医院-家庭过渡期运动干预对高龄心血管病患者功能性体适能的影响
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摘要
目的探讨医院-家庭过渡期运动干预对高龄心血管病患者功能性体适能的影响。方法采用临床对照、单盲试验,2013年12月至2014年2月入院符合标准的40例患者为对照组,2014年3~5月入院符合标准的37例患者为干预组。对照组在出院前1日给予常规出院宣教。干预组接受为期12周的过渡期运动训练和随访干预。患者在入组时和出院后12周分别测量功能性体适能指标。对完成随访、资料完整的61例患者(对照组29例,干预组32例)的数据进行分析。结果两组患者各项功能性体适能指标的主效应(组别效应)无统计学意义(P>0.05),但是下肢肌力、上肢肌力、有氧耐力、灵活性/平衡性指标存在组别和时间的交互效应(组别×时间效应),差异有统计学意义(P<0.05),干预组较对照组改善明显。结论过渡期运动干预能够改善高龄老年心血管病患者的功能性体适能。
Objective To evaluate the effect of exercise-based transitional care on functional fitness in older adults with cardiovascular diseases. Methods This study was a controlled,single-blinded clinical trial. Forty patients with cardiovascular diseases in the control group accepted routine nursing care before and after discharge,while 37 patients in the experimental group received a 12-week exercise-based transitional care program. All patients were assessed using Senior Fitness Test(SFT) at baseline and 12 weeks after discharge. Totally 61 cases(29 cases in the control group and 32 cases in the experimental group) completed the trial. Results No significant group main effect was found in each index of fitness(P>0.05),while there were significant time-group interaction effects in the lower limb strength,upper limb strengthen,aerobic endurance,and agility/dynamic balance(P <0.05),demonstrating significant improvement in the experimental group than that of the control group. Conclusion The exercise-based transitional care is useful to improve functional fitness of older adults with cardiovascular diseases.
Objective To evaluate the effect of exercise-based transitional care on functional fitness in older adults with cardiovascular diseases. Methods This study was a controlled,single-blinded clinical trial. Forty patients with cardiovascular diseases in the control group accepted routine nursing care before and after discharge,while 37 patients in the experimental group received a 12-week exercise-based transitional care program. All patients were assessed using Senior Fitness Test(SFT) at baseline and 12 weeks after discharge. Totally 61 cases(29 cases in the control group and 32 cases in the experimental group) completed the trial. Results No significant group main effect was found in each index of fitness(P>0.05),while there were significant time-group interaction effects in the lower limb strength,upper limb strengthen,aerobic endurance,and agility/dynamic balance(P <0.05),demonstrating significant improvement in the experimental group than that of the control group. Conclusion The exercise-based transitional care is useful to improve functional fitness of older adults with cardiovascular diseases.
引文
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[26]Scalvini S,Zanelli E,Comini L,et al.Home-based versus inhospital cardiac rehabilitation after cardiac surgery:a nonrandomized controlled study[J].Phys Ther,2013,93(8):1073-1083.
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[29]严华,符春晖,邹恩飞,等.步行训练对老年慢性心力衰竭患者心脏功能康复的影响[J].心血管康复医学杂志,2010,19(5):456-459.
[30]周艳,杨宇,邓景贵,等.康复运动治疗老年慢性心力衰竭患者的有效性和安全性研究[J].激光生物学报,2013,22(1):74-78.
[31]Brovold T,Skelton DA,Bergland A.Older adults recently discharged from the hospital:effect of aerobic interval exercise on health-related quality of life,physical fitness,and physical activity[J].J Am Geriatr Soc,2013,61(9):1580-1585.
[32]de Vries NM,van Ravensberg CD,Hobbelen JS,et al.Effects of physical exercise therapy on mobility,physical functioning,physical activity and quality of life in community-dwelling older adults with impaired mobility,physical disability and/or multi-morbidity:a meta-analysis[J].Ageing Res Rev,2012,11(1):136-149.
[33]Naylor MD,Sochalski JA.Scaling up:bringing the transitional care model into the mainstream[J].Issue brief(Commonwealth Fund),2010,103:1-12.
[34]Naylor MD,Feldman PH,Keating S,et al.Translating research into practice:transitional care for older adults[J].J Eval Clin Pract,2009,15(6):1164-1170.
[35]王波,苗茂华,王辉清,等.社区中老年男性体力活动及影响因素分析[J].中国公共卫生,2013,29(9):1343-1346.
[2]Wolinsky FD,Bentler SE,Hockenberry J,et al.Long-term declines in ADLs,IADLs,and mobility among older Medicare beneficiaries[J].BMC Geriatr,2011,11:43.
[3]Kripalani S,Jackson AT,Schnipper JL,et al.Promoting effective transitions of care at hospital discharge:a review of key issues for hospitalists[J].J Hosp Med,2007,2(5):314-323.
[4]Boyd CM,Landefeld CS,Counsell SR,et al.Recovery of activities of daily living in older adults after hospitalization for acute medical illness[J].J Am Geriatr Soc,2008,56(12):2171-2179.
[5]Kortebein P.Rehabilitation for hospital-associated deconditioning[J].Am J Phys Med Rehab,2009,88(1):66-77.
[6]Haines TP,Russell T,Brauer SG,et al.Effectiveness of a videobased exercise programme to reduce falls and improve healthrelated quality of life among older adults discharged from hospital:a pilot randomized controlled trial[J].Clin Rehabil,2009,23(11):973-985.
[7]Hill AM,Hoffmann T,Mc Phail S,et al.Factors associated with older patients'engagement in exercise after hospital discharge[J].Arch Phys Med Rehabil,2011,92(9):1395-1403.
