Mehmet İLERİ, Mitat KOZ, Robert SCALES, Cengiz AKALAN

Developing comprehensive cardiac rehabilitation programs - Review

Kardiyak rehabilitasyon programları, kardiovasküler hastalıkları olan bireylerin yaşamlarını tümden etkileyecek olan davranışlarını kontrol etmelerini kolaylaştıracak bir destek sistemi olmalıdır. Birçok program Amerikan Spor Hekimliği Birliğinin önerilerine göre eksik kalmakta ve yaklaşımları “kapsamlı” olmamaktadır. Geleneksel yaklaşıma göre hastaların çoğu veya tamamı sağlık eğitimi ile ilgili grup tartışmaları ve didaktik konferanslar eşliğinde gözetimli egzersiz programlarına katılmaktadırlar. Bilgi, tek başına sağlık ile ilgili davranışları değiştirmek için yeterli değildir. Hasta eğitimi, insanlara sadece ne yapacaklarını söylemek ve onlara yol gösterici kitapçıklar dağıtmaktan daha fazlasını içermelidir. Risk faktölerinin azaltılması ile ilgili sağlık davranışlarını değiştirmek konusunda yüksek motivasyona sahip ve ciddi şekilde istekli olan kalp hastaları, hastalığı sınırlama konusunda daha yüksek şansa sahiptirler. Hastaları bu tip bir yaşam tarzını benimsemeleri ve devam ettirmeleri konusunda motive etmek, kardiyak rehabilitasyon programları için büyük bir mücadeledir. Tedavi programları bireyin değişime hazır olma motivasyonu ile örtüşmelidir. Geleneksel programlar yeni ve etkili stratejileri kapsamalıdır.

Kapsamlı kalp rehabilitasyonu programlarının geliştirilmesi -Derleme

Cardiac rehabilitation programs should be a support system to facilitate the self management of behaviors that will potentially impact the total well being of the patient with cardiovascular disease. Many programs fall short of the American College of Sports Medicine recommendations, and that they are not ‘comprehensive’ in their approach. In the traditional approach most or all of the patients are required to conform to a regimen of supervised exercise with a series of didactic lectures and group discussions in health education. Knowledge itself is not sufficient to change health behaviors. Patient education involves more than simply telling people what to do, or giving them an instructional pamphlet. There is a greater chance of stabilizing the disease when cardiac patients are highly motivated and aggressively adherent to changing health-related behaviors associated with risk factor reduction. Motivating patients to adopt and maintain this type of lifestyle is, therefore, a major challenge in cardiac rehabilitation programs. Treatment programs need to be matched with an individual’s motivational readiness to change. Traditional programs need to incorporate new effective strategies.

