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The history of exercise rehabilitation comes from the human desire for health. It was first born when some physiatrists created a concept of “Sports Medicine”, the forerunner to the physical medicine and rehabilitation. Physiatrists specialize in restoring the optimal function to people with injuries to the muscles, bones, tissues or nervous system, including those with stroke in particular. Rehabilitation medicine aims to enhance and to restore the functional ability and the quality of life of patients with physical impairment or disability. Physicians who have completed training in this specialty area are called as physiatrists or specialists in rehabilitation medicine. The ‘physiatry’ was coined by Dr. Frank H. Krusen in 1938, and it was accepted by the American Medical Association in 1946 (Grabois et al., 2000). It made a great progress during the World War II to accommodate a large number of injured soldiers. In the United States, there are six formal subspecialties and these include 1) hospice and palliative medicine, 2) neuromuscular medicine, 3) pain medicine, 4) pediatric rehabilitation, 5) spinal cord injury medicine and 6) sports medicine. The next concept of rehabilitation is much broader. Diseases treated by the rehabilitation therapists include amputation, spinal cord injury, sports injury, stroke, musculoskeletal pain syndromes (e.g., low back pain), fibromyalgia and traumatic brain injury. In the cardiopulmonary rehabilitation, the attempts are made to optimize the functions in patients with heart or lung disease. The management of chronic pain is achieved through multidisciplinary approaches by psychologists, physical therapists, occupational therapists, exercise therapists and anesthesiologists. This may also be accompanied, if applicable, by interventional procedures. For example, stroke patients are often treated by speech and recreational therapy, if applicable, concomitantly with conventional treatment methods. With a special focus on disease prevention and the maintenance of health, the exercise rehabilitation is a safer, more efficient modality as compared with conventional interventions. Moreover, its scope has been gradually extended to provide preventive medicine. With the increased number of aging population and the increased prevalence of chronic diseases, the exercise rehabilitation will become a hot issue; this may further have an impact on both patients and the health care system. Meanwhile, the Journal of Exercise Rehabilitation will provide a forward-looking opportunity in Korea. Thus, we’ll strengthen our expertise to improve the current concept of exercise rehabilitation.

During recent years there have been considerable advances in the field of pulmonary rehabilitation.1, 2 However, the advances have been accompanied by some unfulfilled expectations in areas such as respiratory muscle rest and training. This reflects the fact that pulmonary rehabilitation can probably still be regarded as more of an art than a science. In this connection it should be noted that respiratory muscle fatigue is still in search of a precise definition and of objective criteria to assess its presence and prevalence in stable patients with chronic obstructive pulmonary disease (COPD) or other respiratory disorders.3 Apart from providing new valuable information, the 1990 meeting “Up-dating on Cardiopulmonary Rehabilitation” has added a new dimension by combining cardiac and pulmonary rehabilitation. Indeed, cardiac and pulmonary abnormalities are often closely linked, as exemplified by dynamic pulmonary hyperinflation. Such linkage was a most refreshing aspect of this meeting.

Background: Patients in cardiopulmonary rehabilitation often complain of exercise intolerance. While ventilatory limitation is often present, other factors are also important: cardiovascular deconditioning, respiratory muscle dysfunction, gas exchange abnormalities and ventricular dysfunction. Methods: Forty patients, hospitalized for a consecutive 6 month-period, with persistent exercise intolerance due to cardiopulmonary pathologies were included. 90% were COPD II to IV GOLD stage; 5% had chronic cardiac decompensation; 5% had undergone surgery for coronary bypass and/or cardiac valve prosthesis. Patients were excluded who were clinically unstable, unable to cooperate correctly, had arrythmia due to atrial fibrillation and/or receiving beta-blocking therapy. We have, furthermore, measured parameters of ventilatory dysfunction (ventilatory reserve, dynamic inspiratory capacity), the parameters of cardiovascular limitation (peak heart rate and recovery heart rate at the first minute), parametes of respiratory muscles dysfunction (maximal inspiratory pressure and at the end of the 6 min walking test). Afterwards we classified patients into three groups: ventilatory-limited, cardiovascular-limited, respiratory muscles-limited. Results: Exercise performance limitation resulted from ventilatory limitation in 60% of the patients, second by cardiovascular limitation in 30% of the patients and also by respiratory muscle limitation in 10% of the patients. Conclusions: Based on admission diagnosis of 40 patients, 90% were defined as subject to pulmonary rehabilitation and in 10% were receiving cardiac rehabilitation. They divided into three specific functional recovery programs: ventilatory function recovery program (60%), cardiac function recovery program (30%), respiratory muscles recovery program (10%).

