By Serena Agusto-Cox | News & Views
Some of the programming will look a little different than usual at the 40th AACVPR Annual Meeting, starting with the pre-meeting workshops. For the first time, hands-on demonstrations using real equipment will be incorporated into these two activities offered before the official event kicks off on September 18.
Aimee Kizziar, MHAL, RCP, RRT-NPS, AE-C, CES, FAACVPR, and Missy Von Luehrte, RN, BSN, GERO-BC, CNIV, along with Lisa Smith, PT, and Maria Baylon, BS-RRT, will lead “Hands-on Bootcamp: Master Your Pulmonary Rehabilitation Assessment/Intervention Skills” on September 17. A concurrent workshop, “Procedures and Considerations for Setting Exercise Intensity Using Live Case Demonstrations,” will be led by Cemal Ozemek, PhD, RCEP, FAACVPR, FACSM, FCEPA, and Paul Gallo, Ed.D., RCEP, ACSM-GEI, EIM, FACSM. For these instructors*, this milestone 40th year is more than a celebration, it is a testament to AACVPR’s decades of progress and dedication to the field of cardiopulmonary rehabilitation (CR/PR).
Pulmonary Rehabilitation Assessment and Intervention Skills
According to Kizziar (pictured left), “Our hands-on bootcamp emerged from a series of conversations with pulmonary rehab colleagues across the country. What we’ve found is that our field craves hands-on learning experiences. We wanted to take education from the theoretical to real-world practice.”
In addition to engaging in interactive, practical learning with actual equipment donated for the course, participants will engage in role play where they have the opportunity to portray both patient and practitioner. “It will be an environment where attendees can ask questions and experiment with techniques to gain confidence in implementing what they’ve learned,” Kizziar explains. “We hope that attendees will feel inspired and ready to bring their improved skills and ideas to their PR programs.”
The workshop will provide a unique opportunity to hone pulmonary assessment skills with different devices regardless of expertise or years in practice. “I think it can meet needs of all professionals, ensuring their practice is current because things do change,” says Von Luehrte. “Our demonstration will explore evidence-based PR, and practitioners will be able to bring that knowledge back to their teams and their patients.”
Assessments will include 6-minute walk tests, sit-to-stand evaluations, and other functional tests, as well as instruction on how to determine each patient’s oxygen therapy needs. The assessments will help staff learn how to determine the best exercise prescription for each patient, especially when they are using certain oxygen therapy at home that may be inadequate in an exercise setting, according to Von Luehrte. They will each learn what medication therapies patients may be prescribed and how chronic health issues can impact their rehabilitation.
According to Von Luehrte, after the demonstrations, participants will walk away with the same experiences patients have when using the equipment on their own. “Through our visual and engaging bootcamp format, we’re hopeful that our participants will retain what they’ve learned better because they will receive personalized feedback,” she explains.
Von Luehrte (pictured right) continues, “In some cases, it may be the first time participants have seen some of these devices. This is a real opportunity for them to see the pulmonary requirements of these devices in action.” Kizziar adds, “It’s about seeing the concept and action that transforms understanding.” She likens it to how CR/PR staff work with patients in practice, having them do a return demonstration so that staff know the patients are capable of using the devices at home. From different types of inhalers to airway cleaners, Von Luehrte says the demonstration will ensure PR staff can adjust equipment to the needs of the patient.
With the team of registered nurses, physical therapists, and others in the workshop, guided repetition and individualized exercise plans will provide participants with the practical tools they need to improve care in their own practice. “We also want them to see the connection between clinical practice and effective documentation, particularly with regard to outcome measures and reimbursements,” Kizziar says, which she adds will be covered more in depth in the breakaway session “Assessment Skills for Evaluating Candidates for Pulmonary Rehabilitation and Outpatient Respiratory Services” on September 18.
The reality of PR is that many people no longer have just one health condition. Patients with pulmonary fibrosis, bronchiectasis, and pulmonary hypertension like COPD may also have heart disease, diabetes, and autoimmune disease.
