Cardiopulmonary rehabilitation is an organized program designed to improve the status of patients with conditions of the heart and lungs.
As a respiratory therapist or medical professional, this is a topic that you must be familiar with. We created this study guide to provide an overview of cardiac rehab and provided helpful practice questions for your benefit.
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What is Cardiopulmonary Rehabilitation?
Cardiopulmonary rehabilitation is a medically supervised program designed to improve the health and well-being of those who have heart and lung disease. The program typically lasts around 12 weeks but can vary depending on the individual’s needs.
The primary goal is to help participants return to their normal daily activities as soon as possible.
This is done by improving the function of the heart and lungs, reducing the risk of future problems, and educating participants on how to live a healthy lifestyle.
The program usually consists of a combination of physical activity, education, and emotional support. Patients work with a team of health professionals who will create an individualized treatment plan based on their specific needs.
The cornerstone of cardiopulmonary rehab is physical activity. Participants are typically given a tailored exercise program to improve their fitness and overall health.
This can include aerobic exercise, strength training, and stretching.
Education is also an important part of every cardiopulmonary rehab program. Providing education on diseases of the heart and lungs can help participants better understand their condition and how to manage it.
The program also includes counseling on lifestyle changes, such as quitting smoking or eating a healthy diet.
Emotional support is also an essential part of a cardiopulmonary rehab program. This can be invaluable for those who are struggling to cope with their heart or lung disease.
The team can provide encouragement and support throughout the program, which can help participants reach their goals.
Cardiopulmonary Rehabilitation Practice Questions:
1. What term refers to the restoration of an individual to the fullest medical, mental, emotional, social, and vocational potential of which they are capable?
2. What is the overall goal of rehabilitation?
To maximize the functional ability and minimize the impact the disability has
3. What is the art of medical practice wherein an individually tailored, multidisciplinary program is formulated and attempts to return the patient to the highest possible functional capacity?
4. What are the general goals of pulmonary rehabilitation?
To control symptoms, restore functional capabilities, and improve the quality of the patient’s life
5. How does an individual maintain homeostasis at rest?
By balancing external, internal, and cellular respiration
6. What increases in a linear fashion as the exercise intensity increases?
Oxygen consumption and CO2 production
7. What refers to the result of an abrupt upswing in both CO2 and VE?
8. What does exercise in COPD patients result in?
Respiratory acidosis and shortness of breath
9. As ventilation increases in a COPD patient, what else increases significantly?
10. What does reconditioning involve?
It involves strengthening the essential muscle groups, improving the overall oxygen utilization, and enhancing the body’s cardiovascular response to physical activity.
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11. What do patients with COPD often have a tendency of developing?
Severe anxiety, hostility, and stress
12. What are the key ingredients in a good rehabilitation program?
Occupational retraining and job placement
13. What are three examples of rehabilitation program objectives?
The development of diaphragmatic breathing skills, the development of stress management, and a focus on group support
14. What should the patient’s complete history be followed by?
A complete physical examination
15. In order to determine the patient’s cardiopulmonary status and exercise capacity, what may be performed?
Both PFTs and a cardiopulmonary exercise evaluation may be performed
16. What are the two key purposes that the cardiopulmonary exercise evaluation serves in pulmonary rehabilitation?
(1) It quantifies the patient’s initial exercise capacity, and (2) it determines the degree of hypoxemia that occurs with exercise
17. What does the second evaluation allow?
The basis for titrating oxygen during exercise
18. The actual exercise evaluation involves continuous measurements of parameters during graded levels of exercise on what?
Either an ergometer or treadmill
19. To allow for steady-state equilibration, how are these graded levels usually spaced?
In 3 minute intervals
20. Work levels are increased progressively until?
They are increased until the patient cannot tolerate a higher level or until an abnormal/hazardous response occurs.
21. What is the pulse oximeter used for during cardiopulmonary rehab?
It is used as a monitor to warn clinicians of gross desaturation and the patient’s response to oxygen.
