cardiopulmonary physical therapy -...

Cardiopulmonary Physical Therapy

Haneul Lee, DSc, PT

Delivering oxygen to active tissue

Playing an important role in

movement

Limiting factor to performing

functional activities

Physical Therapists are responsible for providing education on the prevention of cardiopulmonary disease and for managing patients.

Introduction to Special Series, Cardiopulmonary Physical Therapy, Journal of the American Physical Therapy Association, May 1996, 76(5)

World HistoryWilliam Heberden, 1772 <Commentaries on the History and Cure of Diseases>

Chest disorder patient – 30 minutes daily exercise for 6 months

History in Korea

Thelma B. Maw (한국명 : 모우숙), 1949

First physical therapy

Eli Anderson, 1958

First cardiopulmonary physical therapy

Korea Cardiopulmonary Therapy Association, 2011

Korea Physical Therapy Board, 2014

▪ 물리치료중재 / 실기시험

aging population

Physicalactivity

Cardiopulmonary

Quality of Life

Decramer M, Janssens W, Miravitlles M (April 2012). "Chronic obstructive pulmonary disease". Lancet 379 (9823): 1341–51

Roughly 915,000 Americans have a hear attack More than 30% have a potentially fatal event Cardiac rehabilitation (CR) risk of a future cardiac

event by stabilizing, slowing or even reversing the progression of cardiovascular disease (CVD).

Other cardiovascular also benefits from a CR such as exercise rehabilitation

Yet despite its clear benefits,

Only 14% to 35% of eligible heart attack survivors Only 31% of patients after coronary bypass surgery

participate in a CR program The more sessions patients attend, the better their

outcomes and the lower their risk for heart attack and mortality compared to those who do not participate

Medically supervised program consisting of exercise training, education on heart healthy living and counseling to reduce stress and help patients return to an active lifestyle

Overall physical, mental, and social functioning of people with heart and lung

related problems

20-30% in all-cause mortality mortality at up to 5 years post participation symptoms (angina, dyspnea, fatigue) exercise performance knowledge about it and its management ability to perform activities of daily living health-related quality of life psychosocial symptoms ability to return to work or engage in leisure

activities

Prevention and management of acute infectious

disease

Prevention and management of lifestyle-related

conditions

Ischemic heart disease (IHD)Smoking-related conditionHypertension and stroke,

diabetes, obesity, and cancer

Assessment of health behaviors and recommendations for healthy living can be put into practice in every patient interaction and, in turn, help reduce the populations’ health risk and mitigate the economic cost of lifestyle-related conditions

Risk Factor

Cardiovascular and Peripheral Vascular Disease

Obstructive Lung Disease Stroke

Type 2 Diabetes Mellitus Cancer Osteoporosis

Smoking X X X X X X

Physical activity X X X X X

Obesity X X X X X

Nutrition X X X X X

High blood pressure X X X

Dietary fat X X X X

Elevated glucose levels X X X X

Alcohol X X X X X

To provide the PT students with a practical working knowledge of: 1. The anatomy and physiological consequences of the more co

mmon cardiopulmonary diseases and disorders.2. The role of physical therapy in cardiopulmonary disease man

agement.3. The application of appropriate physical therapy techniques to

patients with cardiopulmonary dysfunction in a variety of settings.

4. Management of the cardiopulmonary rehab patient using a team approach.

week Topic

1 Informing cardiopulmonary physical therapy

2 pulmonary anatomy & physiology

3 Cardiovascular anatomy & physiology

4 Pulmonary pathology I

5 Pulmonary pathology II

6 Cardiovascular pathology I

7 Cardiovascular pathology II & overview

8 Midterm

9 Cardiopulmonary examination I

10 Cardiopulmonary examination II

11 Cardiovascular diagnostic test

12 Pulmonary rehabilitation I

13 Pulmonary rehabilitation II

14 Cardiac rehabilitation I & Cardiac rehabilitation II

15 Group project presentation

16 Final

Individual Project 1

“The role of physical therapist in Cardiopulmonary Rehabilitation”

