Geriatric Cardiac and Pulmonary Rehabilitation

Geriatric Cardiac and Pulmonary Rehabilitation - #92

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Older adults with cardiac or pulmonary disease experiencing reduced quality of life, function, or symptom control, or with recent or planned cardiopulmonary procedures.

Determine appropriateness of cardiac or pulmonary rehabilitation for geriatric patients by assessing comorbidities, frailty and disease status in context of function and care goals.

 

What is cardiac and pulmonary rehabilitation?

  • Cardiac rehabilitation – 12-week program with up to 36 sessions including evaluation, modification of cardiac risk factors through nutrition and lifestyle changes, individual and group psychologic support and prescription of an exercise program.3
  • Pulmonary rehabilitation – 4 to 12-week multidisciplinary program meeting multiple times a week.  Sessions may include exercise training, breathing exercises, nutritional intervention, individual and group psychological support, and education.6
  1. List three components of cardiac and of pulmonary rehabilitation programs.
  2. List characteristics of patients who may benefit from cardiopulmonary rehabilitation.
  3. Identify three physiologic benefits of engaging in cardiac and pulmonary rehabilitation.

 

  1. Li W, Pu Y, Meng A, Zhi X, Xu G. Effectiveness of pulmonary rehabilitation in elderly patients with COPD: A systematic review and meta‐analysis of randomized controlled trials. International journal of nursing practice. 2019;25(5):e12745.
  2. Austin J, Williams R, Ross L, Moseley L, Hutchison S. Randomised controlled trial of cardiac rehabilitation in elderly patients with heart failure. European Journal of Heart Failure. 2005;7(3):411-417.
  3. Lutz A, Delligatti A, Allsup K, Forman D. CAN CARDIAC REHABILITATION IMPROVE FRAILTY IN ADULTS WITH CARDIOVASCULAR DISEASE? Journal of the American College of Cardiology. 2019;73(9 Supplement 1):1730.
  4. Medicare Cf, Services M. Decision memo for cardiac rehabilitation (CR) programs—chronic heart failure (CAG-00437N). Medicare Coverage Database Baltimore, MD: CMS. 2014;
  5. Anderson L, Oldridge N, Thompson DR, et al. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology. 2016;67(1):1-12.
  6. McCarthy B, Casey D, Devane D, Murphy K, Murphy E, Lacasse Y. Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews. 2015;(2)
  7. Marchionni N, Fattirolli F, Fumagalli S, et al. Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction: results of a randomized, controlled trial. Circulation. 2003;107(17):2201-2206.
  8. Houchen-Wolloff L, Williams JE, Green RH, et al. Survival following pulmonary rehabilitation in patients with COPD: the effect of program completion and change in incremental shuttle walking test distance. International journal of chronic obstructive pulmonary disease. 2018;13:37.
  9. Keteyian SJ, Levine AB, Brawner CA, et al. Exercise training in patients with heart failure a randomized, controlled trial. Annals of internal medicine. 1996;124(12):1051-1057.
  10. Porszasz J, Emtner M, Goto S, Somfay A, Whipp BJ, Casaburi R. Exercise training decreases ventilatory requirements and exercise-induced hyperinflation at submaximal intensities in patients with COPD. Chest. 2005;128(4):2025-2034.
This GFF ___ my competence in geriatrics.

Aaron A Kuntz, MD, Advanced Geriatrics Fellow, Geriatrics Research Education and Clinical Center (GRECC), William S. Middleton Memorial Veterans Hospital, Madison, WI

James Carlson, MPT, CCS, Cardiopulmonary Residency Specialist, Physical Medicine and Rehabilitation Service, William S. Middleton Memorial Veterans Hospital, Madison, WI