Optimal exercise intensity for rehabilitation program in patients with multifunctional disabilities.

有报道称，急性心肌梗死(AMI)后的康复可以改善循环功能和体能。在本项目中，我们证明了急性心肌梗死后的短期强化教育也改善了患者的心理状态，特别是减轻了抑郁和焦虑，这有助于提高急性髓细胞白血病患者的生活质量。此外，强化教育在进行长期运动训练中的重要性也得到了体现。为了评价运动训练的效果，我们应用了心率变异性(HRV)分析。经常进行体育锻炼(医生推荐)的患者心率变异性有良好的变化(静息时副交感神经活动相对增加，应激状态下交感神经活动减少)，而很少锻炼的患者心率变异性无明显变化。脑中风患者的超声心动图检查显示…左室壁增厚、主动脉瓣钙化和/或反流、心房颤动伴左心房扩大等异常发现的发生率更高。这些异常在中风复发病例中更容易被发现，这表明中风的危险因素(高血压、高脂血症、糖尿病等)的处理。对于减少中风的复发非常重要。我们对脑卒中患者在康复过程中的心率变异性进行了分析，观察到经常进行体育锻炼的急性心肌梗死患者的心率变异性也有类似的变化。针对多功能残疾，我们报道了在肾功能衰竭血液透析(HD)条件下的中风患者的康复方法，这类患者在HD当天容易疲劳而要求康复治疗的次数较少。当然，疲劳取决于许多因素，但HD期间的出血量是导致这些患者疲劳的主要决定因素之一。对于多功能残障患者，最好以患者一般情况没有恶化的程度来确定康复锻炼的强度。一般来说，通过对无禁忌症患者的循环和一些其他功能的调查，无氧阈值或更低的运动强度水平将最有利于康复，尽管强度水平必须根据任何其他器官的功能障碍情况进行调整。较少

It has been reported that rehabilitation after acute myocardial infarction (AMI) improves circulatory functions and physical performance. In the current project, we have demonstrated short-term intensive educational program following AMI also improves the mental status, especially diminishing depression and anxiety, which contributes to better quality of life for patients with AML Moreover, the importance of intensive education has been revealed in conduction of long-term exercise training. As to evaluate the efficacy of exercise training, we have applied heart rate variability (HRV) analysis. The patients who have frequently performed physical exercise (as recommended from the doctors) demonstrates favorable changes in HRV (relatively increased parasympathetic activity at rest, and reduced sympathetic activation under stress conditions)while patients with rarely exercised shows no remarkable changes in HRV.Ultrasonic cardiographical examination in patients with cerebral stroke has sho … More wn higher rates of abnormal findings, i.e., thickening of left ventricular wall, calcifications and/or regurgitation of aortic valve, atrial fibrillation with enlarged left atrium, etc. These abnormalities have much more frequently detectedin cases of recurrence of stroke, which suggests management of risk factors of stroke (hypertension, hyperlipidemia, diabetes mellitus, ...) is very important for reducing the recurrence of stroke. We have performed HRV analysis during the course of rehabilitation in patients with stroke, in which we have observed similar changes in HRV with AMI patients who have conductedphysical exercise frequently.Concerning with the multifunctioal disabilities, we have reported rehabilitation methods for stroke under the condition of hemodialysis (HD) due to renal failure, Such patients as HD often claimed less numbers of rehabilitation therapy because of easily fatigue on the day of HD.Of course the fatigue depends on many factors, but extraction volume during HD is one of the major determinants of fatigue in these patients. It will be better for patients with multifunctional disability to determine the intensity of rehabilitation exercise by the levels that the general conditions of patients are not getting worse. In general, intensity levels of exercise with anaerobic threshold or less will be most convenient for rehabilitation from the survey of circulatory and some other function in patients without contraindications, although the intensity levels must be adjusted by conditions of functional disorder in any other organs. Less