Coronary Heart Disease Research and Application of Exercise Prescription

 Coronary heart disease research and application of exercise prescription
coronary heart disease (CHD) is when the coronary arteries, the blood supply to the heart is obvious vascular atherosclerotic stenosis or obstruction, and / or mergers on this basis, spasm, thrombus lumen caused by formation of some or all of the obstruction, resulting in coronary insufficiency, myocardial ischemia or infarction caused necrosis, the most common is angina and myocardial infarction. It is, on the main causes of death in developed countries, 1987 data showed that 35% of death from heart disease, coronary heart disease accounted for 24.1% of them. China Ministry of Health statistics for 1989 show that the mortality rate for acute myocardial infarction 18.68/10 million, and coronary heart disease mortality compared with 24.73/10 million. Therefore, the formation of people fully understand the risk factors of coronary heart disease, a comprehensive understanding of effective ways and means of prevention and rehabilitation, to develop good habits to reduce the incidence of coronary heart disease, improve people's health is important.
1 World Health Organization classification of coronary heart disease coronary heart disease will be divided into the following five types: ① primary cardiac arrest; ② angina (angina pectoris and spontaneous sub angina pectoris); ③ myocardial infarction (sub-acute and myocardial infarction categories); ④ heart failure; ⑤ arrhythmia.
2 risk factors for coronary heart disease formation
2. 1 high cholesterol high blood cholesterol in the blood lipid levels are high. cholesterol and triglyceride high levels of glycerol, low levels of high density lipoprotein and cholesterol / HDL ratio high will increase the risk of coronary heart disease. high blood cholesterol increased lipid accumulation in the injury site and promote coronary artery intimal injury, leading to arterial atherosclerosis. epidemiologic studies have shown that high dietary fat, especially in the diet in countries with high milk fat composition, heart disease rates than the national diet mainly vegetarian higher.
2.2 high blood pressure for hypertension is usually no obvious symptoms, sometimes called the resting and exercise oxygen consumption, and cause the cells within the heart and vascular changes.
2.3 Smoking Smoking in atherosclerosis has not been fully confirmed in the role. smoking may increase blood pressure, heart rate, platelet adhesion and fatty acid mobilization, and reduce high density lipoprotein and stimulate coronary heart disease. Smoking can reduce the ventricular fibrillation threshold and cause coronary vasoconstriction involved in fatal heart rhythm disorders. smoking and with other major risk factors a geometric increase the risk of coronary heart disease.
2.4 family history, family history of gender and age, gender and age, and the impact of genetic and social risk factors is complex. Although these risk factors are not easily changed, However, the relative risk of any individual risk factors through strict control programs declined.
2.5 statistical study of the life insurance body fat mass between overweight and heart disease. Obesity is increasing risk factor for coronary heart disease. of obesity on other risk factors, such as hypertension, hyperlipidemia and hyperinsulinemia phospholipids have a negative impact.
2.6 lack of physical activity in 1987, the U.S. Centers for Disease return to physical inactivity as a major cardiovascular risk factors. The lack of the risk of physical activity and smoking, hypertension and high cholesterol similar. a lot of evidence that normal physical activity in reducing risk of disease is extremely important. physically fit and less people suffering from coronary heart disease, even if suffering from coronary heart disease, its severity is also smaller, and the onset of the lack of physical activity than those who come late. exercise training may cause atheroma degradation and reduce the impact of other risk factors.
3 exercise therapy indications, contraindications and its effect on coronary heart disease exercise therapy indications
3.1 stable myocardial infarction recovery, stable angina, coronary artery bypass grafting (CABG) and percutaneous coronary angioplasty (PTCA), the compensatory function of congestive heart failure, cardiomyopathy, heart and other organ transplants, heart valve replacement and pacemaker implantation, peripheral vascular disease.
3.2 contraindications of exercise therapy unstable angina, systolic pressure> 200mmHg and diastolic blood pressure> 110mmHg, accompanied by symptoms and less than 19.5mmHg of orthostatic hypotension, severe aortic stenosis, acute systemic illness, do not control atrial or ventricular arrhythmia, not on behalf of the incomplete compensation of cardiac function, Ⅲ degree atrioventricular block, active myocarditis, endocarditis, quiet state of ECG ST-T changes of> 2mm, uncontrolled diabetes (blood glucose> 22.2mmol / L) and acute thyroid Yan, hypokalemia, hypovolemia, etc..
3.3 Effect of exercise therapy, according to the American Heart Association summarized the effect of exercise therapy: increased heart stroke volume and oxygen uptake associated with the highest increase; skeletal muscle mitochondrial enzyme activity increased; capillary bed and increase the oxygen utilization capacity enhancement; sub-level reduction in the number amount of cardiac motion, blood and urine catecholamine concentrations decreased, blood lactate concentration decreased with increased anaerobic threshold; there is high blood pressure improved, high-density lipoprotein (HDL) increased, increased glucose tolerance, body fat rate reduction and anxiety, depression improvement.
4 to develop and implement exercise prescription based on exercise test results, the evaluation of myocardial ischemia and exercise tolerance , out of exercise prescription. exercise prescription including sport, exercise intensity, time and frequency.
5 coronary heart disease health status of sport and exercise prescription application
medical sports rehabilitation programs for coronary heart disease has been a major part of . exercise intervention as a separate physical aspects of patient rehabilitation has a positive effect without the extra risk, exercise should be conducted under the guidance of doctors and professionals. Of course, the best instrumental detection and first aid equipment, and other medical care measures. coronary heart disease health sports including aerobics, strength sports, professional sports, relaxation of the sports, entertainment, sports, medical gymnastics training, and traditional Chinese exercise method.