22. What are three examples of relative contraindications to exercise testing?
(1) Patients who won’t/can’t perform the test, (2) Severe pulmonary hypertension, and (3) An SpO2 < 80%
23. What can an exercise evaluation help differentiate between?
It can help differentiate between respiratory or cardiac limitations to increased work capacity.
24. What are the five safety measures during exercise evaluation?
(1) Physical examination, (2) Qualified physician, (3) Emergency resuscitation device, (4) Basic/advanced life support techniques, and (5) Terminate when indicated
25. When are patients excluded from pulmonary rehabilitation activities?
When their problems limit/preclude participation, and when their condition is complicated by malignant neoplasms (lung cancer)
26. The ideal rehabilitation session should run for about how long?
27. What does the respiratory therapist initially do during ventilatory muscle training?
They measure the patient’s maximum inspiratory pressure using a calibrated pressure manometer.
28. What is the rate at which a patient should breathe in the manometer?
29. As the level of resistance becomes more tolerable over time, the patient should progressively increase session duration up to how long?
Up to 30 minutes
30. What is the cornerstone for the physical reconditioning effort?
Breathing control methods
31. What does the length of a program often depend on?
The length of a program is dependent on insurance coverage and expected reimbursement.
32. What is a normal class size in pulmonary rehab?
33. What does program viability realistically depend on?
The number of participants
34. Sudden cardiac events and orthopedic injuries
Sudden cardiac events and orthopedic injuries
35. What are the common outcome measures in the program results?
Exercise tolerance, levels of dyspnea at rest/exertion, and quality of life surveys
36. What is one of the major predictors for improvement in a COPD patient’s health-related quality of life?
Frequent attendance in a maintenance program
37. What are the major reasons for unsatisfactory outcomes?
Insufficient training, lack of uniformity, inadequate program length, and a lack of follow-up
38. Pulmonary rehabilitation has become recognized as a prerequisite for which patients?
Emphysema patients who are able to undergo lung volume reduction surgery
39. What is defined as a comprehensive exercise and educational program designed for patients with cardiovascular diseases?
40. What are the goals of cardiac rehabilitation?
Patient education, physical reconditioning to improve work capacity, weight loss, and to help the patient return to work
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41. What is the goal of a structured cardiac rehabilitation program?
To assist patients in developing a regular pattern of safe exercise to achieve greater performance
42. What is the age of cardiac patients compared to pulmonary patients?
The age ranges from 30 to 70 for cardiac patients. For pulmonary patients, it’s typically indicated at the age of 50 and up.
43. Absolute contraindications for conducting a cardiopulmonary exercise evaluation include all of the following except?
Diastolic blood pressure greater than 110 mmHg
44. Attrition in pulmonary rehabilitation programs is most associated with which of the following?
The degree to which patients’ psychosocial needs are met
45. Below what level of the predicted FEV1/FVC are patients with irreversible airway obstruction considered good candidates for pulmonary rehabilitation?
46. By following the reimbursement guidelines for a comprehensive outpatient rehabilitative facility (CORF), Medicare will reimburse up to what percentage of the allowable charge for a rehabilitation program?
47. A cardiopulmonary exercise evaluation is conducted on a patient before participation in pulmonary rehabilitation for what purposes?
To quantify the patient’s baseline exercise capacity, develop an exercise prescription (including target heart rate), and determine how much desaturation occurs with exercise
48. During exercise, the point at which increased levels of lactic acid production result in an increased VCO2 and VE is referred to as what?
The ventilatory threshold
49. During inspiratory resistive exercises, the desired load should be about what percentage of the maximum inspiratory pressure?
50. For which of the following patients would you recommend an open-ended format for a pulmonary rehabilitation program?
Those with scheduling difficulties, those who require individual attention, and those who are self-directed
51. In preparing an outpatient for a cardiopulmonary stress test to be conducted the next day, which of the following instructions would you provide?
The patient should fast for at least 8 hours before testing. The patient should wear loose-fitting clothing and sneakers. The patient should review the drugs with the physician.
