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1、CardiacRehabilitation2011 UpdateforPrimaryCareProvidersDouglassAMorrison,MD,PhDCardiacRehabilitation,MedicalDirectorYakimaRegionalandYakimaValleyMemorialHospitalsRehabilitationTorestoretogoodhealthorusefullife,throughtherapyandeducation.Changingourownbehavior,forbetterhealthChangingBehavior Resi
2、stancesTherapy:connotationof‘mentalillness’Rehabilitation:connotationof‘substanceabuse’PersonalResponsibilityismuchmoredifficultthanblamingNoonecanrehabilitateanother;mostoftheworkisdonebythepatient,forhimself..ActiveversusPassive SecondPersonversusFirstPersonItiseasiertotellothershowtheyshould
3、change,thantochangeourselves:empathyCardiacRehabilitation2011 BillofFareWhatiscardiacrehabilitation?Whatisthedifferencebetweenprimaryandsecondaryprevention?Istheregoodclinicalevidencewhichsupportstheefficacyofcardiacrehabilitation?SurvivalMyocardialinfarct(MI)reductionStroke(CVA)preventionAvoida
4、nceofsubsequentbypasssurgery(CABG)Reducedrepeatstenting(PCI)ReducedfrequencyofhospitalizationCardiacRehabilitation2011 BillofFare(2)4.Doestheevidence,whichsupportstheuseofcardiacrehabilitationapply:Inthe‘reperfusion-era’ofpostMIcare?Totheelderly(Medicarepopulation)?Women?Care-givers,themselves?5
5、.Inyourpersonal,andprofessionalexperience,isbehaviorchange:Easy,i.e.a‘slam-dunk’?Impossible,andtherefore,notevenworthdiscussingPossible,butrequiringsustainedeffortDefinitionofCardiacRehabilitationAmulti-componentintervention,whichisdesignedto:Optimizeacardiacpatient'sphysical,psychologicalandsoc
6、ialfunction,andStabilize,slow,orevenreversetheunderlyingatherosclerosis;therebyReducingthemorbidityandmortalityofcoronaryarterydisease(CAD).PhysicalActivityandthePreventionofCoronaryHeartDiseaseMeta-analysisof43studiesfromworldliteratureofphysicalactivityandCADupto1987Objectiveassessmentsofindiv
7、idualactivity,andofCHDAttempttoinfercausalrelationshipbasedoncriteriaofABHillandRothmanSequence:activityprecedesincidenceofCHDConsistencyacrossstudiesStrengthofassociationGradedacrossmultiplelevelsofactivityPlausibilityCoher
