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Tai Chi in Heart Failure

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Title: Tai Chi in Heart Failure


1
Tai Chi in Heart Failure
  • Sarah Terry
  • BHF Community Heart Failure Sister

2
Heart Failure
  • Mortality in 5 years is 50
  • Incidence increasing with age
  • Physically-
  • Dyspnoea
  • Limited Exercise tolerance
  • Activity limitation
  • Muscle deconditioning
  • Psychosocial-
  • Depression
  • Anxiety
  • Stress
  • Isolation

3
Exercise in patients with Heart Failure.
  • A vicious circle
  • Reduced activity ? Muscle cardiac
  • de-conditioning ? Reduced exercise tolerance ?
    Reduced activity
  • Exercise poses a special challenge for people
    with heart failure (Morantz 2003)
  • Patients with heart failure may have lt50 of the
    maximal cardiac output of a healthy person at
    peak exercise (Morantz 2003)

4
The Guidelines
  • NICE (2003) states
  • Patients with CHF should be encouraged to adopt
  • regular aerobic and/or resistive exercise
  • AHA (2003) states
  • Exercise training is safe and can benefit
    patients with
  • heart failure
  • Cardiac Rehab programmes have already shown the
    benefit of exercise for patients following an MI
    or ACS

5
Trials Studies
  • A study in South Korea of 68 older adults made
    comparisons between those who practised Tai Chi
    and those who did not (Choi 2005)
  • Yeh et al (2004) randomised controlled trial
    with Tai Chi vs. Control group. 30 patients
    included, mean age 64 years with chronic stable
    heart failure

6
The Aim of Exercise
  • To improve the patients overall functional status
    as a result of decreasing their breathlessness
    and fatigue symptoms on exertion

7
The Benefits of Exercise
  • Reductions in systolic and diastolic blood
    pressure (Taylor-Pillae 2003)
  • Improvement in peak oxygen uptake
    (Wang et al 2004)
  • Improved balance, lower limb strength and gait
    (Wolf et al 1997)
  • Increased exercise tolerance due to adaptations
    in skeletal muscles (Morantz 2003)
  • Reductions in stress, depression and fatigue
    (Dimeo et al 2001)

8
What is Tai Chi?
  • Developed by Taoist monk in 13th century
  • Primarily used as a martial art, now used in
    healing and meditation
  • In traditional Chinese medicine it is believed
    that illness is a result of imbalance between
    opposing life forces
  • Moving meditation that generates the bodys
    natural energy
  • Gentle and controlled movements increasing
    flexibility, co-ordination balance

9
Why Tai Chi?
  • Aging population in local area
  • High multiple admissions with heart failure
  • Benefits of exercise in patients with heart
    failure
  • Evidence of Tai Chi used as an effective form of
    exercise in other medical conditions
  • Tai Chi provided a programme that did not
    restrict by age, mobility, ability or
    co-morbidities

10
How does it work?
  • Cardiovascular system is gently exercised
  • The parasympathetic nervous system is stimulated
    causing a decrease in heart rate and dilation of
    the blood vessels
  • A basic element of Tai Chi is relearning to walk
  • Weight is transferred from one flexed leg to the
    other, improving venous blood return
  • Emphasis is placed upon breathing in a positive
    way
  • Exercises can be adapted to mirror activities of
    daily living

11
Psychological aspects
  • Concentration on the movements results in day to
    day worries being left aside
  • Encouragement is given to empty the mind of
    stresses prior to starting the session
  • Depression anxiety are reduced when practised
    regularly
  • Improved mood through changes in concentrations
    of neurohormones and cytokines
  • Increased social contact offers a support network

12
Tai Chi at Hastings Getting started
  • A need was identified for an exercise programme
  • An Instructor was found with an interest in the
    health benefits of the art
  • Central community venue
  • Private transport firm approached for sponsorship
  • GP consent obtained
  • Patients identified invited
  • Audit evaluation tools produced
  • Guidelines approved by Lead Consultant for Heart
    Failure

13
Hastings The Guidelines
  • Patients must be diagnosed with heart failure by
    echocardiogram
  • Patients must be aware of their diagnosis
  • NYHA I III
  • Stable heart failure symptoms
  • Exclusions
  • NYHA IV
  • Patient has had chest pain/discomfort in the past
    24 hours
  • Patient is unduly breathless, more than normal
    for them
  • Recent surgical intervention
  • Unstable on medication
  • Current symptomatic arrhythmia
  • History of exercise induced arrhythmia