52. Knowledge from the clinical sciences is used in pulmonary rehabilitation programming for mainly what purpose?
To quantify the extent of physiological impairment and to set expectations for reasonable outcomes
53. Knowledge from the social sciences is used in pulmonary rehabilitation programming for mainly what purpose?
To determine the impact of the disability on the patient or family and to establish ways to improve the patient’s quality of life
54. Minimum equipment requirements for the physical reconditioning component of a pulmonary rehabilitation program include which of the following?
Inspiratory resistive breathing devices, rowing machines or upper extremity ergometers, and pulse oximeters
55. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following pulmonary function tests would you recommend be performed as a component of the preliminary evaluation?
Lung volumes, including functional residual capacity (FRC), Diffusing capacity (DLCO), and Pre- and post-bronchodilator flow rates
56. A patient is being considered for participation in a pulmonary rehabilitation program. Which of the following test regimens would you recommend in order to ascertain the patient’s cardiopulmonary status?
Cardiopulmonary exercise evaluation and pulmonary function testing
57. The physical reconditioning component of a pulmonary rehabilitation program usually includes which of the following?
Aerobic exercises for the extremities, timed walking exercises, and ventilatory muscle training
58. The principal objectives of pulmonary rehabilitation include which of the following?
To control and alleviate the symptoms, restore functional capabilities as much as possible, and improve the quality of life
59. Reconditioning the inspiratory muscles of patients undergoing pulmonary rehabilitation is accomplished through which of the following methods?
Performing inspiratory resistive breathing exercises
60. A small-group discussion format for pulmonary rehabilitation educational sessions is recommended in order to foster which of the following?
Group interaction, peer support, and group identity
61. A small pulmonary rehabilitation program class size has which of the following beneficial effects?
It facilitates group interaction, allows for more individualized attention, helps to sustain participant motivation, and reduces the likelihood of attrition
62. To deal with incidents of hypoxemia, dyspnea, or airway hyperreactivity during physical reconditioning activities, which of the following should be available in the rehabilitation area?
Bronchodilator agents and emergency oxygen
63. To increase the likelihood that positive patient results are lasting, what must pulmonary rehabilitation programs provide?
Periodic follow-up and reinforcement
64. To physically recondition a patient and increase exercise tolerance, which of the following must be accomplished?
The body’s overall oxygen utilization must be improved, the patient’s essential muscle groups must be strengthened, and the cardiovascular response to exercise must be enhanced
65. What are some relative contraindications for cardiopulmonary exercise testing?
Severe pulmonary hypertension or cor pulmonale, known electrolyte disturbances (e.g., hypokalemia), SaO2 or SpO2 less than 85% breathing room air, and untreated or unstable asthma
66. What are the overall goals of rehabilitation?
To minimize the disability’s impact on the individual or family and to maximize the functional ability of the individual
67. What is the first step in evaluating patients for participation in a pulmonary rehabilitation program?
Complete patient history
69. What are the three components of a cardiopulmonary rehabilitation program?
Physical activity, education, and emotional support
70. What are the differences between cardiac and pulmonary rehabilitation?
Cardiac patients are typically younger, reimbursement is easier to obtain with cardiac rehabilitation, and breathing exercises are not essential for cardiac patients.
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71. Which of the following medical professionals are commonly involved in cardiopulmonary rehabilitation programs?
Respiratory therapists, nurses, cardiologists, and pulmonologists
72. Which of the following elements should be considered in most pulmonary rehabilitation programs?
The individual’s needs, the patient’s education, the patient’s personality, and the patient’s attitude
73. Which of the following is NOT a factor affecting the cost of a pulmonary rehabilitation program?
The patient’s health insurance
74. Which of the following is NOT a reasonable expectation for a pulmonary rehabilitation program?
Reversal of the disease process
75. Which of the following measures during cardiopulmonary exercise evaluation are most useful in differentiating between exercise intolerance of cardiac versus ventilatory origin?
PaCO2 and PaO2
76. Which of the following occur when the ventilatory threshold is exceeded during exercise?
The patient’s metabolism becomes anaerobic, and fatigue increases.
77. Which of the following outcome measures is considered a major predictor for improvement in a COPD patient’s health-related quality of life?