[8]Kortebein P,Ferrando A,Lombeida J,et al.Effect of 10 days of bed rest on skeletal muscle in healthy older adults[J].JAMA,2007,297(16):1772-1774.
[9]Office of disease prevention&health promotion,US department of health and human services.2008 physical activity guidelines for Americans[EB/OL].(2008-10)[2013-11-04].Available from:www.health.gov/paguidelines.
[10]Vanhees L,Geladas N,Hansen D,et al.Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors:recommendations from the EACPR(Part II)[J].Eur J Prev Cardiol,2012,19(5):1005-1033.
[11]Rikli RE,Jones CJ.Development and validation of criterionreferenced clinically relevant fitness standards for maintaining physical independence in later years[J].The Gerontologist,2013,53(2):255-267.
[12]Mezzani A,Hamm LF,Jones AM,et al.Aerobic exercise intensity assessment and prescription in cardiac rehabilitation:a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation,the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation[J].Eur J Prev Cardiol,2013,20(3):442-467.
[13]美国心肺康复协会.美国心脏康复和二级预防项目指南(第4版)[M].王增武,译.北京:人民军医出版社,2010:72.
[14]Achttien RJ,Staal JB,van der Voort S,et al.Exercise-based cardiac rehabilitation in patients with coronary heart disease:a practice guideline[J].Neth Heart J,2013,21(10):429-438.
[15]Yancy CW,Jessup M,Bozkurt B,et al.2013 ACCF/AHA guideline for the management of heart failure:executive summary:a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines[J].Circulation,2013,128(16):1810-1852.
[16]O'Gara PT,Kushner FG,Ascheim DD,et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction:a report of the American college of cardiology foundation/American heart association task force on practice guidelines[J].JACC,2013,61(4):e78-e140.
[17]Jneid H,Anderson JL,Wright RS,et al.2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction(updating the 2007 guideline and replacing the 2011focused update):a report of the American college of cardiology foundation/American heart association task force on practice guidelines[J].JACC,2012,60(7):645-681.
[18]伍绍祖.中华体育健身方法[M].天津:天津科学技术出版社,1997:120-160.
[19]Rikli RE,Jones CJ.Senior fitness test manual(2nd edition.)[M].America:Human Kinetics Publishers,2012:42-123.
[20]Rikli RE,Jones CJ.Development and validation of criterionreferenced clinically relevant fitness standards for maintaining physical independence in later years[J].The Gerontologist,2013,53(2):255-267.
[21]郑彩娥,李秀云.实用康复护理学[M].北京:人民卫生出版社,2012:50.
[22]Hirsch CH,Sommers L,Olsen A,et al.The natural history of functional morbidity in hospitalized older patients[J].J Am Geriatr Soc,1990,38(12):1296-1303.
[23]Sager MA,Franke T,Inouye SK,et al.Functional outcomes of acute medi cal illness and hospitalization in older persons[J].Arch Intern Med,1996,156(6):645-652.
[24]Covinsky KE,Justice AC,Rosenthal GE,et al.Measuring prognosis and case mix in hospitalized elders-The importance of functional status[J].J Gen Intern Med,1997,12(4):203-208.
[25]Alexander KP,Newby LK,Cannon CP,et al.Acute coronary care in the elderly,part I:Non-ST-segment-elevation acute coronary syndromes:a scientific statement for healthcare professionals from the American Heart Association Council on Clinical Cardiology:in collaboration with the Society of Geriatric Cardiology[J].Circulation,2007,115(19):2549-2569.
[26]Scalvini S,Zanelli E,Comini L,et al.Home-based versus inhospital cardiac rehabilitation after cardiac surgery:a nonrandomized controlled study[J].Phys Ther,2013,93(8):1073-1083.
[27]Mutwalli HA,Fallows SJ,Arnous AA,et al.Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program[J].Saudi Med J,2012,33(2):152-159.
[28]Jolly K,Taylor R,Lip GY,et al.The Birmingham Rehabilitation Uptake Maximization Study(BRUM).Home-based compared with hospital-based cardiac rehabilitation in a multiethnic population:cost-effectiveness and patient adherence[J].Health technology assessment(Winchester,England),2007,11(35):1-118.
[29]严华,符春晖,邹恩飞,等.步行训练对老年慢性心力衰竭患者心脏功能康复的影响[J].心血管康复医学杂志,2010,19(5):456-459.
[30]周艳,杨宇,邓景贵,等.康复运动治疗老年慢性心力衰竭患者的有效性和安全性研究[J].激光生物学报,2013,22(1):74-78.
[31]Brovold T,Skelton DA,Bergland A.Older adults recently discharged from the hospital:effect of aerobic interval exercise on health-related quality of life,physical fitness,and physical activity[J].J Am Geriatr Soc,2013,61(9):1580-1585.
[32]de Vries NM,van Ravensberg CD,Hobbelen JS,et al.Effects of physical exercise therapy on mobility,physical functioning,physical activity and quality of life in community-dwelling older adults with impaired mobility,physical disability and/or multi-morbidity:a meta-analysis[J].Ageing Res Rev,2012,11(1):136-149.
[33]Naylor MD,Sochalski JA.Scaling up:bringing the transitional care model into the mainstream[J].Issue brief(Commonwealth Fund),2010,103:1-12.
[34]Naylor MD,Feldman PH,Keating S,et al.Translating research into practice:transitional care for older adults[J].J Eval Clin Pract,2009,15(6):1164-1170.
[35]王波,苗茂华,王辉清,等.社区中老年男性体力活动及影响因素分析[J].中国公共卫生,2013,29(9):1343-1346.