Lawrence Cahalin, PhD, PT

Lawrence Cahalin, PhD, PT

Activities of physical therapy and rehabilitation are critical in improving outcomes for the patient with heart disease.  The areas to be focused on include aerobic exercise training, resistance/strength training, and inspiration muscle training. These may have important impacts on measures such as hospitalization, quality of life (QOL), and even survival. One of the first steps is understanding your risk for heart attack. Cahalin urged the audience to visit the American Heart Association's website for heart attack risk factor assessment and asked that we have our patients do the same and take the assessment.

Cahalin suggests that we do more cardiac rehabilitation and even do cardiac rehab as a preventive measure. Currently, the qualifying conditions for reimbursement for cardiac rehabilitation are stable angina, post myocardial infarction, the placement of a stent or experience of angioplasty, coronary artery bypass graft surgery, valve surgery and heart transplant. One place to start is a conversation with patients on how they can begin doing the type of exercise done in cardiac rehab before they have one of those qualifying conditions.

Andrew Coats identifies effect of physical therapy in congestive heart failure (CHF): the cycle of CHF: Coats, Br Ht J 1994, Muscle hypothesis of CHF.

 

Captured from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025572/pdf/brheartj00004-0038.pdf 12-06-2011Captured from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025572/pdf/brheartj00004-0038.pdf 12-06-2011

 

This concept was the central paradigm of Cahalin's talk and includes a cycle involving a range of physiologic changes in the failing heart. The central concept of the process is that catabolic changes occurring in a low cardiac output state lead to skeletal myopathy, then exercise intolerance, and excitation of the sympathetic nervous system. These, in the presence of ongoing catabolic changes, lead to a vicious cycle of declining performance and remodeling of the left ventricle. The goal of physical therapy interventions is to interrupt this cycle and restore optimal function.

With that goal of interrupting the cycle and improving cardiac function in mind, Cahalin suggests that we we start by identifying the proper mode of exercise, duration, frequency and intensity for each patient and revisit this for optimal affect. Combining resistance, strength, and aerobic training finds the most benefit for the patient. The optimal frequency is three days per week, but has to be adjusted to the individual patient. Cahalin also suggests that providers stress the importance of body positioning as a way to speed up the results of any exercise prescription.

-Contributions from Paul McKinney, MD

Captured from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1025572/pdf/brheartj00004-0038.pdf 12-06-2011

By Ryan Squire