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Herz

, Volume 24, Issue 3, pp 242–249 | Cite as

Herzgruppentherapie — eine Standortbestimmung

  • Hans-Christian Heitkamp
Weitere Originalarbeit
  • 66 Downloads

Zusammenfassung

In Herzgruppen werden Patienten mit koronarer Herzerkrankung und anderen Herzkrankheiten der Sporttherapie zugeführt. Nach Metaanalysen führt die Herzgruppentherapie zur Steigerung der kardialen Arbeitsökonomie, zur Verbesserung der Lebensqualität und zur Senkung der Letalität in den ersten Jahren nach Myokardinfarkt, zeigt allerdings eine wenig günstige Kosten-Nutzen-Relation. Unter der Voraussetzung einer kardiologischen Eingangsdiagnostik und verantwortungsvoller Zuweisung in Trainingsoder Übungsgruppen mit über bzw. unter 1 W/kg Belastbarkeit sowie einem dosierten Trainingsprogramm unter der Leitung von speziell ausgebildeten Übungsleitern konnte mit einem Todesfall auf 750 000 Stunden eine niedrige Komplikationsrate belegt werden. Bei den zunehmend besser belastbaren Patienten sollte die anaerobe Schwelle im Trainingsprozeß mehr Berücksichtigung finden.

Metabolische Effekte auf Lipide und Kohlenhydrate ließen sich genausowenig nachweisen wie eine Blutdrucksenkung bei Hypertonie oder eine Gewichtsreduktion bei Adipositas. Diese fehlenden Effekte einerseits und die hohe Erfolgsquote auf die Leistungsfähigkeit und Belastbarkeit andererseits machen den Einsatz von weiteren Interventionsmaßnahmen, wie Entspannungstraining, allgemeine aerobe Ausdauerbeanspruchung und Diätberatung, in der Herzgruppentherapie notwendig. Die neue Einbeziehung herzinsuffizienter Patienten in eine adäquat dosierte, intensiv kontrollierte Sporttherapie scheint einen hohen Effekt auf den krankheitsbedingten reversiblen Muskelfunktionsverlust auszuüben.

Schüsselwörter

Koronare Herzkrankheit Therapiesicherheit Chronische Herzinsuffizienz Qualitätskontrolle Belastungssteuerung Kosten-Nutzen-Analyse Lebensstil 

Cardiac rehabilitation outpatient therapy — the current stage

Abstract

In contrast to most industrial countries Germany provides inpatient cardiac rehabilitation after myocardial infarction in specialized hospitals, before outpatient therapy is implemented. Within 30 years outpatient exercise therapy has successfully gained a degree of therapeutic importance comparable to medical treatment and interventional therapy. Each ambulatory cardiac patient is eligible for outpatient exercise therapy after qualified assessment by a cardiologist, following specific guidelines. Functional capacity is tested by treadmill or bicycle ergometry. Patients with no ventricular dilatation, no complicated arrhythmias and no signs of angina below 1.0 W/kg are assigned to controlled exercise groups, and above 1.0 W/kg to less limited training groups. Specially licensed therapists qualified in physical education develop programs for improvement of coordination, flexibility, muscle strength and endurance.

A major result of exercise therapy is the reduction of cardiac mortality during the first 3 years after myocardial infarction. according to meta-analyses of a number of randomized studies. Cardiovascular complications have decreased despite a growing number of involved patients with reduced left ventricular function. The rate of cardiac arrest is currently only 1 per 155 000 exercise sessions, and of cardiac death is 1: 750 000. This is comparable to rates for sport activity by apparently healthy individuals.

According to longitudinal studies, the success of this intervention was achieved by increases in the efficiency of heart work, the work capacity and the quality of life. The most relevant adaptations take place in skeletal muscles, rather than in the heart. Improved coronary blood perfusion was observed only in intensive, strictly controlled studies. Regular participation in general outpatient groups failed to show significant long-term influences on hypercholesterinemia, dyslipoproteinemia, hypertension, obesity or diabetes mellitus. An exception were patients with nearly normal cardiac function, when training programs including running were possible.

The anaerobic threshold must be taken more into account, especially in those patients with a high exercise tolerance. The pulse limit derived at the threshold is an excellent parameter for monitoring endurance training and helps to avoid catecholamine increase.

Although lower rehospitalization costs were found in patients taking part in outpatient therapy, most analyses showed only a small financial benefit.

More recent investigations involving patients with chronic heart failure have shown clear benefits for improvement of reduced skeletal muscle function and the functional status of peripheral arterioles. Outpatient therapy for these patients was carried out only under strict supervision during exercise and with frequent cardiologic controls.

New trends for cardiac therapy include muscle training controlled by isokinetic devices. Patients with an exercise tolerance of more than 1.5 W/kg body weight may participate in swim therapy, and may engage in some game activities without constant medical surveillance. Further therapeutic possibilities include yoga or other beneficial relaxation methods designed to improve life style. Cardiac outpatient therapy can now be regarded as a safe method for secondary prevention with confirmed positive effects on economy of movement, work capacity and quality of life. Additional therapeutic steps need to be taken to effectively reduce cardiovascular risk factors.

Key Words

Coronary artery disease Chronic heart failure Exercise control Therapeutic safety Quality control Cost benefit analysis Life style Cardiac rehabilitation 

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Copyright information

© Urban & Vogel 1999

Authors and Affiliations

  • Hans-Christian Heitkamp
    • 1
  1. 1.Abteilung SportmedizinMedizinische Klinik und Poliklinik der UniversitätTübingen

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