Phase I of cardiac rehabilitation: A new challenge for evidence based physiotherapy

Table 1 Presentation of end-points of papers disclosed since 1992 about evidence based on cardiopulmonary physiotherapy

Study	Design of study	Study objective	Study conclusions
Dean et al[28], 1992	Review study involving 61 articles	Examines advances in cardiopulmonary physiology and clinical medicine since the development of classic chest physical therapy practice, and the discordance of current physical therapy practices with the physiologic advances	(1) Cardiopulmonary physiology, pathophysiology and clinical medicine have advanced exponentially compared with physical therapy; (2) Establishing the efficacy of conventional chest physical therapy has been confounded by the lack of specificity of the underlying pathophysiology; (3) Needed to define the parameters for prescribing, position and mobilization so that the efficacy of these noninvasive interventions can be maximally explored in patient care
Stiller et al[29], 1994	Randomized controlled trial, involving 127 patients	Investigate whether prophylactic chest physical therapy affected the incidence of postoperative pulmonary complications	The results suggest that the necessity for prophylactic chest physiotherapy after routine coronary artery surgery should be reviewed
Johnson et al[30], 1996	Randomized controlled trial involving 78 patients	To determinate whether higher personnel intensive chest physical therapy can prevent the atelectasias that routinely follows cardiac valve surgery	The routine prescription of high intensity physical therapy does not improve patient outcomes but does add significantly to patient costs
Stiller[31], 2000	Review study involving 82 articles	To evaluate actuation of physiotherapy in intensive care	Although recommendations can be made concerning evidence based practice for physiotherapy, in the intensive care unit (ICU) these are limited because of the lack of data evaluating the effectiveness of physiotherapy in these settings. There is an urgent need for further research to be conducted to justify the role of physiotherapy in ICU
Wynne et al[32], 2004	Metanalyses involving 159 articles	To evaluate postoperative pulmonary dysfunction in adults after cardiac surgery	No single method of pulmonary physiotherapy is superior to others in preventing pulmonary complications
van der Peijl et al[33], 2004	Randomized controlled trial involving 246 patients	Compare the effectiveness of a low frequency program with high frequency and to assess whether the latter would yield sufficient benefit for the patient to justify higher costs in material end personnel	High frequency exercise program leads to earlier performance of functional tasks but would allow a sensible redistribution of the physiotherapists activity towards complicated and, therefore, more demanding patients
Pasquina et al[20], 2003	Review study involving 18 trials (1457 patients)	To assess whether respiratory physiotherapy prevents pulmonary complications after cardiac surgery	The usefulness of respiratory physiotherapy for the prevention of pulmonary complications after cardiac surgery remains unproved

Table 2 Presentation of the ACSM recommendations for the prescription of exercises in phase I of cardiac rehabilitation

Intensity

TPE below 13 (scale 6-20)

Post AMI: HR below 120 bpm or resting HR + 20 bpm (Arbitrary lower limit)

Post-surgery: resting HR + 30 bpm (Arbitrary upper limit)

Up to tolerance if non-symptomatic

Duration

Intermittent sessions lasting from 3 to 5 min

Resting periods

As the patient wishes

Lasting from 1 to 2 min

Shorter than the time of the exercise sessions

Total duration of 20 min

Frequency

Early mobilization: 3 to 4 times per day (1st to 3rd days)

Subsequent mobilization: twice per day (As from the 4th day)

Progression

Initially increase the duration by up to 10 to 15 min of exercise time and then increase the intensity

AMI: Acute myocardial infarction; TPE: Table of perceived effort; HR: Heart rate; ACSM: American college of sports medicine.