disease and rhythm disturbances“Because of the reduction in cardiovascular risk factors that results from exercise training,and because of the need to pre

37、vent progressive deconditioning,dialysis patients may actually be placed at a greater risk for cardiac events and adverse musculoskeletal outcomes in the are not participating in regular physical activity”Adv Ren Repl Ther,Vol 6,No 2,1999:pp 165-171Exercise Tips Breathing is at conversational level

38、Feel complete recovery in one hour post exericse Warm up and cool down essential Expect some mild soreness after exercise but not so much that it prevents activity.When Not to Exercise Body temperature 101.0 degrees(38.3 degrees C)Missed more than one treatment Newly undiagnosed illness Pain Not fee

39、ling well Blood Pressure 200/100 Unstable sugar levels1.Follow the advice of Barbara Francis2.Be consistent3.Have Sean Swarmer take you for a little hike in NepalACSMs Guidelines for Exercise Testing and Prescription,7th EditionManual of Exercise Testing,3rd Edition Froelicher and MyersACSMs Exercis

40、e Management for Persons with Chronic Diseases and Disabilities,2nd Edition Durstine and MooreACSMs Resource Manual for Guidelines for Exercise Testing and Prescription,5th EditionExercise and the Heart,4th Edition,Froelicher and MyersCardiac Rehabilitation,Adult Fitness,and Exercise Testing,3rd Edi

41、tion Fardy and YanowitzNSCAs Essentials of Strength Training and ConditioningClinical Exercise Physiology Application and Physiological Principles LeMura and Von DuvillardACSMs Resources for Clinical Exercise PhysiologyThe American Physical Therapy Association Book of Body Maintenance and Repair Moffat and VickeryExercise Physiology Human Bioenergetics and Its Applications,2nd Edition Brooks,Fahey and WhiteGood Ol Fashioned Experience since 1989