Getting to the Heart of Cardiopulmonary Physical Therapy
Heart and Lung Trouble Ruining Your Day?
Rehabbing Your Heart and Lungs With Physical Therapy…
When you hear the words “physical therapist” most people picture professionals that help people recover from injuries to their back, neck, arms, and legs. Fewer people know that physical therapists (PTs) are also trained to help persons recover from heart and lung conditions. With specialized education and training in the cardiopulmonary system and in depth understanding of the principles of exercise, PTs are a vital part of a care team for someone looking to strengthen their heart and their lungs so they can get back to their everyday activities.
According to the Centers for Disease Control and Prevention, 4.6% of American adults have been diagnosed with respiratory conditions including COPD, chronic bronchitis, and emphysema. Hundreds of thousands of visits to the emergency department will occur each year for complications related to conditions like COPD. Conditions affecting the function of the lungs can be acute–such as a recent COVID-19 infection–or chronic such as with asthma, lung cancer or restrictive lung disease. They may be caused by bacterial, viral, or fungal infections or from environmental causes. In any case, these conditions can have a significant impact on the lungs ability to absorb the vital oxygen we need to sustain life, get rid of the carbon dioxide byproduct, and support our body’s functions from sitting up to running a marathon.
Cardiovascular disease is the leading cause of death among Americans. According to the CDC, someone in the United States has a heart attack every 40 seconds and over 18.2 million Americans over the age of 18 are living with coronary artery disease. Just as the lungs are vital for supplying the body with the oxygen it needs, the heart is the organ that ensures this oxygen gets transported to all the cells in the body. The cardiovascular system is a network of vessels that transports oxygenated blood to and deoxygenated blood from all the muscles and organs and which is pumped by the strong smooth muscles of the four chambers of the heart. This system can become less efficient and effective due to any condition that impacts the heart and the vessels such as congestive heart failure, coronary artery bypass graft surgeries, a heart attack, and many others.
EXERCISING THE HEART AND LUNGS
When we are healthy we take for granted that our heart and lungs can support all of the physical activities we do each day. If you take up running as a new sport, you can expect your heart and lungs will become more efficient at their jobs over time allowing you to run faster and longer with less effort. When the heart and lungs are injured or impacted by disease, their ability to perform at a level that supports even your basic functions can be compromised. This is where cardiopulmonary physical therapy can assist in restoring the function of these organs to the greatest degree possible.
WHAT CAN I EXPECT FROM CARDIOPULMONARY PT?
If you’ve been referred to cardiac or pulmonary rehabilitation or if you are reading this article wondering if you might be a good candidate, you should know that your therapist will be working closely with your cardiac and pulmonary specialist physicians to understand the restrictions and contraindications to exercise you may have. Each person and each body is different, but the goals of this type of rehabilitation are to help individuals improve their breathing and their aerobic capacity in a carefully monitored environment.
Establishing a Baseline: If appropriate, your physical therapist may administer an exercise test to help establish your baseline lung and aerobic capacity. Typically in this setting it is a submaximal test due to concerns for safety. Most often these tests include pedaling on a stationary bike or walking on a treadmill at gradually increasing speeds, resistances, or inclines while carefully monitoring things like symptoms, rate of perceived exertion, heart rate, oxygen saturation and heart rhythm.
Safety First: Monitoring vitals and heart rhythm is how your therapists know that you are exercising in an optimal and safe range. Before beginning your exercise program for the day, you can expect to have your baseline heart rate, oxygen saturation, blood pressure and symptoms recorded. These will then be monitored either continuously or intermittently while you exercise. If you have been referred to a specialized cardiac or pulmonary rehab program versus a regular physical therapy clinic, you may be asked to wear a portable EKG so your therapists, nurses, or exercise physiologists can also monitor your heart rhythm.
Graded Aerobic Exercise: To improve aerobic capacity and breathing, you will be performing aerobic conditioning that will always challenge you but never exceed your capabilities. As your body adapts to the exercise it may increase in speed, duration or intensity so that gradually, over time, you can tolerate more activity outside of therapy.
Graded Resistance Training: Resistance training such as free weights or weight machines is also an important aspect of cardiopulmonary physical therapy. If you haven’t done resistance training before, don’t worry! Your therapist will work with you to develop a resistance training program that is appropriate for you and that you can progress as you get stronger.
Breathing Exercises and Airway Clearance Techniques: Learning how to breathe more efficiently to take in oxygen and clear out carbon dioxide, specific exercises to strengthen the muscles that expand and compress the lungs, and techniques for clearing out secretions in the airways are all a part of pulmonary physical therapy.
Exercises and Manual Therapy to Improve Ribcage Mobility: Having a mobile and flexible ribcage and spine will allow the lungs to expand and compress to their maximal capabilities. Rigidity in the trunk muscles, stooped posture, or conditions like scoliosis can reduce the flexibility of the ribcage and impair lung function. You may be prescribed mobility exercises that you perform yourself and your therapist may also apply some hands on techniques such as joint or soft tissue mobilization to improve tissue and joint flexibility around the spine and ribcage.
Lots of Learning: One of the most important aspects of cardiopulmonary physical therapy is the education it provides. While restoring function is always the ultimate goal, understanding the anatomy and physiology of your condition and how it affects long term prognosis is an important part of these programs. Learning strategies to conserve energy, how to balance rest and activity, understanding what assistive devices are available to you to support you in being more independent and active, and getting referrals to other medical professionals and community resources are all a part of cardiopulmonary physical therapy.
If you have been feeling like you can’t participate in life like you did before because of a heart or lung condition, cardiopulmonary physical therapy can help. It can be scary and intimidating to begin a new exercise program when your heart or lungs aren’t in top shape, but you do not have to do it alone. A better quality of life is out there and your physical therapists are standing by to guide you there.
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First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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