5.1 is the highest aerobic exercise aerobic exercise Heart health sports main methods commonly used in aerobic exercise, including walking, jogging, swimming, cycling, hiking, etc., the ideal exercise intensity aerobic exercise for the control in 50% m80% maximum oxygen uptake, or 60% m90% maximum heart rate , each at least 15 minutes exercise 3 times per week or more. exercise intensity and exercise time was a negative correlation, low intensity exercise requires a longer exercise time to achieve the purpose of enhanced cardiac function, this exercise can reduce the incidence of complications Features can reduce the risk of exercise-induced. the primary purpose of fitness training at a moderate intensity (60% m75% of maximum oxygen uptake, or 70% m85% of the maximum heart rate) is appropriate, the total activity more important than exercise intensity .
5.1.1 Zhu Weidong, etc. Walk with acute myocardial infarction after discharge procedures. convalescent rehabilitation, the most simple walking program, walking to asymptomatic for the degree of fatigue-free, the number of heart rate before and after activities, family members should be accompany walking, to ensure safety.
5.1.2 Liu Lezhi that patients with coronary heart disease can be selected according to maximum heart rate of 50 to 70% as the target heart rate. with the disease can refer to the following basis. (l) with coronary heart disease, physical Optional post-mood angina HRmax70%; by 90 m / min pace exercise. (2) coronary heart disease, physical activity a little limited, there may be exertional palpitation, dyspnea or angina, rest after mitigation, Select HRmax60%, or 60 ~ 90 m / min step speed training. (3) coronary heart disease, physical activity was limited, such as rest angina occurs after the remission by the optional HRmax50% for the target heart rate, a 60 or 40 m / step-speed exercise. 10 minutes warming up before exercise, exercise for 10 minutes and finishing activities, target heart rate exercise for 15 minutes, 2 or 3 times a week. Select a quiet space environment, step by step exercise between the two meals. < br> 5.1.3 Li Ying and other 78 cases of angina pectoris patients taking aerobic exercise training as the main content of the rehabilitation hospital, the observation group, 53 cases daily from 5 to 7 pm in the rehabilitation training under the watchful eye doctors teachers to lead the following activities: ① comfortable operating voltage, from breathing, rocking groove, respiratory care days, so embrace bird tail, flat blood breathing, Chuibei, United breathing, chest buckle, ② simplified Taijiquan; ③ Quantitative health walk , given time, the speed from 60 m / min gradually increased to 100 m / min or more. exercise intensity was doubled when the second step stress test for 80% of maximum heart rate. to exercise intensity for 15 to 30 minutes to prepare and organize their activities 10 to 15 minutes each. 4 to 8 weeks of their training, the expansion of the crown to stop taking the drugs during the training process of angina can be issued temporary 10mg sublingual isosorbide dinitrate in order to ease the training process in case of worsening symptoms of angina who is to stop training, and to exclude outside in the observation group. The patients had varying degrees of precordial or chest men Tong, weakness, palpitations, shortness of breath and other symptoms. symptoms disappeared after rehabilitation was markedly to reduce to improve, no improve or worsen as invalid. Results: 25 patients in the control group, the effective efficiency of 28.0% in 7 cases, 53 cases in the observation group, 37 cases effective, effective rate was 69.8%, significantly higher (P <0 .01). < br> 5.2 power of the power of movement is generally not used for movement rehabilitation of coronary heart disease in recent years, there is a circular strength training method for rehabilitation of patients with coronary heart disease, the training intensity is a maximum amount of anti-resistance of 40% m50%, in 10 seconds Repeat 8m10 contractions within 1 group, 5 groups as a cycle. rest interval between each 30 seconds, 1 Repeat 2 cycles of training, training three times a week, and gradually adapted according to increment of 5% exercise. training mainly in large muscle groups, to slow the whole range of joint anti-resistance exercise.
5.3 professional and recreational sports professional sports is to simulate a variety of professional sports, home activities to achieve their goals; entertainment Sports are a variety of class activities and ball games chess main coronary artery disease can improve the enthusiasm of people to participate in activities to improve the training effect, but the ball should avoid confrontation during intense exercise.
5.4 relax movement and the movement of medical gymnastics should be relaxed abdominal breathing, relaxation technique and the static power of Qigong in the main; medical gymnastics generally soft, based drawing activities, such as tai chi and other movement-based boxing operation Rouhuan .
tube Huiying that qigong therapy to relax power, strong work as the good practice to exclude distractions, natural breathing, meaning keep the pubic region, 2 to 4 times a day to do the maintenance work (work sitting or lying power), can reduce angina. and tai chi therapy helps recovery. Taijiquan movements ShuSong nature, hardness and softness, moving in seeking quiet, more suitable for rehabilitation of patients with coronary heart disease.
conclusion, exercise rehabilitation treatment can significantly reduce angina and improve quality of life, so that early restoration of coronary heart disease patients to normal social activities and work to reduce the social, family burden and pressure on hospitals, community-based rehabilitation for coronary heart disease and prevention of the effective way. coronary heart disease medical depend Sports Rehabilitation in a gradual, long-term adherence with regular exercise. In addition, the specific amount of exercise must be based on physical examination by specialists to determine exercise prescription. In the beginning of exercise, exercise in the custody of the need for specialized health care workers. In the daily exercise in the future Patients themselves also have to learn to self-monitoring. and regular medical examinations to ensure the safety exercise.
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