Cardiopulmonary Physiotherapy
Cardiopulmonary Physiotherapy
This domain tests chest assessment, secretion clearance, exercise testing, and safe exercise prescription in cardiac and respiratory disease, including cardiac and pulmonary rehabilitation.
Core rules
- Auscultation guides technique: crackles suggest ACBT and positioning; coarse retained secretions suggest PEP or gravity-assisted drainage with monitoring.
- Active cycle of breathing technique: breathing control, thoracic expansion, then huff or forced expiration.
- Six-minute walk test: standardised 30-metre course, standardised encouragement, record distance, SpO2, heart rate and Borg dyspnoea. Stop for chest pain, SpO2 below 85%, or intolerable dyspnoea.
- Prescribe using heart rate reserve (Karvonen): target = resting HR + %(max HR − resting HR). Use a measured max HR where available; 220 − age is only an estimate.
- Beta blockers blunt the heart-rate response, so prescribe by rating of perceived exertion (Borg 11–13) plus symptoms.
- Rehabilitation phases: inpatient, supervised outpatient, then maintenance; pulmonary rehabilitation typically runs 6–12 weeks, two to three sessions weekly.
Worked example
A 60-year-old man, four weeks after myocardial infarction, resting HR 70, not on a beta blocker, target 60–70% heart rate reserve. Estimated max HR 160. HRR = 160 − 70 = 90. At 60%: 70 + 54 = 124 bpm. At 70%: 70 + 63 = 133 bpm. Prescribe 20–30 minutes at 124–133 bpm, RPE 11–13, with warm-up and cool-down, and stop criteria explained.
Traps
- Applying 220 − age to a patient on beta blockers.
- Prescribing by heart rate alone in atrial fibrillation.
- Ignoring the desaturation stopping rule during walking tests.
- Forgetting pacemaker, anticoagulation and sternal precautions after cardiac surgery.