Chapter 12

The reader may recall that Chapters 9 and 10 presented information on pulmonary and cardiac evaluations. This information included tests and measures appropriate for diagnosis and measurement of cardiac and pulmonary status. Heart rate and blood pressure (BP) determination as well as pulse oximetry and evaluation of ventilatory muscle function were also included. Chapter 11 introduced electrocardiography, which provided another important measurement tool. However, knowledge of examination, instrumentation, and procedures is only part of the picture: During an exercise session, the clinician must also interpret these data and decide what to do with the information once it is acquired. Use of this information may be confined to deciding whether or not to stop exercise. Certainly this would be an appropriate first consideration. Just as important is the synthesis of this information with therapeutic interventions that optimizes outcomes. Examination and intervention are thus dynamic processes that are not only restricted to the therapist–patient relationship. Appropriate documentation and consultation may also bring in other members of the multidisciplinary team—the nurse, cardiologist, and social worker, for example. A physical therapy program that utilizes ongoing continuous evaluation, blended with treatment, and integrated with documentation that incorporates other members of the health care team would appear to optimize results. Indeed, such an approach is of benefit in at least three ways: (1) It enhances the physical therapist's ability to develop an effective exercise prescription, (2) it provides the referral source with information elicited during an exercise state; information that might not be otherwise available, and (3) it ultimately benefits the patient, the recipient of the combined care of both the physical therapist and the other members of the health care team.

This chapter* has two sections. The first portion will present pathophysiological processes that limit exercise capacity. These processes will be summarized in two cardiopulmonary hypothesis–oriented algorithms—one for patients with cardiovascular disease and the other for patients with pulmonary disease. These can be used to direct the physical therapist's actions by assignment of exercise response into categories subsumed under them. The second part of the chapter will apply the algorithms to two case studies of patients with cardiopulmonary disease. In this way, the chapter will provide a systematic approach to patient management during an exercise session and will highlight hypothesis testing as a means of identifying impairments and functional limitations in patients who are limited by cardiovascular or pulmonary disease. This chapter will also prepare the reader for subsequent discussion of patient management strategies for an overall plan of care, found in the six preferred practice pattern chapters.

*Portions of this chapter were modified and reprinted from DeTurk WE. Exercise and the intolerant heart. Clin Manag. 1992;12(1):67-73 and DeTurk WE. Exercise and the intolerant heart, part 2. Clin Manag. 1992;12(2):32-39, with the permission of APTA.

This chapter will serve to reinforce an important point: Ongoing, systematic examination and evaluation during treatment may be important determinants for an overall plan of care. ...

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