Who needs cardiac rehab?

Anyone who has had a heart problem, such as a heart attack, heart failure, or heart surgery, can benefit from cardiac rehab. Studies have found that cardiac rehab helps men and women, people of all ages, and people with mild, moderate, and severe heart problems.
But certain people are less likely to go to or finish a cardiac rehab program. These include:

• Women Studies show that women, especially minority women, are less likely than men to go to or complete a cardiac rehab program. This may be because doctors may be less likely to suggest cardiac rehab to women.
• Older adults Older adults are also less likely to join a cardiac rehab program following a heart problem.They may think they are unable to do the physical activity because of their age, or they may have other conditions that can make exercising harder, such as arthritis. This makes cardiac rehabilitation especially useful for older adults, since it can improve strength and mobility to help make daily tasks easier.

How does cardiac rehab help?

Cardiac rehab can have many benefits to your health in both the short and long-term, including:

• Strengthening your heart and body after a heart attack.
• Relieving symptoms of heart problems, such as chest pain.
• Building healthier habits, including getting more physical activity, quitting smoking, and eating a heart-healthy diet. A nutritionist or dietitian may work with you to help you limit foods with unhealthy fats and eat more fruits and vegetables that are high in vitamins, minerals, and fiber.
• Reducing stress.
• Improving your mood. People are more likely to feel depressed after a heart attack. Cardiac rehab can help prevent and lessen depression.
• Increasing your energy and strength, making daily activities easier, such as carrying groceries and climbing stairs.
• Making you more likely to take your prescribed medicines that help lower your risk for future heart problems.
• Preventing future heart problems and death. Studies have found that cardiac rehab decreases the chances you will die in the five years following a heart attack or bypass surgery by around 20% to 30%

Pulmonary Therapy

A primary goal of pulmonary rehabilitation is to reduce the patient’s perception of shortness of breath.

Dyspnoea severity should be assessed before and after PR (see Patient reassessment section).
There are a number of measurement tools available for assessing dyspnoea, including:

• Modified Medical Research Council (MMRC) Dyspnoea Scale.
• Modified Borg Dyspnoea Scale (0-10).

Some health-related quality of life measures also include dyspnoea as a component. For example, the Chronic Respiratory Disease Questionnaire includes a standardised dyspnoea measure.
Some measures of dyspnoea are useful for clinical assessment (e.g. the MMRC Scale) and can provide a baseline indication of the patient’s status. However, these scales are not particularly sensitive to interventions such as PR.
Important features of two dyspnoea scales, which are valid, reliable and commonly used, are summarised in the table below.

How will I know if Pulmonary Rehabilitation is right for me?

Your healthcare provider will determine if you qualify for pulmonary rehabilitation by:

• Evaluating your current state of health and lung function test results.
• Discussing your current activity level and your ability to do the things you want to do.
• Determining your willingness and ability to attend. Pulmonary rehabilitation programs are limited in the number of people who can attend so that you get close supervision. You will be evaluated before you begin the program to make sure you do not have health issues that would limit your ability to join. This evaluation may take place at the rehabilitation site or in a clinic by a physician, advanced practice nurse, or physician assistant.
  Once the program begins, a team of healthcare professionals (nurses, respiratory therapists, physical therapists, occupational therapists, psychologists, dieticians, social workers, spiritual advisors such as a chaplain and others) will work with you to put you in charge of your breathing

Components of Pulmonary Rehabilitation

Exercise training

Exercise training is the most important component of pulmonary rehabilitation. It reduces the effects of inactivity and deconditioning, resulting in less shortness of breath and an increased ability to exercise. However, physical limitations may restrict the types of exercise training that can be used. Aerobic exercise and strength training are both important components of exercise training in people with lung disorders.Exercise of the legs is the cornerstone of training. Because walking is necessary for most activities of daily living, many rehabilitation programs use walking (sometimes on a treadmill) as the preferred mode of training. Some people may prefer exercising on a stationary bicycle. Choosing an exercise that is comfortable and satisfying for the person enhances willingness to participate long-term. Exercise training of the arms is also beneficial for people with chronic lung diseases who have shortness of breath or other symptoms during their normal activities of daily living, such as washing their hair or shaving. Such training is needed because chronic lung disease can cause muscle loss, and some of the shoulder muscles are used in breathing as well as in moving the arms. Activities involving arm work can quickly overexert these muscles.

Inspiratory muscle training

Inspiratory muscle training (IMT) is often a component of pulmonary rehabilitation. With IMT, the person uses breathing exercises and devices to strengthen the muscles involved in breathing. IMT is usually used together with traditional aerobic exercise and helps reduce shortness of breath and increase the person's ability to exercise.

Neuromuscular electrical stimulation

ENeuromuscular electrical stimulation (NMES) uses a device that applies electrical impulses through the skin to selected muscles to stimulate contraction and thus strengthen them. NMES can be effective in people with severe lung disease because it does not cause the shortness of breath that often prevents these people from participating in typical exercise training.

Psychosocial counseling

Depression and anxiety are common reactions to the life changes a person with lung disease experiences. In addition, shortness of breath itself may cause anxiety and depression, interfere with sexual activity, and cause difficulty managing stress and relaxing. Through counseling, group therapy, and, when needed, drug treatment, people may be able to better cope with these psychosocial problems. Sometimes family members participate in counseling to help them cope with the stress involved in caring for a person with lung disease.

Nutritional evaluation and counseling

People who have lung disease often need nutritional evaluation and counseling. For example, those with the most severe chronic obstructive pulmonary disease often experience weight loss. Pulmonary rehabilitation programs help people avoid weight loss and maintain muscle mass. People must be taught to eat in such a way that they maintain adequate caloric intake while avoiding becoming too full, which can interfere with breathing. Alternatively, some people gain weight because of a reduced activity level. In this case, breathing places a greater demand on an already taxed respiratory system. Weight reduction benefits such people.

Drug use and education

People with severe lung disease usually take several drugs. Often these drugs must be taken according to precise instructions and a complex schedule. Through a rehabilitation program, people can learn about the appropriate timing and doses of all drugs they need to take. Education often includes information about the nature of the lung disease and the role of drug therapy, including expected benefits, potential side effects, and the proper technique for use of inhaled drugs. Programs closely monitor how well people follow instructions and teach them and their families about the importance of appropriate drug use. People are also taught about the need for smoking cessation, breathing strategies (such as pursed-lip breathing, in which exhalations are begun against closed lips to decrease breathing rate and shortness of breath), and the principles of conserving physical energy.