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各位朋友，大家好，現在是“每天健康三分鐘”時間，我是道簡-心血管康復醫生集團的醫生郭振浩。今天由我來給大家講講心臟康復五大處方之運動處方。
心臟康復是指以醫學整體評估為基礎，通過五大核心處方（藥物處方、運動處方、營養處方、心理處方、戒菸處方)的聯合干預，為心臟病患者在急性期、恢復期、維持期以及整個生命過程中提供的生理、心理和社會的全面及全程管理服務和關愛”。
完整的心臟康復包括了體能康復、心理康復、職業康復、適應社會及二級預防等。
據調查顯示，超過八成的心臟病患者都不瞭解心臟康復的重要性，只有兩成的醫生會指導患者進行心臟康復。另據同期調查的報告顯示只有少數醫院能提高心臟康復服務，但質量也不理想，每個人心臟負荷能力都不一樣，所以一定要在正規醫院或康復治療師的評估指導下進行康復運動訓練。
一、為什麼要進行心臟康復：
1.加快疾病恢復 2.減少復發幾率 3.提高生活質量 4. 減輕醫療負擔
二、影響心臟康復的因素：
1 .心臟受損的程度 2. 個人的恢復能力 3 .以前是否進行過心臟手術 4 .患者其他的合併症情況 5.外部條件 ，包括醫生經驗、設備、環境等。
三、心臟康復內容：
包括康復評估、心肺運動負荷試驗、心臟危險因素管理 、營養諮詢與指導、心理諮詢與指導。
四、體力活動諮詢和心肺儲備功能指導下運動訓練
1．住院康復期 。術後一月內保持心情舒暢愉快，保證睡眠，適當休息，避免乾重活，如恢復良好，可在醫生或康復師的指導下進行一些簡單的活動，如掃地，散步等，早期康復治療介入，如氣壓治療，呼吸功能訓練等。這時的鍛鍊必須要嚴密檢測，根據醫生的建議和心血管數據的變化調整鍛鍊量。
2.出院後院外康復期，鞏固第二期的康復治療效果，逐步恢復發病前的生活和工作狀態，但原則上不建議繼續維持之前的生活和工作強度，應降低體力活動的程度。在身體沒有不適感的前提下，進行快走，慢跑，騎自行車等輕型體育訓練
五、哪些患者不宜做運動訓練
1．不穩定性心絞痛 2．剛做完臨床治療，病情還沒穩定的患者3．不穩定的嚴重心律失常4．嚴重的未控制的高血壓和低血壓5．未控制的心力衰竭和急性心功能障礙 6．未受過專業醫生或康復治療師指導的患者
六、心臟運動康復禁忌症
1、不穩定性心絞痛、急性心肌梗死後病情不穩定、心力衰竭沒有控制、嚴重房性或室性心律失常（沒控制的房顫、室上性心動過速，多源、頻發性室早）
2確診或疑似的假動脈瘤。動脈夾層術前、感染性休克及膿毒血癥。重度瓣膜病變手術前或心肌性心臟病心衰急性期、臨床醫生認為運動可導致的惡化的神經系統、運動系統疾病或風溼性疾病
最後祝大家生活愉快，身體健康！想了解更多心血管科普小知識，請關注我們，咱們下期見。
【英文版】
Exercise prescription of five prescriptions for cardiac rehabilitation
Dear friends, nice to meet you!Now it is time for “health talk for three minutes every day”,My name is Guo Zhenhao, a doctor of Daojian Doctor Group of Cardiovascular Rehabilitation.Today, I'd like to talk about the exercise prescription of the five major prescriptions for cardiac rehabilitation.
Cardiac rehabilitation refers to the comprehensive and whole process management service and care provided by five core prescriptions (drug prescription, exercise prescription, nutrition prescription, psychological prescription and smoking cessation prescription) for patients with heart disease in acute stage, recovery period, maintenance period and the whole life process.
Complete cardiac rehabilitation includes physical rehabilitation, psychological rehabilitation, occupational rehabilitation, social adaptation and secondary prevention.
According to the survey, more than 80% of patients with heart disease do not understand the importance of cardiac rehabilitation, only 20% of doctors will guide patients to carry out cardiac rehabilitation. According to the report of the same period, only a few hospitals can provide cardiac rehabilitation services,but the quality is not ideal. Everyone's cardiac load capacity is different, so rehabilitation exercise training must be carried out under the guidance of regular hospitals or rehabilitation therapists.
Why do patients need cardiac rehabilitation.
1. Accelerate disease recovery.
2. Reduce the recurrence rate.
3. Improve the quality of life.
4. Reduce medical burden.
Factors affecting cardiac rehabilitation.
1. The degree of heart damage.
2. Individual resilience.
3. Have you ever had heart surgery before.
4. Other complications.
5. External conditions, including doctor's experience, equipment, environment, etc.
Contents of cardiac rehabilitation.
The contents of cardiac rehabilitation include rehabilitation assessment, cardiopulmonary exercise load test, management of cardiac risk factors, nutritional counseling and guidance, psychological counseling and guidance.
Exercise training under the guidance of physical activity consultation and cardiopulmonary reserve function
1. Convalescence in hospital.
During the first month after the operation, keep a good mood, sleep, rest properly and avoid heavy work. If the patient recovers well, some simple activities, such as sweeping the floor and walking, and early rehabilitation intervention, such as air pressure treatment and respiratory function training, can be carried out under the guidance of doctors or rehabilitation specialists.At this time, exercise must be closely monitored,and the amount of exercise should be adjusted according to the doctor's advice and cardiovascular data.
2. Out of hospital rehabilitation after discharge.
Consolidate the effect of the second stage of rehabilitation treatment, and gradually restore the life and work status before the onset of the disease, but in principle, it is not recommended to continue to maintain the previous life and work intensity, you should reduce the degree of physical activity. On the premise of no discomfort, light sports training such as fast walking, jogging, cycling, etc can be done.
Which patients are not suitable for exercise training.
1. Patients with unstable angina pectoris.
2. Patients who have just finished clinical treatment and whose condition is not stable.
3. Unstable patients with severe arrhythmia.
4. Severe uncontrolled hypertension and hypotension.
5. Patients with uncontrolled heart failure and acute cardiac dysfunction.
6. Patients who have not been instructed by professional doctors or rehabilitation therapists.
Contraindications of cardiac exercise rehabilitation.
1. Unstable angina pectoris, unstable condition after acute myocardial infarction, uncontrolled heart failure, severe atrial or ventricular arrhythmias (uncontrolled atrial fibrillation, supraventricular tachycardia, multi-source, frequent ventricular premature).
2.Confirmed or suspected pseudoaneurysm. Before the operation of artery dissection, septic shock and sepsis. Severe valve disease before surgery or myocardial heart disease, heart failure, the patients that exercise may lead to deterioration of their nervous system, motor system disease or rheumatic disease.
Finally, I wish you all a happy life and good health!To learn more about cardiovascular disease, please pay attention to us. See you next time.