Frequent attendance in a maintenance program
78. Which of the following patients are NOT good candidates for pulmonary rehabilitation?
Unstable cardiovascular patients who require monitoring, and patients with malignant neoplasms involving the lungs
79. Which of the following topics should be covered in a rehabilitation education session on respiratory home care?
Self-administration of therapy, care of the home equipment (e.g., cleaning), and safe use of the home care equipment
80. Which of the following would you not expect to observe after a chronic obstructive pulmonary disease (COPD) patient completes a sound pulmonary rehabilitation program?
A permanent increase in forced expiratory volume in 1 second (FEV1) and forced expiratory flow (FEF25%-75%)
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81. While you are assisting in a treadmill cardiopulmonary stress test procedure, the patient complains to you of severe shortness of breath and some chest pain. Which of the following actions would you recommend at this time?
Terminate the procedure at once and notify the physician
82. What are the two types of pulmonary rehabilitation that improve ventilation?
Diaphragmatic breathing and pursed-lip breathing
83. What is the goal of cardiopulmonary rehab?
The primary goal is to achieve and maintain the individual’s maximum level of independence and functionality in the community.
84. Under the psychosocial support component of cardiopulmonary rehab, what two factors are common with patients who have a chronic pulmonary disease?
Depression and hostility
85. What can cause or aggravate physical problems associated with cardiopulmonary rehab?
86. What are the two major aims of a cardiopulmonary rehab program?
(1) To control and alleviate disease symptoms, and (2) To help patients achieve optimal levels of activity
87. What happens with cardiac output during exercise in healthy adults?
At low workloads, both SV and HR contribute to an increased output, and it increases linearly with an increasing workload.
88. What happens to the end-expiratory lung volume during exercise in patients with COPD?
89. How often should intensity be increased in a pulmonary rehab program?
The intensity should be increased every 5th session.
90. What happens to the blood flow to the brain during intense exercise?
Absolute blood volume stays the same, but the percentage of blood flow to the brain decreases.
Cardiopulmonary rehabilitation is an important step in the treatment of many heart and lung conditions. It’s essential for helping patients get back into their daily routine.
Hopefully, this article has given you a better understanding of this topic and how it can help those with cardiopulmonary diseases. We have a similar guide on delivering respiratory care in alternative settings that I think you’ll find helpful. Thanks for reading and, as always, breathe easy, my friend.
Medical Disclaimer: This content is for educational and informational purposes only. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition. Never disregard professional medical advice or delay seeking it because of something you read in this article. We strive for 100% accuracy, but errors may occur, and medications, protocols, and treatment methods may change over time.
The following are the sources that were used while doing research for this article:
- Faarc, Kacmarek Robert PhD Rrt, et al. Egan’s Fundamentals of Respiratory Care. 12th ed., Mosby, 2020. [Link]
- Jardins, Des Terry. Cardiopulmonary Anatomy & Physiology: Essentials of Respiratory Care. 7th ed., Cengage Learning, 2019. [Link]
- Rrt, Des Terry Jardins MEd, and Burton George Md Facp Fccp Faarc. Clinical Manifestations and Assessment of Respiratory Disease. 8th ed., Mosby, 2019. [Link]
- Tessler, Joseph. “Cardiac Rehabilitation – StatPearls – NCBI Bookshelf.” National Center for Biotechnology Information, 2 June 2020, www.ncbi.nlm.nih.gov/books/NBK537196.
- “Physiological Basis of Cardiopulmonary Rehabilitation in Patients with Lung or Heart Disease.” PubMed Central (PMC), 1 June 2015, www.ncbi.nlm.nih.gov/pmc/articles/PMC4487369.
- “Cardiac Rehabilitation Past, Present and Future: An Overview.” PubMed Central (PMC), 1 Mar. 2012, www.ncbi.nlm.nih.gov/pmc/articles/PMC3839175.
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Medical Disclaimer: The information provided by Respiratory Therapy Zone is for educational and informational purposes only. It should not be used as a substitute for professional medical advice, diagnosis, or treatment. Please consult with a physician with any questions that you may have regarding a medical condition.