West Park Healthcare Centre, Toronto, Ontario, Canada.
Chron Respir Dis. 2011;8(4):259-69. doi: 10.1177/1479972311423111.
Patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) commonly suffer from exertional symptoms of breathlessness and fatigue. The similar systemic manifestations of the conditions, including skeletal muscle dysfunction, are a major contributing factor to the limitation in exercise capacity. A period of exercise training has been shown to improve exercise performance and health-related quality of life for both conditions. Exercise training is a key component of pulmonary rehabilitation (PR) which is now a standard of care for patients with COPD and is symptom based. Although it may be assumed that patients with CHF could be incorporated into cardiac rehabilitation, this is predominantly a secondary prevention programme for patients who are largely asymptomatic. It has been shown that patients with CHF can be successfully trained together with patients with COPD by the same therapists within PR. There are comparable outcome measures that can be used for both COPD and CHF. Many patients with CHF still do not have access to an exercise rehabilitation programme and incorporating them into the PR model of care could be one solution. This article reviews the (1) similar symptoms, mechanisms and consequences between COPD and CHF, (2) rationale and evidence for exercise training in CHF, (3) model of PR, (4) safety of exercise training in CHF, (5) evidence for combined exercise rehabilitation for CHF and COPD, (6) adaptations necessary to include patients with CHF into PR, (7) the chronic care model and (8) summary.
患有慢性阻塞性肺疾病（COPD）和慢性心力衰竭（CHF）的患者通常会出现呼吸困难和疲劳等运动相关症状。这两种疾病具有相似的全身表现，包括骨骼肌功能障碍，这是导致运动能力受限的主要因素。运动训练已被证明可改善这两种疾病的运动表现和健康相关生活质量。运动训练是肺康复（PR）的重要组成部分，目前已成为 COPD 患者的标准治疗方法，且基于症状。虽然人们可能认为 CHF 患者可以纳入心脏康复，但这主要是针对无症状患者的二级预防计划。已经表明，CHF 患者可以由 PR 中的同一位治疗师与 COPD 患者一起成功训练。COPD 和 CHF 都有可比的疗效评估方法。许多 CHF 患者仍然无法获得运动康复计划，将他们纳入 PR 护理模式可能是一种解决方案。本文回顾了（1）COPD 和 CHF 之间的相似症状、机制和后果，（2）CHF 中运动训练的原理和证据，（3）PR 模型，（4）CHF 运动训练的安全性，（5）CHF 和 COPD 联合运动康复的证据，（6）将 CHF 患者纳入 PR 所需的适应，（7）慢性病护理模式和（8）总结。
