Cardiopulmonary Physiotherapy: Assessment, Exercise and Safety
Reading the cardiorespiratory system
Cardiopulmonary physiotherapy requires sound assessment of respiratory pattern, breath sounds, sputum characteristics, oxygenation, and exercise tolerance, alongside understanding of obstructive and restrictive disease, heart failure, and postoperative respiratory risk. Candidates must know airway clearance techniques, breathing exercises, positioning, mobilisation, and pulmonary rehabilitation principles. Exercise prescription should be grounded in baseline capacity, with monitoring of heart rate, blood pressure, oxygen saturation, breathlessness, and perceived exertion. Know the indications and precautions for positioning, incentive spirometry, and manual techniques, and recognise when to stop an intervention and escalate.
Traps that catch candidates
Frequent traps include assuming oxygen desaturation always requires stopping exercise, when the decision depends on baseline, trend, symptoms, and protocol; and applying airway clearance to a patient who cannot tolerate it or has an untreated pneumothorax. Another trap is misinterpreting breathlessness as anxiety without screening for hypoxia, arrhythmia, or deterioration. Questions may test the difference between pursed-lip breathing and diaphragmatic breathing, or when positioning, such as sitting forward, is preferred for breathlessness. Always consider the whole patient, including hydration, nutrition, and mobility.
Worked rule of thumb
Use the stop-and-escalate rule: stop exercise for chest pain, new arrhythmia, severe desaturation with symptoms, or a fall in blood pressure with dizziness. For example, a patient whose saturation falls from 96% to 88% with breathlessness during walking should stop, rest, reassess, and report rather than simply continuing with encouragement.