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1.American Heart Association. Heart disease and stroke statistics - Dallas, TX: American Heart Association; 2004.
2.Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004; 364:937-52.
3.Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery Disease. Ann Intern Med 2005; 143:659-72.
4.Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized trials. Am J Med 2004;116:682-97.
5.Balady GJ, Ades PA, Comoss P, Limacher M, Pina IL, Southard D, et al. Core components of cardiac rehabilitation/ secondary prevention programs: a statement for healthcare professionals from the American Heart Association and American Association of Cardiovascular and Pulmonary Rehabilitation Writing Group. Circulation 2000;102:1069 -73.
6.Pollock ML, Franklin BA, Balady GJ, Chaitman BL, Fleg JL, Fletcher B, et al. Resistance exercise in individuals with and without cardiovascular disease: benefits, rationale, safety, and prescription: an advisory from the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association; position paper endorsed by the American College of Sports Medicine. Circulation 2000;101:828-33.
7.Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Association of Cardiovascular and Pulmonary Rehabilitation (Subcommittee on Physical Activity), in Collaboration With the American Prevention) and the Council on Nutrition, Physical Activity, and Metabolism Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and An American Heart Association Scientific Statement From the Council on Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease. Circulation 2005; 111:369-76.
8.American College of Sports Medicine. Guidelines for exercise testing and prescription. Fourth edition. Philadelphia, PA: Lea & Febiger;1991.
9.Wolfe LA, Herbert WG, Miller J, Miller DS. Status of cardiovascular rehabilitation in Virginia. J Cardiopulm Rehab 1987;7: 42-50.
10.The Dialogue Company. A survey of the structure of cardiac rehabilitation programs nationwide and the patients they serve. Proceedings of a conference. American Association of Cardiovascular and Pulmonary Rehabilitation 9th Annual Meeting, Portland, OR. 1994.
11.Wolfe LA, Dafoe WA, Hendren EA., Goodman LS. Cardiovascular Rehabilitation in Ontario (Canada). J Cardiopulm Rehab 1990; 10: 130- 140.
12.Armstrong KL, Wolfe LA, Amey MC. Cardiovascular rehabilitation in Canada: A national survey. J Cardiopulm Rehab 1994; 14: 262-72.
13.Worcester MC. Cardiac rehabilitation programmes in Australian hospitals. Melbourne: National Heart Foundation of Australia.1986.
14.Worcester M C, Goble AJ. Cardiac rehabilitation programmes in Australian hospitals. Melbourne: National Heart Foundation of Australia.1990.
15.Dacey J. Cardiac rehabilitation in Australia. Proceedings of a conference. American Association of Cardiopulmonary Rehabilitation 12th Annual Meeting, Orlando, FL. 1993.
16.Worcester MC. 1992 Survey: Cardiac rehabilitation programmes in Australian hospitals. Melbourne: National Heart Foundation of Australia. 1994.
17.Horgan J, Bethell H, Carson P, Davidson C, Julian, D, Mayou RA, et al. Working party report on cardiac rehabilitation. British Heart J 1992; 67: 412-18.
18.Thompson DR, Bowman GS. An audit of cardiac rehabilitation services in England and Wales. University of Hull, England. 1995.
19.Coates A, McGee H, Stokes H, Thompson D. British Association of Cardiac Rehabilitation guidelines for cardiac rehabilitation. Oxford, England: Blackwell Science.1995.
20.Maes S. Psychosocial aspects of cardiac rehabiliation in Europe. British J Clinical Psych 1992; 31: 473-83.
21.Joint Commission on Accreditation of Healthcare Organizations. Accreditation Manual for Hospitals.1994. Library of Congress Catalogue Number 93-78938.
22.Wenger NK. Future directions in cardiovascular rehabilitation. J Cardiopulm Rehab 1987; 7: 168-74.
23.Wenger NK. Today’s approach to the rehabilitation of low-risk coronary patients: Exercise and educational programs that can increase patient compliance. J Critic Illness 1991a; 6, 7: 642-48.
24.Gordon NF. Comprehensive cardiovascular disease risk reduction in a cardiac rehabilitation setting. Proceedings of a conference. American Association of Cardiopulmonary Rehabilitation 12th Annual Meeting, Dallas, TX. 1997.
25.Barbarowicz P, Nelson M, DeBusk RF, Haskell WL. A comparison of in-hospital education approaches for coronary bypass patients. Heart & Lung 1980; 9(1): 127-33.
26.Tirrel BE, Hart LK. The relationship of health beliefs and knowledge to exercise compliance in patients after coronary bypass. Heart & Lung 1980; 9(3): 487-93.
27.Young D, Kottke T, McCall M, Blume D. A perspective control study of in-hospital myocardial rehabilitation. J Cardiopulm Rehab 1982; 2: 32-40.
28. Morley D, Ribish P, Miller H. A comparison of patient education methodologies in outpatient cardiac rehabilitation. J Cardiopulm Rehab 1984; 4: 434-39.
29.Kinsey MG, Fletcher BJ, Rice CR, Watson PH, Fletcher GF. Coronary risk factor modification followed by home-monitored exercise in coronary bypass surgery patients: A four-year follow-up study. J Cardiopulm Rehab 1989; 9: 207-12.
30.Nelson D, Baer PE, Cleveland SE, Revel KF, Montero AC.Six month follow-up of stress management training versus cardiac education during hospitalization for acute myocardial infarction. J Cardiopulm Rehab 1994; 14(6): 384-90.
31.Daltroy LH. Improving cardiac patient adherence to exercise or programs: A clinical trial of health education. J Cardiopulm Rehab 1985; 5: 40-49.
32.Thuesen L, Henrikson LB, Engby B. One-year experience with a low-fat, low-cholesterol diet in patients with coronary heart disease. Am J Clin Nutr 1986; 44: 212.
33.Ockene J, Ockene I, Kristeller J.). The Coronary Artery Smoking Intervention Study. Worcester, MA: National Heart, Lung, & Blood Institute. 1988a.
34.Holbäck AM, Säwe U, Fagher B. Training after myocardial infarction: Lack of long-term effects on physical capacity and psychological variables. Archives of Phys Med Rehab 1994; 75(5): 551-54.
35.Rigotti NA, McKool KM, Shifman S. Predictors of smoking cessation after coronary artery bypass graft surgery. Ann Int Med 1994; 120: 287-93.
36.Bairey-Merz, NC, Felano MN, Klein J. Cholesterol awareness and treatment in patients with coronary artery disease participating in cardiac rehabilitation. J Cardiopulm Rehab 1996; 16(2): 117-22.
37.Durstine LJ, Webster WW, Jameson BF. Impact of the new national cholesterol education program (NCEP) guidelines on management of cardiac rehabilitation patients: Traditional vs. aggressive management. Abstract S-16. J Cardiopulm Rehab 1996; 16(5): 375.
38.United States Preventive Services Task Force. Guide to clinical preventive services: Report of the United States Preventive Services Task Force. Second edition. Baltimore, MD: Williams & Wilkins. 1996.
39.Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990; 336: 129-33.
40.Schuler G, Hambrecht R, Schlierf G, Niebauer J, Hauer K, Neumann J.et al. Regular physical exercise and low-fat diet: Effects on progression of coronary artery disease. Circulation 1992; 86: 1-11.
41.Haskell W, Alderman EL, Fair JM, Maron DJ, Mackey SF, Superko RH. Et al. Effects of intensive risk factor reduction on coronary atherosclerosis and clinical events in men and women with coronary artery disease: The Stanford Coronary Risk Intervention Project (SCRIP). Circulation 1994; 89: 975-90.
42.Hambrecht R, Niebauer J, Marburger C, Grunze M, Kalberer B, Hauer K. et al. Various intensities of leisure time physical activity in patients with coronary artery disease: Effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. J Am Coll Cardiol 1993; 22(2): 468-477.
43.Prochaska JO, DiClemente CC. Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research & Practice, 1982; 20: 161-173.
44.Fitzgerald TE, Prochaska JO. Nonprogressing profiles in smoking cessation: What keeps people refractory to self-change? J Subs Abuse, 1988; 2: 93-111.
45.Ockene J, Kristeller JL, Goldberg R, Ockene I, Merriam I, Barret S. Smoking cessation and severity of disease: The Coronary Artery Smoking Intervention Study (CASIS). Health Psychology 1992; 11(2): 119-26.
46.Prochaska JO, DiClemente CC, Velicer WF, Ginpil S, Norcross JC. Predicting change in smoking status for self-changers. Addictive Behaviors 1985; 10: 395-406.
47.Noonan WC, Moyers TB. Motivational interviewin