Oldridge N
Department of Health Sciences, University of Wisconsin, Milwaukee 53201, USA.
Aging (Milano). 1998 Aug;10(4):273-83. doi: 10.1007/BF03339789.
Rehabilitation for patients with heart disease consists of exercise training, behavioral interventions, counseling, and education with the goal of improving physiologic and psychosocial status. The Cardiac Rehabilitation Clinical Practice Guidelines, recently published in the United States, list the most substantial benefits of cardiac rehabilitation as an improvement in exercise tolerance, symptoms, blood lipid levels, and psychosocial well-being, and a reduction in cigarette smoking, stress, and mortality. With the evidence-base on the elderly in the Guidelines derived from 1 non-randomized controlled trial and 7 observational studies, the efficacy and effectiveness of cardiac rehabilitation is based almost exclusively on data generated on young and middle-aged males. We have located an additional 10 randomized and 2 non-randomized controlled trials published since the Guidelines, but only one provided age-specific data. The elderly are the fastest growing segment of the population, and may be more responsive to the effects of cardiac rehabilitation as they often have greater initial disability and less independence than younger patients. While referral of elderly persons to cardiac rehabilitation services appears safe and warranted in the secondary prevention of heart disease, the lack of rigorous scientific evidence has created an important clinical research and clinical policy vacuum which urgently needs to be filled.
心脏病患者的康复治疗包括运动训练、行为干预、咨询和教育，目标是改善生理和心理社会状况。美国最近发布的《心脏康复临床实践指南》列出了心脏康复的最主要益处，即提高运动耐量、改善症状、降低血脂水平、增进心理社会幸福感，以及减少吸烟、缓解压力和降低死亡率。由于该指南中关于老年人的证据基础来自1项非随机对照试验和7项观察性研究，心脏康复的疗效几乎完全基于年轻和中年男性的数据。自该指南发布以来，我们又找到了另外10项随机对照试验和2项非随机对照试验，但只有1项提供了特定年龄的数据。老年人是人口中增长最快的群体，而且由于他们通常比年轻患者有更大的初始残疾程度和更低的独立性，可能对心脏康复的效果反应更明显。虽然在心脏病二级预防中，将老年人转诊至心脏康复服务似乎是安全且必要的，但缺乏严格的科学证据造成了一个重要的临床研究和临床政策空白，亟待填补。
