Kachur Sergey, Lavie Carl J, Morera Rebecca, Ozemek Cemal, Milani Richard V
Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-the University of Queensland School of Medicine , New Orleans , LA , USA.
Department of Graduate Medical Education, Ocala Regional Medical Center , Ocala , FL , USA.
Expert Rev Cardiovasc Ther. 2019 Aug;17(8):585-596. doi: 10.1080/14779072.2019.1651198. Epub 2019 Aug 8.
: The aim of this review is to introduce the audience to exercise training (ET) as a therapeutic tool in coronary heart disease (CHD) and to discuss the role of and advances in cardiac rehabilitation (CR) as a means of effectively delivering ET. : The physiological mechanisms behind ET effects on the cardiovascular (CV) system as well as the implementation of ET in CR and the effects of CR on CV morbidity, risk factor modification, and mortality will be reviewed. Additionally, the clinical and financial impact of CR in today's healthcare systems will be discussed. : It is well-established that CR continues to be under-utilized despite significant benefits to patients and healthcare systems alike. Innovation in the structure of CR (such as the implementation of high-intensity protocols) and in accessibility (home and tele-health CR programs) is already helping improve efficacy and increase utilization of CR. However, the efficacy of home/remote delivery protocols is not well established and they comprise a minority of available CR services. More data and efforts are needed to improve such protocols and maximize the reach of remote delivery systems in order to effectively deliver CR services to more eligible individuals at lower costs.
本综述的目的是向读者介绍运动训练（ET）作为冠心病（CHD）治疗工具的相关内容，并讨论心脏康复（CR）作为有效实施ET手段的作用及进展。将对ET对心血管（CV）系统产生影响的生理机制、ET在CR中的实施情况以及CR对CV发病率、危险因素改善和死亡率的影响进行综述。此外，还将讨论CR在当今医疗保健系统中的临床和经济影响。尽管CR对患者和医疗保健系统都有显著益处，但目前其使用率仍然较低，这一点已得到充分证实。CR结构方面的创新（如实施高强度方案）和可及性方面的创新（家庭及远程医疗CR项目）已经有助于提高CR的疗效并增加其使用率。然而，家庭/远程交付方案的疗效尚未得到充分证实，且它们在现有CR服务中占比很小。需要更多数据和努力来改进此类方案，并最大限度地扩大远程交付系统的覆盖范围，以便以更低的成本为更多符合条件的个体有效提供CR服务。