3 pages Page 1 – literature review Page 2 – Compare cardiopulmonary rehab between Korea and Other countries Page 3 – What do “YOU” think? Font size 12, double space by using Microsoft word You are allowed to write this report in Korean but you will get 5 extra points if

you write this in English Plagiarism is an acceptable in any case

Please submit the project1 by April 8th 12:oo pm via email (leehaneul84@gachon.ac.kr)

Plagiarism is the "wrongful appropriation" and "stealing and publication" of another author’s "language, thoughts, ideas, or expressions" and the representation of them as one's own original work

Write Check beta; http://en.writecheck.com/ways-to-avoid-plagiarism/

"...the consequences of plagiarism are much more serious than the consequences of turning in a paper late..."

Understand what you're doing when you write a paper

Follow a method that is systematic and careful as you do your things

1. Harvard Guide to Using Sources, http://isites.harvard.edu/icb/icb.do?keyword=k70847&pageid=icb.page3420572. Write Check beta; http://en.writecheck.com/ways-to-avoid-plagiarism

1. Paraphrase

2. Cite

3. Quoting

4. Citing Quotes

5. Citing Your Own Material

6. Referencing

Self-plagiarism

https://www.copykiller.co.kr/

Individual Project 2“Evidence Based

Practice”

Please submit the project1 by May 11th 12:oo am via email (leehaneul84@gachon.ac.kr)

Short presentation (5minutes)

Group 1 : May 13

Group 2 : May 20

Group 3 : May 27

Group 4 : June 3

Final Presentation Project

Design an exercise prescription Discuss clients (patients) goals Determine persons’ VO2 predicted max level by using Sub-max testing-

discuss test and results Assign a risk stratification, determine their fitness level Discuss designed exercise program for participant FITT – frequency, intensity, time, type of the exercise prescription

15-20 minutes (Maximum 20 minutes) PowerPoint presentation on the results

The purpose of this presentation is to evaluate, assess and discuss a person’s overall fitness by using test and measures. Keep in mind to present the person’s overall goals, and possible lifestyle changes if any.

1. Personal Demographic

26 years old

Female

Asian

A graduate student

Material Status – Single

2. Chief Complain

She is out of breath when she goes up hills.

e.g. She even feels puffy when going to Nichol Hall from Lindsay Hall

She feels uncomfortable with gained weight since last one year.

3. Past Medical History

Surgery for Atrial Septal Defect

Surgery for Pulmonary Stenosis

4. Drug History

Currently taking no medication

5. Family History

Older sister died because of Congenital Heart defect at 3-month-old.

Grandmother had a heart problems and has gotten a heart pacemaker for 15 years.She has a heterotaxia.

6. Life Style (Social history)

Alcohol – socially ( 1~2 a month) Non smoker Sedentary life style Irregular diet

(Change diet : Asian home style foods-> High-fat foods)

No working out at all Car-oriented life style Have gained weight 15 lbs. for 1 year

BASIC INFORMATION

26 years old, Female

H : 5”7 // W : 152 lbs.

BMI : 23.87 kg/m2

BP : 108 / 67

HR : 84

Body Fat : 36%

(Body composition Analyzer)

Choo V., WHO reassesses appropriate body-mass index for Asian populations,The Lancet, Jul 2002 20;360(9328):235

"The range for acceptable, normal, or optimum body-mass index (BMI) for Asian populations should be narrowed to 18.5-23 kg/m2, according to a WHO expert consultation on appropriate BMI for these populations that took place on July 8-11 in Singapore".

≥ 2 risk factors Past medical history

1. Decrease BMI by 10% for 3 months (24 -> 21.5)

- Increase skeletal muscle mass

- Decrease fat mass

- Increase basal metabolism

2. Change life style

- Change dietary habit

- Aerobic exercise ≥ 30mins per 3times a week

1 mile walk test

Time : 13 min 50 sec10 second HR : 32 / 33

VO2 Max : 33.9 ml/kg/min

Kline GM, Porcari JP, Hintermeister R, Freedson PS, Ward A, McCarron RF, Ross J, RippeJM; Med Sci Sports Exerc 1987 Jun;19(3):253-9

Normative data for VO2max for Female

Patient's VO2 Max : 33.9 ml/kg/min GOOD

The Physical Fitness Specialist Certification Manual, The Cooper Institute for Aerobics Research, Dallas TX, revised 1997 printed in Advance Fitness Assessment & Exercise Prescription, 3rd Edition, Vivian H. Heyward, 1998.p48

Functional Capacity of 10 METS.

