Cardiovascular &

pulmonary
physiotherapy

Physiotherapists treating patients

following uncomplicated coronary artery
bypass surgery (also called coronary
artery bypass graft surgery, or CABG)
surgery continue to use interventions such
as deep breathing exercises that are not
supported by best available evidence.
Standardised guidelines may be required
to better match clinical practice with
current literature.[1]

Diseases and conditions

treated
Cystic Fibrosis

Cystic fibrosis (CF), also known as

mucoviscidosis, is a genetic disorder that
affects mostly the lungs, but also the
pancreas, liver, kidneys, and intestines.[2]
Major advances over the past few years in
the management of cystic fibrosis (CF)
have resulted in dramatic improvements in
longevity and quality of life for many
patients. However, respiratory dysfunction
remains responsible for much of the
morbidity and mortality associated with
the disorder. Physiotherapy has long
played an important role in the respiratory
management of the disease, and has had
to adapt to the changes in disease pattern
from infancy to adulthood. The role of the
physiotherapist is not limited to airway
clearance, but also includes
encouragement and advice regarding
exercise, posture and mobility, inhalation
therapy and, in the later stages of the
disease process, non-invasive respiratory
support. It is generally felt that the use of
chest physiotherapy in CF has lacked good
scientific basis, and the current call for
evidence-based medicine requires
physiotherapists to scrutinize their
practice closely.[3]

Chronic Obstructive Pulmonary

Disorder (COPD)

Chronic obstructive pulmonary disease

(COPD), also known as chronic obstructive
lung disease (COLD), and chronic
obstructive airway disease (COAD), among
others, is a type of obstructive lung
disease characterized by chronically poor
airflow. It typically worsens over time. The
main symptoms include shortness of
breath, cough, and excess sputum
production.[4] As COPD gets worse, subject
may be short of breath even when one
does simple things like get dressed or fix a
meal. It gets harder to eat or exercise, and
breathing takes much more energy. People
often lose weight and get weaker.[5]

Deep Venous Thrombosis

(DVT)

Deep vein thrombosis, or deep venous

thrombosis (DVT), is the formation of a
blood clot (thrombus) within a deep vein,
most commonly the legs.[6] Nonspecific
signs may include pain, swelling, redness,
warmness, and engorged superficial veins.
Pulmonary embolism, a potentially life-
threatening complication, is caused by the
detachment (embolization) of a clot that
travels to the lungs. Together, DVT and
pulmonary embolism constitute a single
disease process known as venous
thromboembolism.

Techniques
Chest physiotherapy:Postural
drainage

Active cycle of breathing

techniques
The active cycle of breathing techniques
(ACBT) is a flexible regimen comprising
breathing control, thoracic expansion
exercises and the FET, frequently
combined with gravity-assisted
positioning. Increasing lung volumes
during thoracic expansion allows air to get
behind distal secretions via collateral
ventilatory channels. During a forced
expiratory manoeuvre, compression and
narrowing occurs within the airways at a
point dependent on lung volume (the equal
pressure point). This is shifted distally as a
forced expiration is continued to low lung
volume, thereby mobilizing peripheral
secretions.

This technique has been reported to be an

effective and efficient means of airway
clearance[7][8] with documented
improvements in lung function[9] and no
detrimental effect on oxygen saturation.[10]
In comparative studies the ACBT has been
found to be advantageous when compared
with CCPT,[8] Flutter,[11][12] and PEP.[13]
When compared with the technique of
autogenic drainage (AD) Miller et al.,
reported no differences in efficacy,
although ACBT was associated with
oxygen desaturation in some cases.[14]
There was, however, no significant overall
difference in saturation between the two
techniques. A more recent comparison of
the Flutter and forced expiration with the
ACBT reported no significant differences
between the treatments for sputum
weight, lung function tests or oxygen
saturation.[15]

Assessment Tests
6 Minute Walk Test (6MWT)

Pulmonary rehabilitation is an evidence-

based intervention for the management of
patients with chronic obstructive
pulmonary disease (COPD). In clinical
practice, the 6-minute walk test (6MWT) is
commonly used to assess changes in
functional exercise capacity in COPD
patients following pulmonary rehabilitation
with the primary outcome reported being
the distance walked during the test (i.e.
6MWD). The 6MWD has demonstrated
validity and reliability after one
familiarisation test and the capacity to
detect changes following pulmonary
rehabilitation. In addition to assessing the
outcomes of pulmonary rehabilitation,
6MWD may be used to quantify the
magnitude of a patient's disability,
prescribe a walking programme, identify
patients likely to benefit from a rollator and
to identify the presence of exercise-
induced hypoxemia.

Current concepts
Randomized trials have demonstrated that
pulmonary rehabilitation (PR) can improve
dyspnea, exercise tolerance, and health-
related quality of life. Rehabilitation has
traditionally been provided in secondary
care to patients with moderate to severe
disease. However, current concepts are
recommending that it should be delivered
in a primary and community care setting
for patients with milder disease.[16]
There are several opportunities for
spreading the word for PR in primary care.
One of these is to improve access to PR
for all those disabled by their disease by
the increase of community schemes. One
such scheme being utilised in Canada is
reviewed. The essential components of PR
include behavior change, patient self-
management and prescriptive exercise. In
the last decade new strategies have been
developed to enhance the effects of
exercise training. An overview of these
new approaches being an adjunct to
exercise training is reviewed. Although the
role of exercise training is well established,
we are only just beginning to appreciate
the importance of behavior change and
patient self-management in contributing to
improved health and diminished
healthcare resource utilisation.[17]

References
1. Inverarity, Laura; Grossman, K (28
November 2007). "Types of Physical
Therapy". About.com. The New York Times
Company. Retrieved 29 May 2008
2. O'Sullivan, BP; Freedman, SD (2009).
"Cystic fibrosis". Lancet. 373 (9678): 1891–
904. doi:10.1016/S0140-6736(09)60327-5 .
PMID 19403164 .