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INTRODUCTION

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Physical therapists are often called on to treat patients/clients with one or more chronic medical conditions, which are inherent causes of impairments, dysfunctions, and disabilities, and/or increase the risk of other pathologic conditions. Consider, for example, diabetes and coronary artery disease (CAD). Diabetes is, itself, a cause of considerable dysfunction and disability, and it is also a risk factor for CAD, which is the number one killer in the United States.1 Both diabetes and CAD and other cardiopulmonary diseases are highly prevalent and may be present in medically complex patients/clients who are seen by physical therapists in a wide range of practice settings. CAD is also associated with other medical conditions (hypertension, hyperlipidemia, and obesity) and behaviors (cigarette smoking and physical inactivity) that are considered to be risk factors. These risk factors, too, are often encountered by physical therapists in clinical practice. Physical therapy (PT) interventions can help to prevent cardiopulmonary diseases from developing, even among individuals with risk factors. This process is called primary prevention, and an individual referred to physical therapists for risk-factor management may be best referred to as a client. Physical therapists can also intervene in the presence of known, overt cardiopulmonary disease. These interventions are aimed at reducing symptoms and/or slowing the progression of the disease. This process is termed secondary intervention and these people are usually referred to as patients. Regardless of whether clients or patients seek PT services, these individuals may be restricted in their activities due to deconditioning. Some have chronic medical conditions, including cardiopulmonary disease, and may restrict their activities because of symptoms, illness, or hospitalization. This deconditioning causes impairment due to reduced aerobic capacity, which can lead to disability and dependency.

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Both clients with risk factors and patients who are deconditioned may be treated in a variety of practice settings. They may be in hospital, recovering from surgery; they may be outpatients who visit the hospital several days a week for exercises and patient education, or they may receive services in the home. They may also be found in wellness centers for weight-reduction programs and dietary counseling. Cardiopulmonary Practice Patterns A and B are intended to address both prevention of cardiopulmonary disease and the management of the deconditioning that often accompanies cardiopulmonary and other medical conditions.

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Patterns A and B may be positioned on different points of the lifespan continuum. Pattern A is seen earlier, where the potential for cardiopulmonary disease is present, but not manifest. Pattern B represents progression such that cardiopulmonary disease may have occurred and has begun to affect not only physiology but also function. Many conditions that are “risk factors” for cardiopulmonary disease in Pattern A may also be present in pattern B. Moreover, Patterns A and B share common primary PT interventions—physical activity, patient education—for which there is ample evidence of its effectiveness.

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This chapter reviews the pathophysiology related to conditions and behaviors ...

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