: Based on patient’s specific health condition (medical history and no exercise last few years),I determine patient should be started at 50% of her functional capacity with aerobic exercise.

- Avoid diets of less than 800 kcal a day- Safety all nutritional needs- Avoid specific diet ( very low-fat diet / low carb, high protein)- A dietary program needs to be cope with

exercise program - The exercise program needs to be tailored

to the individual.(Especially, she has a medical history)

Find an exercise or physical activities that are enjoyable and do not require a certain instrumentto promote increase physical activity.

1st month Regular exercise

: Walking at an average pace(2mi/hr) 2days a week:Participate in Water Aerobic class at drayson center3 days a week ( 1hour session)

Life style exercise: go to somewhere in campus

by foot: Enjoy window shopping on

weekend

2nd month Regular exercise

: Walking at a brisk pace (3mi/hr) 2 days a week (30mins): Take a dance class at drayson center 3times a week

( Salsa Aerobics / Jazz movement)

Life style exercise: keep doing 1st month exercise: use gym ball as a chair to improvebalance and strength abs.

3rd month and after Regular exercise

: Walking at a very brisk pace (4mi/hr) 3 days a week (30min): Start to learn a tennis or squish 2days -> 3days a week

( 1 hour session)

Life style exercise: keep doing 1st & 2nd month exercise: start to go to stater bros by foot

She had a heart surgery before so therapist always keeps eyes on her health condition.

Question?Thank

you

1. The 10 leading causes of death in the world, 200 and 2011.World Health Organization. July 2013. November 29, 2013.

2. Introduction to Special Series, Cardiopulmonary Physical Therapy, Journal of the American Physical Therapy Association, May 1996, 76(5)

3. Lomborg, Bjørn (2013).Global problems, local solution: costs and benefits. Cambridge University Pres. p. 143

4. Decramer M, Janssens W, Miravitlles M (April 2012). "Chronic obstructive pulmonary disease". Lancet 379 (9823): 1341–51

5. Vestbo, Jørgen (2013). "Definition and Overview". Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease. Global Initiative for Chronic Obstructive Lung Disease. pp. 1–7.

6. Rycroft CE, Heyes A, Lanza L, Becker K (2012). "Epidemiology of chronic obstructive pulmonary disease: a literature review". Int J Chron Obstruct Pulmon Dis 7: 457–94.

7. Currie, Graeme P. (2010). ABC of COPD (2nd ed.). Chichester, West Sussex, UK: Wiley-Blackwell, BMJ Books. p. 32

8. O'Donnell DE (2006). "Hyperinflation, Dyspnea, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease". The Proceedings of the American Thoracic Society 3 (2): 180–4.

9. O'Donnell DE (2006). "Hyperinflation, Dyspnea, and Exercise Intolerance in Chronic Obstructive Pulmonary Disease". The Proceedings of the American Thoracic Society 3 (2): 180–4.

10. U.S. National Heart Lung and Blood Institute. Retrieved 2013-07-23.11. Puhan MA, Gimeno-Santos E, Scharplatz M, etc (2011). Puhan. "Pulmon

ary rehabilitation following exacerbations of chronic obstructive pulmonary disease". Cochrane Database Syst Rev (10): CD00530

12. Holland AE, Hill CJ, Jones AY, McDonald CF (2012). Holland, Anne E, ed. "Breathing exercises for chronic obstructive pulmonary disease". Cochrane Database Syst Rev 10: CD008250.

13. Borg, G. (1970). "Perceived exertion as an indicator of somatic stress". Scandinavian journal of rehabilitation medicine 2 (2): 92–98. PMID 5523831

14. Exercise for persons with chronic obstructive pulmonary Disease, American College of Sports Medicine