Kinesiology and Applied Physiology Department, University of Delaware, Newark (Dr Overstreet); Department of Kinesiology and Health Sciences, Virginia Commonwealth University, Richmond (Dr Kirkman); Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan (Ms Qualters and Drs Kerrigan, Brawner, Ehrman, and Keteyian); Faculty of Nursing, University of Alberta, Edmonton, Canada (Dr Haykowsky); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota (Dr Tweet); and Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California (Dr Christle).
J Cardiopulm Rehabil Prev. 2021 Nov 1;41(6):389-399. doi: 10.1097/HCR.0000000000000654.
Although cardiac rehabilitation (CR) is safe and highly effective for individuals with various cardiovascular health conditions, to date there are only seven diagnoses or procedures identified by the Centers for Medicare & Medicaid Services that qualify for referral. When considering the growing number of individuals with cardiovascular disease (CVD), or other health conditions that increase the risk for CVD, it is important to determine the extent for which CR could benefit these populations. Furthermore, there are some patients who may currently be eligible for CR (spontaneous coronary artery dissection, left ventricular assistant device) but make up a relatively small proportion of the populations that are regularly attending and participating. Thus, these patient populations and special considerations for exercise might be less familiar to professionals who are supervising their programs. The purpose of this review is to summarize the current literature surrounding exercise testing and programming among four specific patient populations that either do not currently qualify for (chronic and end-stage renal disease, breast cancer survivor) or who are eligible but less commonly seen in CR (sudden coronary artery dissection, left ventricular assist device). While current evidence suggests that individuals with these health conditions can safely participate in and may benefit from supervised exercise programming, there is an immediate need for high-quality, multisite clinical trials to develop more specific exercise recommendations and support the inclusion of these populations in future CR programs.
尽管心脏康复（CR）对各种心血管健康状况的个体都是安全且高度有效的，但迄今为止，医疗保险和医疗补助服务中心（Centers for Medicare & Medicaid Services）仅确定了七种符合转诊条件的诊断或程序。考虑到心血管疾病（CVD）患者或其他增加 CVD 风险的健康状况的人数不断增加，确定 CR 对这些人群的益处程度非常重要。此外，还有一些患者目前可能有资格接受 CR（自发性冠状动脉夹层、左心室辅助装置），但在定期参加和参与的人群中占比较小。因此，监督这些患者的专业人员对这些患者群体和特殊的运动考虑因素可能不太熟悉。本综述的目的是总结目前围绕四个特定患者群体的运动测试和方案的文献，这些群体目前不符合（慢性和终末期肾脏疾病、乳腺癌幸存者）或符合但在 CR 中较少见（急性冠状动脉夹层、左心室辅助装置）。虽然现有证据表明，这些健康状况的个体可以安全地参与并可能从监督下的运动方案中受益，但迫切需要高质量、多地点的临床试验来制定更具体的运动建议，并支持将这些人群纳入未来的 CR 计划。
