Life is Movement (Aristotle, 4th century BC)
نویسندگان
چکیده
During our clinical or outpatient contacts we often tell patients with coronary heart disease that physical activity will lessen the burden of their disease, reduce their risk of mortality and enhance their quality of life. However, after delivering this one-liner we have no illusions that patients will start moving and stay active straight away. Many practical barriers deter them and behavioural change, such as adopting a physically active lifestyle, is only achieved when various stages of change have been successfully completed [1]. What really helps is referring patients quickly to an outpatient or clinical cardiac rehabilitation (CR) program. This does not always happen properly, but with the help of allied professionals such as the nursing specialist, the situation (in the Netherlands) is better now than 10 years ago. The number of referrals has also increased due to the Netherlands Society of Cardiology/Netherlands Heart Foundation (NVVC / NHS) Cardiac Rehabilitation Guidelines of 2004, updated in 2011 [2], as well as through the encouragement of the Healthcare Inspectorate. At the patient's intake, the cardiac rehabilitation goals are clarified and established in consultation with the patient. The intake includes an exercise test (ergometry). Then, with the patient's medical history and exercise test results in hand, a multidisciplinary team decides on a CR program. In Groning-en we speak of 'Short Fit', 'Long Fit' and occasionally 'Fit Plus' programs. Underlying the choice is the patient's single, multiple or complex heart-related problems. Often, the backbone of the CR trajectory is exercise, the component applied by the physiotherapist, which gives this allied professional a crucial role in CR. But in addition to physical therapy (and movement agogics), other allied professionals in social work, psychology, dietetics, nursing, case management (logistics and evaluation) as well as the cardiologist all contribute. In this issue of Netherlands Heart Journal (NHJ), movement scientists, epidemiologists, and members of the Royal Dutch Society of Physiotherapists (KNGF) present a concrete proposal for the contents of the movement program [3]. This is an excellent initiative because their own guidelines, established by the physical therapy professionals themselves, stand a better chance of implementation than the cardiologists' guidelines [4]. What we like about the guidelines in their present shape is that they include: 1. Recommendations for physiotherapy prior to heart surgery: for example, respiratory muscle and cough training pre-coronary bypass grafting (CABG), preferably 20 minutes/day starting 4 weeks before surgery [5], 2. Recommendations for postoperative patients, not only …
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