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ID naloge: 51 Letnik: 1998 Predmet: interna medicina
Potek in ucinki telesne vadbe med ambulantno rehabilitacijo pri razlicnih skupinah bolnikov po srcnem infarktu
Avtor: Špela Sušnik
Mentor: Prof. dr. Irena Keber
Problem Telesna vadba je ena od kljucnih sestavin rehabilitacije bolnikov po srcnem infarktu. Njeni številni ugodni ucinki so nedvomno dokazani pri dolocenih skupinah bolnikov po srcnem infarktu, ni pa dovolj podatkov o varnosti in ucinkih telesne vadbe pri starejših bolnikih.
Metode Opravili smo retrospektivno analizo vseh bolnikov, ki so opravili ambulantno rehabilitacijo po srcnem infarktu na Klinicnem oddelku za žilne bolezni v letih 1988 do 1997. Zbrali smo podatke 475 bolnikov (360 bolnikov mlajših od 65 let in 115 bolnikov starih 65 let in vec) in primerjali naslednje parametre: potek rehabilitacije, rezultate obremenitvenega testiranja ter vrednosti krvnih lipidov pred rehabilitacijo in po njej.
Rezultati Glede na akutno obdobje bolezni so se starejši bolniki pomembno kasneje vkljucili na rehabilitacijo kot mlajši (3.9±6.1 vs 2.8±4.5 mesecev, p<0.05), potek rehabilitacije pa so spremljali nekoliko pogostejši zapleti, vec je bilo srcnega popušcanja in motenj srcnega ritma. Po rehabilitaciji se je pri starejših bolnikih v enaki meri zvecala simptomatska omejitvena zmogljivost kot pri mlajših (starejši: od 4.42*1.70 MET do 5.90*2.10 MET, porast za 33% vs mlajši: od 5.43*2.00 MET do 7.21*2.30 MET, porast za 33%). Iztisni delež levega prekata se ni pomembno spremenil, tako ne pri celotni skupini starejših kot tudi ne pri tistih s sistolicno disfunkcijo. Pri starejših bolnikih, ki niso dobivali lipolitikov, je prišlo do sprememb v krvnih lipidih v bolj aterogeno smer, za razliko od mlajših, kjer so bile spremembe ugodne.
Zakljucki Ambulantna rehabilitacija se je izkazala za koristno in varno tudi pri starejših bolnikih po srcnem infarktu, zato bi jo morali pri teh bolnikih bolj spodbujati, saj so je deležni v bistveno manjšem obsegu kot mlajši.
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[Abstract / English version]
Course and effects of exercise training in the rehabilitation after myocardial infarction in different groups of patients
Author: Špela Sušnik
Mentor: Prof. dr. Irena Keber
Background Exercise training is the most important part of the cardiac rehabilitation in patients after myocardial infarction (MI). Despite the well proved benefits of cardiac rehabilitation and exercise training, only limited data are available for the elderly patients on the benefits of cardiac rehabilitation.
Methods We performed the retrospective analysis of all patients having completed an out-patient rehabilitation program in convalescence after myocardial infarction at the University Department of Angiology during the period between 1988 and 1997. We gathered the data of 475 patients (360 younger than 65 years and 115 elderly, aged 65 years or more) and compared the course of the rehabilitation program, the results of exercise stress testing and serum lipids before and after rehabilitation.
Results The elderly patients were included in the rehabilitation program significantly later than younger ones (3.9±6.1 vs 2.8±4.5 months, p<0.05). More complications occurred during the rehabilitation in elderly patients, there were more cases of heart failure and cardiac arrhytmias. After rehabilitation, the elderly demonstrated significant improvement in symptom-limited aerobic capacity at exercise stress testing, the increase being the same as in younger patients (elderly patients: from 4.42*1.70 to 5.90*2.10 METs; younger patients: from 5.43*2.00 to 7.21*2.30 METs). As in younger patients, the mean left ventricular ejection fraction did not change after rehabilitation either in elderly patients with normal left ventricular systolic function or in those with significant systolic dysfunction. In those patients being not treated with lipid-lowering drugs after rehabilitation, more atherogenic serum lipid profile was observed in elderly patients, while in younger ones the observed changes were favourable.
Conclusions These data showed that an out-patient rehabilitation program in convalescence after myocardial infarction is useful and safe also for elderly patients. Therefore, its more intensive application should be encouraged in this population.
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