Centre for Active Living, University Centre Shrewsbury/University of Chester, Chester, UK.
Disabil Rehabil. 2021 Dec;43(24):3515-3522. doi: 10.1080/09638288.2021.1921062. Epub 2021 May 14.
This paper aims to demonstrate how the rationale and delivery of cardiac rehabilitation (CR), in those countries with long term established standards of practice, has changed over the past eight decades.
A narrative report based on the evolution of key published guidelines, systematic reviews and medical policies since the 1940s.
Case reports of the value of exercise in cardiac disease can be dated back to 1772. Formative groundwork for exercise-based CR was published between 1940 and 1970. However, it was not until the late 1980s that a large enough data set of controlled trials was available to show significant reductions in premature all-cause and cardiac mortality. Since the mid 1990s, cardiac mortality has been greatly reduced due to enhanced public health, emergency care and more sensitive diagnostic techniques and aggressive treatments. As a result, there appears to be an associated reduced potency of CR to affect mortality. New rationales for why, how and where CR is delivered have emerged including: adapting to a longer surviving ageing multi-morbid population, where healthcare cost savings and quality of life have become increasingly important.
In light of these results, an emerging focus for CR, and in some cases "pre-habilitation", is that of a chronic disability management programme increasingly delivered in community and home settings. Within this delivery model, the use of remote personalised technologies is now emerging, especially with new needs accelerated by the pandemic of COVID-19.
IMPLICATIONS FOR REHABILITATIONWith continued advances in medical science and better long term survival, the nature of cardiac rehabilitation has evolved over the past eight decades. It was originally an exercise-focused intervention on short term recovery and reducing cardiac and all-cause mortality, to now being one part of a multi-factor lifestyle, behavioural, and medical chronic disease management programme.Throughout history, the important influence of psycho-social well-being and human behaviour has, however, always been of key importance to patients.The location of rehabilitation can now be suited to patient need, both medically and socially, where the same components can be delivered in either a traditional outpatient clinic, community settings, at home and more recently all of these being supported or augmented with the advent of mobile technology.
本文旨在展示在那些长期建立实践标准的国家，心脏康复（CR）的原理和实施方式在过去八十年中是如何变化的。
基于 20 世纪 40 年代以来的关键出版指南、系统评价和医疗政策的演变，进行叙述性报告。
早在 1772 年，就有关于运动对心脏病价值的病例报告。20 世纪 40 年代至 70 年代发表了形成性的基于运动的 CR 基础工作。然而，直到 20 世纪 80 年代末，才有足够大的对照试验数据集显示出显著降低的过早全因和心脏死亡率。自 20 世纪 90 年代中期以来，由于公共卫生、紧急护理以及更敏感的诊断技术和积极治疗的改善，心脏死亡率大幅下降。因此，CR 对死亡率的影响似乎有所减弱。出现了新的理由来解释为什么、如何以及在哪里提供 CR，包括：适应存活时间更长的多系统疾病老年人群，以及医疗保健成本节约和生活质量变得越来越重要。
鉴于这些结果，CR 的一个新焦点，在某些情况下是“预适应”，是作为一种在社区和家庭环境中越来越多地提供的慢性残疾管理计划。在这种交付模式中，现在正在出现远程个性化技术的使用，特别是由于 COVID-19 大流行加速了新的需求。
对康复的影响随着医学科学的不断进步和长期生存的改善，过去八十年中，心脏康复的性质发生了演变。它最初是一个以短期恢复和降低心脏和全因死亡率为重点的锻炼干预措施，现在是多因素生活方式、行为和慢性疾病管理计划的一部分。在历史上，心理社会健康和人类行为的重要影响一直是患者的关键。康复的地点现在可以根据患者的医疗和社会需求来确定，在这些需求中，相同的康复组件可以在传统的门诊诊所、社区环境、家庭中提供，或者最近，所有这些都可以通过移动技术的出现得到支持或增强。