BACKGROUND The need for travel between rural and tertiary hospitals for cardiopulmonary services is a reality many patients experience. Communication between hospitals is essential in providing the most effective and efficient patient care. This work involved incorporating NANDA, NIC, and NOC into standard care plans and the ongoing documentation expansion for the care of an outpatient cardiopulmonary population. MAIN CONTENT POINTS This regional project involved cardiopulmonary rehabilitation programs from three Mayo Health System affiliates. Acute care had begun to use NANDA, NIC, and NOC for computerized documentation. Cardiopulmonary services realized the benefits of following acute care's lead in applying standardized nursing language to outpatients. The project was undertaken to enhance communication across the care continuum. Pertinent NANDA nursing diagnoses, NIC interventions, and NOC outcomes were identified, a process that invoked the discussion of the commonalities and differences among the three taxonomies. This became beneficial in benchmarking the different program structures and gleaning best practices. Through much discussion the care plans were developed with subsequent revisions as necessary. Issues surrounding the project included getting used to the terminology and computerization, getting bogged down in the details, trusting each other with information about programs, building a group cohesiveness, seeing timely results of our efforts, and communication among sites. CONCLUSIONS Benefits realized through this project were strengthening the comprehensiveness of the plan of care for cardiopulmonary patients and computerizing the patient record. Through this process the interdisciplinary cardiopulmonary practice was better defined. Communication was strengthened because standardized nursing language took the “fuzz” out of communication between providers and across the care continuum. Another outcome included establishing trust and collegiality among the three sites for future networking and problem solving. Outcomes data can be used to test the effectiveness of nursing interventions for the improvement of patient care. This research should encompass studying the effectiveness of care provided within the programs as well as across the care continuum.

This self-directed learning module highlights the clinical characteristics, medical treatment, and rehabilitation interventions of several cardiac scenarios encountered in physiatric practice. It is part of the chapter on cardiac rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article discusses myocardial infarction during amputation, stroke as a result of cardiac surgery, myocardial perfusion defects in spinal cord injury, and heart murmur in Down syndrome. It also covers current medical management and the benefits of comprehensive rehabilitation and interventions for specific impairments seen in these conditions. Overall Article Objective: To describe the clinical characteristics, medical treatment, and rehabilitation interventions of 4 cardiac scenarios encountered in physiatric practice.

The effects of participation in a structured, outpatient cardiac rehabilitation program on psychosocial function after acute myocardial infarction or coronary artery bypass surgery, or both, were evaluated prospectively in 141 patients who were married or living with “a significant other” (89% men, mean [± standard deviation] age 63 ± 9 years old). Forty-one patients who were participants in a 3-month cardiac rehabilitation program were compared with 100 patients who did not participate in a formal program. On average, patients in both groups were well educated, older Caucasians who had minimal cardiac dysfunction (New York Heart Association class I or II). Patients in the 2 groups were not different at baseline in sociodemographic or clinical characteristics or in any of the dependent measures of anxiety, depression, psychosocial adjustment to illness or marital adjustment. Six months after initial testing, patients who attended cardiac rehabilitation were significantly less anxious (F[1,139] = 5.09, p = 0.03), less depressed (F[1,139] = 8.39, p = 0.004), had better psychosocial adjustment (F[1,139] = 5.87, p = 0.02), and were more satisfied with their marriages (F[1,139] = 8.6, p = 0.004) than nonparticipants. The findings support the effectiveness of group cardiac rehabilitation for this subgroup of patients in facilitating their psychosocial recovery after an acute cardiac event.

