International Circulation: You gave a presentation today entitled “Outgoing Cardiac Rehabilitation in Austria – A Possible Model for China?” In China， there is very little structured rehabilitation， so what are the benefits of having structured rehabilitation?
　　《国际循环》：您介绍了题为“奥地利院外心脏康复模式——中国可借鉴模式”的演说，但在今天的中国，很少有结构性的康复计划，这种康复模式的好处有哪些？
　　Prof Niebauer: There are lots of benefits. When patients are in the acute care hospital， most times it is for the first time; until then they didn’t even know they had heart disease. They are treated by PCI or surgery quickly and especially with PCI you can be sent home the same day， or a couple of days later. When they revisit the doctor， many times they just need someone to translate to them what happened during those two or three days as they have little idea of what occurred. First of all， there is the fear that their life expectancy will not be what it was now they have heart disease. They have heard lots of things but don’t really know what it is. Will they die young? Will they be able to return to their jobs? And with family to support， there are lots of things on their mind. So they don’t pay attention too much to what they have been told in the hospital. In cardiac rehabilitation， you have the time to go through with them and educate them on what it is all about and also what the chances are; not just the risks. Of course they need to know that heart disease is potentially lethal， but they need to be aware that there is a way out; that there is good treatment these days and that they need to comply with it. Cardiac rehabilitation first of all educates the patient but then also ensures that compliance in taking medication is much better and introduces them (either for the first or hopefully reintroduces them) to physical activity and that they get into the routine of daily exercise like there used to be in China. I came to China for the first time ten years ago and there was much more morning tai chi and more people walking around exercising. That is obviously decreasing. I see the same with bicycles. There are fewer bicycles and more electric bikes and cars. They need to get back into the habit of exercising daily as one way of helping patients make a lifestyle change.
　　Niebauer教授：这种模式有很多好处。许多突发心脏病的患者因急诊入院时往往是他们第一次入院治疗，他们甚至不知道自己患有心脏疾病。这些患者入院后接受急诊PCI或手术治疗，PCI治疗后当天或数天之后即可出院回家，他们可能并不清楚自己发生了什么，因此复诊时，非常需要专业人士解释在急诊入院的两三天里发生的事情。首先，他们知道了自己患有心脏疾病，而可能导致寿命缩短，会因此而产生恐惧。这些患者不一定真的清楚发生了什么，但他们会反复思考以下问题：我会年纪轻轻就死去吗？我能够重返工作岗位吗？他们会将家人的支持记在心中，但也因此不太会关注医生所告诫的事情。而在有计划的康复过程中，你有时间去陪伴患者，告诉患者住院期间所发生的事情，教给他们相关的知识，以及此次心脏病发不只是风险，还存在着机会。患者需要知道心脏疾病是可能致命的，但他们还需要知道是有出路的，目前已有很好的治疗措施，他们只需要配合康复就能达到很好的预后。心脏康复中心在教育患者的同时还可提高服药的依从性，并向患者介绍（无论是第一还是再次介绍）体力活动和中国传统的日常锻炼。10年前我第一次来到中国，清晨有很多打太极拳和散步锻炼的人们，但今天我再次来到这里，锻炼和骑自行车的人数明显减少，取而代之的是电动自行车和汽车。心脏康复中心能够进一步帮助患者找回锻炼的习惯，培养良好的生活方式。
　　International Circulation: So one part of cardiac rehabilitation is education. I assume the other part is exercise itself? What sort of things do they do?
　　《国际循环》：教育是心脏康复治疗的一部分，那另一部分是不是是自我锻炼呢？怎样进行自我锻炼呢？
　　Prof Niebauer: The mainstay is actually exercise training. Two-thirds of the time they spend in cardiac rehabilitation will be in exercise training. In the aged patient setting， for the first six weeks they will come three times a week and maybe spend three to four hours each time. Of those three to four hours they will exercise for two hours. One hour will be endurance training either on a stationary bike or treadmill and the other hour will be strength training so they will start to build muscle again but also teach co-ordination and prevent falls and build up their strength so they are able to climb stairs again and to be able to go shopping again to keep them out of nursing homes and avoid re-admittance to hospital due to frailty or illness. So exercise training is two-thirds of the time. A psychologist also talks to them， as heart patients after an acute event tend to be depressive to some extent. When they are in this situation for the first time in their lives， the psychologist can help them to identify why they are afraid and show them ways to get out of that. There is also stress management as quite a few people are under tremendous stress and don’t know how to cope with all of it. There is a social worker involved as maybe they are not able to go back to their job. What are their options? Is there another job they can be retrained for? Maybe a retirement plan is required. There is a dietician to teach them about how to improve their diet. They are the mainstays and can be supplemented with whatever is needed. A patient after surgery will need physical therapy， so there will be a physiotherapist on board.
　　Niebauer：心脏康复中心教育的主体实际上是运动训练。心脏康复的3分之2的时间都是运动训练，例如老年患者的康复，前6周是每周3次、每次3到4个小时康复时间，其中2个小时在进行运动训练。1小时的耐力训练为固定自行车、跑步机形式，另1小时为力量训练，患者将开始重新恢复肌肉运动，防止跌倒并逐步恢复自己的体力，之后他们将能够爬楼梯、逛街，避免回到养老院或由于体弱生病重新住院治疗，因此，运动训练时间占了三分之二。心理学家认为，这些经历了急性心脏事件发生的患者往往患有一定程度上的抑郁症，对于这种首次的不良患病经历，心理学家可以帮助他们找出害怕的原因，并帮助消除低落情绪。这些患者中不少人都承受着巨大的压力，不知道该如何应对这一切，在压力管理中，当患者出现无法重返工作岗位时即可派出社会工作者帮助他们。他们有什么选择呢？是否有另一种他们可以接受再培训的工作？也许患者需要一个退休计划？康复中心的营养师将教会患者如何改善自己的饮食，物理治疗师将指导手术后患者所需要物理治疗，以及其他任何所需的支持及任何需要补充。

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