14
The First group
  • 8 patients, plus 1 relative
  • Long standing heart failure patients
  • Already known to the Community Heart Failure
    Service
  • Weekly sessions over 8 weeks
  • 6 required transport
  • Minnesota QOL assessment completed pre post
    programme
  • 1 hour Tai Chi completed
  • 45 minutes education session after the Tai Chi
  • Supervised by Heart Failure Sister

15
What did we learn? The Good
  • The transport scheme allowed those usually unable
    to access such programmes to join in
  • The subjective major benefit appeared to be
    social interaction between the patients and their
    carers/relatives
  • Evaluation showed a need to increase the duration
    of the programme and also the need to continue
    the project

16
…….and the Bad!
  • Venue not ideal for colder weather
  • QOL Scores did not improve
  • Transport issues

17
Hastings - Overall Outcomes
  • 31 patients have attended the programme
  • 16 Males vs. 15 Females
  • Average Age 75 years (Range 48-91 years)
  • All NYHA class II III
  • 26 brought a partner
  • 61 used the transport scheme
  • Only 15 QOL assessments fully completed
  • Small reduction in QOL scores (3)

18
Anecdotal Outcomes
  • Patients enjoyed the opportunity to meet their
    nurse regularly to ask questions express
    concerns
  • Patients stated that they could do more activity
    before getting their usual symptoms
  • Patients showed high interest in written
    materials

19
Education Discussion topics
20
Tai Chi at Hastings The Future
  • The programme has spread to the Bexhill Rother
    area, since appointment of Community HF Sister in
    the area
  • Referrals accepted from other health care
    professionals
  • Review QOL measurement tools
  • Cost implications of the programme continue to
    determine venue and accessibility

21
What do the Patients think?
  • I used to fall over several times a week, Ive
    havent fallen over in 5 days, since the last
    session
  • Improvement to my posture, breathing and
    circulation
  • Happy to be here, I feel like I have made new
    friends
  • This has benefited my balance, tension and
    self-esteem
  • I found the sessions useful informative and
    the social aspect helpful
  • The sessions were very relaxing
  • I have realised that I am not alone
  • Many HF patients are fearful of their future
    regarding their ability to cope with everyday
    life as a result of their altered physical
    condition. The Tai Chi course and discussion
    sessions would most likely dispel that fear

22
References
  • Morantz C. 2003. Practice GuidelinesAHA releases
    statement on Exercise and Heart Failure. American
    Family Physician. Sept 1.
  • Pina IL et al. 2003. Exercise and Heart Failurea
    statement from the American Heart Association
    Committee on Exercise, Rehabilitation and
    Prevention. Circulation. 107. 1210-1225.
  • Song et al.2003.Effects of Tai Chi exercise on
    pain, balance, muscle strength and perceived
    difficulties in physical functioning in older
    women with osteoarthritisa randomised clinical
    trial. Journal of Rheumatology.30(9).2039-44.
  • Taylor-Pillae RE. 2003. Tai Chi as an adjunct to
    Cardiac rehabilitation exercise training. Journal
    of Cardiopulmonary Rehabilitation. 23. 90-96.
  • Wang C et al. 2004. The effect of Tai Chi on
    health outcomes in patients with chronic
    conditions. Archives on Internal Medicine. 164.
    493-501.
  • Wenger NK et al. 1995. Cardiac RehabilitationClin
    ical Practice guideline No.17. US Dept of Health
    and Human Services.
  • Wolf SL et al. 1996. Reducing frailty and falls
    in older persons. Journal of the American
    Geriatric Society. 44. 489-497.
  • Wolf SL et al. 1997. Exploring basics for Tai Chi
    Chaun as a therapeutic exercise approach.
    Archives of Physical Medicine and Rehabilitation.
    78. 886-892.
  • Yeh GY et al. Effects of Tai Chi Mind Body
    Movement Therapy on Functional Status and
    Exercise capacity in patients with chronic heart
    failure. American Journal of Medicine. 117.
    541-548.

23
Any Questions?
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