SummaryBackgroundBenefits of cardiopulmonary rehabilitation (CPR) in patients with chronic obstructive pulmonary disease (COPD) are well established, but long-term sustainability of training-induced effects and its translation into healthy lifestyles are unsolved issues. It is hypothesized that Integrated Care Services supported by Information and Communication Technologies (ICS-ICT) can overcome such limitations. In the current study, we explored 3 ICS-ICT deployment experiences conducted in Barcelona, Trondheim and Athens.MethodsIn the 3 sites, a total of 154 patients completed an 8-week supervised CPR program. Thereafter, they were allocated either to an ICS-ICT group or to usual care (CPR + UC) during a follow-up period of at least 12 months with assessment of 6-min walking test (6MWT) as main outcome variable at all time points in the 3 sites. Because real deployment was prioritized, the interventions were adapted to site heterogeneities.ResultsIn the ICS-ICT group from Barcelona (n = 77), the use of the personal health folder (PHF) was the cornerstone technological tool to empower COPD patients for self-management showing high applicability and user-acceptance. Long-term sustainability of training-induced increase in exercise capacity was observed in ICS-ICT compared to the control group (p = 0.01). Likewise, ICS-ICT enhanced the activities domain of the SGRQ (p

Of 547 men and 56 women enrolled up to April 1974 in Cardiopulmonary Research Institute (CAPRI) community programs for cardiopulmonary rehabilitatation, 84.5 percent had clinical manifestations of coronary heart disease. These medically supervised programs of physical training involved 30 to 60 minutes of graded levels of working, calisthenics and, if indicated, jogging for 3 mornings/week. Altogether 352 (58.4 percent) dropped out after an average of 8.6 months for men and 5.7 months for women. The remaining 230 men and 21 women remained active for 22 and 20 months, respectively. In retrospect, there were few minor differences between active participants and dropouts in physical characteristics, clinical diagnoses and responses to exercise testing on enrollment. Elapsed time to morbidity tended to be longer in active persons than in dropouts. Over one half of active men and about one third of dropouts were working. Of six early deaths, one occurred before training was instituted, and five within the first 2 weeks of training. Among men, the respective total mortality rates were 2.7 and 4.7/100 person-years for active participants and dropouts; among women, the rates were 0 and 3.8 respectively. Whereas 24 episodes of cardiac arrest occurred in 13 men, with three fatalities outside the training program, in 11 instances of exertional arrest during class training all defibrillations were successful. Without this benefit of medical supervision there would have been little difference in mortality experience.

Introduction Cardiopulmonary exercise test (CPET) is widely used in preoperative assessment and cardiopulmonary rehabilitation. The effect of peripheral arterial disease (PAD) on oxygen delivery (VO 2 ) measured by CPET is not known. The aim of this study was to investigate the effect of PAD on VO 2 measurements during CPET. Methods and analysis We designed a prospective cohort study, which will recruit 30 patients with PAD, who will undergo CPET before and after treatment of iliofemoral occlusive arterial disease. The main outcome measure is the difference in VO 2 at the lactate threshold (LT) between the 2 CPETs. The secondary outcome measure is the relationship between change in VO 2 at the LT and peak exercise pretreatment and post-treatment and haemodynamic measures of PAD improvement (ankle–brachial index differential). For VO 2 changes, only simple paired bivariate comparisons, not multivariate analyses, are planned, due to the small sample size. The correlation between ABI and VO 2 rise will be tested by linear regression. Ethics and dissemination The study was approved by the North West-Lancaster Research and Ethics committee (reference 15/NW/0801). Results will be disseminated through scientific journal and scientific conference presentation. Completion of recruitment is expected by the end of 2016, and submission for publication by March 2017. Trial registration number NCT02657278.

The purpose of monitoring vital signals on patients in cardiopulmonary rehabilitation is to quickly obtain relevant information for therapeutical decisions. During the patient’s locomotion, however, such measurement could be less efficient, due to motion artifacts that distorts the signal and usually difficult its recovery. This study deals with the development of a photoplethysmographic (PPG) transducer for telemetry of vital signals of patients engaged in physical exercise. The transducer will have small mass and reduced dimensions, making it less susceptible to moving artifacts. The transducer will allow the acquisition of multiple PPG signals. A transmission station communicates by radiofrequency, relaying the PPG signals to a radio-base station attached to a computer. The software receives, stores and analyzes this data, and still allows the monitoring of several patients simultaneously. Thus, the monitoring of these signals can provide essential information regarding heart rate, oxygen saturation, noninvasive blood pressure and cardiac arrhythmias. This system is used, for example, during a session of cardiovascular rehabilitation in which the patients exercise, walking, light trotting and light racing, and cardiopulmonary rehabilitation programs at pre-operatory stage, post-operatory stage and even profilatically.