“Patients with more than one condition complicates care. PR staff need to be able to craft individualized care plans and adjust treatments by using their clinical judgment after careful patient evaluation,” says Kizziar. “PR staff should be looking at their baseline respiratory function. What does that spirometry look like? What is their pulmonary function, their pulse oximetry, and their functional capacity? What distance did they travel on that 6-minute walk test? And how did they physiologically respond to that?”
Reviewing what patients’ daily activities at home look like and what their symptoms are when completing those tasks, as well as what psychosocial factors are in play or what their dyspnea scores are when they cannot breathe, are key parts of an assessment. How are anxiety and depression impacting level of activity? These are all important to help educate patients and caregivers on how best to care for themselves. “No two patients are alike, care customization is vitally important,” Kizziar explains. Von Luehrte agrees. “When you can’t breathe well, it causes serious anxiety and fear,” she says. “Understanding how the patient is doing at home and in rehab is important for building trust, and that’s accomplished by asking the right questions.”
Setting Exercise Intensity for Cardiac Rehabilitation
The other pre-meeting workshop, with Ozemek and Gallo, will also provide equipment for attendees to use. Ozemek (pictured left) says hands-on demonstrations enable practitioners to see standards of care in action.
“After initial demonstrations, attendees will be able to participate in running practical cardiorespiratory and muscular fitness assessments, followed by setting aerobic and resistance training exercise intensities and conducting exercise tests,” he explains. “Unlike traditional presentations that review study results, recite standard of care guidelines, and provide descriptive examples, hands-on demonstrations will make it easier for CR staff to appreciate the finer details and implement what they learn when they return to their programs.”
Patients often need an exercise prescription that is tailored to their current recovery journey and their capabilities, not a broad one-size-fits-all approach. “Through this hands-on workshop, participants will learn how to fine-tune exercise prescriptions to the needs of the patient,” he says. “Even as CR programs treat patients in group settings, the patients are individuals with their own care needs. In many cases, exercise prescriptions based on guidelines may not be appropriate for every patient, especially if they have other health conditions or specific limitations.”
The goal of the demonstration is to show CR staff how to adjust exercise assessments and prescriptions and aerobic and resistance training intensities to address patients’ individual abilities and functionality. AACVPR attendees will be able to use treadmills, upright and stationary bikes, resistance training equipment, medicine balls, and recumbent cross-trainer machines. “There are also some new and innovative packages for resistance training, equipment that is quite portable and very compact,” Ozemek shares. “This equipment will come in handy in very small cardiac rehab programs.”
“All of these tools are found in traditional CR settings,” he points out. “Training on each of these will help them learn how to adjust exercise prescriptions so that they are prepared to work with any patient who walks into their programs.”
Ozemek notes that there are some instances where individual patients see no improvement in their fitness, which could be associated with a subpar exercise prescription. “The demonstration will talk about the gold standard methods of setting exercise intensity, and how to develop similarly effective exercise prescriptions when gold standard strategies are not practical,” he explains. “We’re going to show attendees very specific techniques they can use to get those patients to specific exercise intensities.”
Because many CR patients only come two to three days weekly for 30-45 minutes of exercise in 60-minute classes, some patients may not achieve the physical activity recommendations they are expected to reach by the end of the program. “This is where exercise intensity becomes vitally important,” Ozemek emphasizes. “We’re going to give our practitioners the skills to progress exercise intensity relative to where that patient is and where they need to go, so that they can achieve the outcomes they want by the end of that CR program.”
As many CR staff know, CR participants have limitations related to other health conditions, including diabetes, frailty, limited function, and kinesophobia (the fear of being physically active). Ozemek indicates that the hands-on workshop is tailored to helping CR staff craft programs with the right level of exercise intensity for each patient, targeting each potential barrier to a successful recovery, and helping practitioners build their own self-confidence.
Learn more about these demonstrations at the 40th AACVPR Annual Meeting.