Health care professionals know those who have experienced a cardiac or pulmonary event can greatly benefit from cardiac and pulmonary rehabilitation. But are there others out there who also might benefit from the structure of CR/PR care?
New studies show patients with a range of ailments—including those with mental health issues and those recovering from COVID-19—can greatly benefit from tenants of CR/PR care, specifically exercise routines.
“We know exercise is beneficial,” said David Prince, MD, FAAPMR, director of the Cardiopulmonary Rehabilitation Department of Rehabilitation Medicine at Albert Einstein College of Medicine/Montefiore Health Systems. “ It’s still greatly underutilized, and that’s a bit unfortunate.”
Three health care professionals from the Albert Einstein College of Medicine/Montefiore Health Systems spoke at a session recorded at the 35th AACVPR Annual Meeting. They said different patient populations benefit from the structure and setup of CR/PR exercise programs.
COVID-19 is a huge patient population that can benefit from exercise during their recovery. Prince said while data is still very new, early studies indicate those who adhere to structured exercise routines. Anne Ambrose, MD, MS, FAAPMR, director of research in the Department of Rehabilitation Medicine, said she and her team developed a COVID-19 guideline for those recovering and their caregivers.
It broke down exercises for three different varying patient populations: those who are bed bound, those who can sit up and those who are able to stand. Based on their level of comfort, each group was given specific exercises ranging from moving large joints to over strength and coordination.
“The main aim of this manual was really for patients to be able to do exercises by themselves because they are in isolation,” Ambrose said. “This is based on some of the research I’ve done creating exercise programs for frail, elderly patients to be done at home without a therapist.”
While overall results are yet to be seen, Prince said we know COVID-19 impacts the entire circulatory system. The disease opens up a whole new path of care for CR/PR professionals to develop, as well as an abundance of research opportunities.
But there are other patient populations who can benefit from CR/PR care. Research shows patients who experienced a stroke saw improved aerobic capacity, improved cognitive function and overall better health when cardiac rehabilitation was added into their overall care plan.
Patients with peripheral artery disease (PAD) also had similar experiences with exercise care. A study looking at patients from the Netherlands with PAD compared to those in the US with PAD showed decreased sedentary behavior prolonged over a period time improved their overall outcomes even if they stopped exercising eventually.
Prince said its important for CR/PR professionals to advocate for this type of care, and connect with cross-disciplined professionals to help encourage more patient populations to seek CR/PR care.
And it’s not just physical ailments CR/PR can help address. Mental health patients greatly benefit from regimented exercise routines. Matthew Bartels, MD, MPH, chairman of the Department of Rehabilitation Medicine, said studies show patients with schizophrenia show improved outcomes when doing CR/PR exercise programs.
“Patients who have schizophrenia and psychiatric disorders generally have poor general health and also have a lot of side effects from the medications they’re taking,” he said. “Cardiac rehabilitation would be beneficial for their overall health.”
In a study he conducted, they took a group of patients with schizophrenia and put then on a 12-week exercise regimen. They found 85% of people adhered to the program, and of those people who did, all say improved outcomes. What was most notable was not only did they see health improvements, it helped them to be more social—something many with schizophrenia struggle with. More importantly, it put to the test the theory that this type of care can impact patient populations across a wide spectrum.
“Nobody really seriously thought we would be able to have benefits that showed significant improvements in all functioning domains for our patients—and a lot of people were surprised,” he said. “The patients themselves very much appreciated being in this program because it was a normal treatment that allowed them to be involved in what they knew was generally healthy behavior that can be applied to any population and they could apply it to their own disease.