Cardiac and Respiratory Rehabilitation

💡 Cardiac and Respiratory Rehabilitation are evidence-based programmes aimed at improving exercise tolerance, reducing symptoms, enhancing quality of life, and lowering hospital readmission rates. They combine exercise training, education, and psychosocial support.

📖 Introduction

Both cardiac and pulmonary rehabilitation are multidisciplinary, patient-centred approaches delivered in community or hospital settings. They target functional recovery after major cardiovascular or respiratory illness, with a strong emphasis on secondary prevention and lifestyle change.

❤️ Cardiac Rehabilitation

• Indications: Post–myocardial infarction, PCI, CABG, stable angina, heart failure, valve surgery.
• Aims: Reduce mortality, improve exercise capacity, promote medication adherence, address risk factors (smoking, hypertension, obesity).
• Core components: – Supervised aerobic and resistance training. – Optimisation of cardioprotective drugs (beta-blockers, ACEi, statins). – Risk factor education (diet, exercise, smoking cessation). – Psychological support (anxiety/depression post-MI are common). – Return-to-work and vocational guidance.

🫁 Respiratory (Pulmonary) Rehabilitation

• Indications: COPD (main evidence base), interstitial lung disease, bronchiectasis, post-COVID, pre/post thoracic surgery.
• Aims: Improve exercise tolerance, reduce breathlessness, enhance self-management, decrease exacerbations and admissions.
• Core components: – Supervised exercise training (walking, cycling, resistance bands). – Breathing control techniques (pursed-lip breathing, pacing). – Education: inhaler technique, recognition of exacerbations, oxygen use. – Nutritional advice (malnutrition and obesity both worsen outcomes). – Psychological and social support.

🔎 Evidence Base

• Cardiac rehab reduces all-cause mortality by ~20% post-MI (NICE, Cochrane).
• Pulmonary rehab improves 6-minute walk distance, quality of life, and reduces hospitalisations in COPD.
• Both models are cost-effective and recommended by NICE (CG172 for MI, NG115 for COPD).

⚠️ Contraindications

• Cardiac: unstable angina, uncontrolled arrhythmias, severe aortic stenosis, decompensated HF.
• Respiratory: acute exacerbation with hypoxaemia, unstable cardiac comorbidity, recent pneumothorax.

👩‍⚕️ Multidisciplinary Team

• Physiotherapists (exercise prescription, airway clearance).
• Nurses (monitor vitals, risk stratification).
• Doctors (optimise medical therapy, safety assessment).
• Dietitians (nutrition, weight management).
• Psychologists (CBT, anxiety/depression management).
• Occupational therapists (daily activity planning, work reintegration).

📚 Case Example

Mr A, a 64-year-old ex-smoker, admitted with NSTEMI, successfully treated with PCI. He has hypertension, type 2 diabetes, and reduced exercise tolerance. He is enrolled in a 12-week cardiac rehab programme: gradual treadmill exercise, dietary counselling, smoking cessation support, and CBT for post-MI anxiety. At discharge, he reports improved stamina, better medication adherence, and confidence returning to work.

📌 Teaching Pearls

• Rehab is as important as pharmacology in secondary prevention.
• Always check for red-flag contraindications before supervised exercise.
• Psychological support is integral — depression is common post-MI and in COPD.
• Community-based programmes increase accessibility and adherence.

📚 References

• NICE CG172: Secondary prevention in MI (2020 update).
• NICE NG115: COPD (2019 update).
• Cochrane Reviews: Cardiac rehabilitation, Pulmonary rehabilitation.