cardiopulmonary physical therapy -...
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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 ([email protected])
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
Individual Project 2“Evidence Based
Practice”
Please submit the project1 by May 11th 12:oo am via email ([email protected])
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