UAB Synopsis, Vol. 25, No. 15, July 3, 2006

UAB’s CardioPulmonary Rehabilitation Department opened in 1996 with a commitment to fulfill UAB’s mission: provide quality program services that include patient care, teaching, and research. Celebrating its 10th anniversary, the department has consistently employed this philosophy and has provided care to over 1,200 cardiology patients and 450 pulmonary patients during the past decade, says Vera Bittner, MD, MSPH, medical director of the program’s cardiac component.

In 1999, UAB cardiac and pulmonary rehabilitation programs were among the first in the nation to receive national certification from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR), and have met recertification requirements every 3 years. AACVPR certification recognizes programs that meet the well-defined and measurable standards of AACVPR guidelines for cardiac and pulmonary rehabilitation.

UAB’s team includes Dr. Bittner, UAB pulmonologist James E. Johnson, MD, medical director of the pulmonary rehabilitation program, program manager Bonnie K. Sanderson, RN, PhD, and four full-time staff — two registered nurses, a clinical exercise physiologist, and a clinical support specialist. Patients also may consult with dietitians, diabetes educators, pharmacists, psychologists, and other specialists.

Today’s comprehensive rehabilitation substantially improves outcomes,” Dr. Bittner says. A recent population-based analysis among individuals with myocardial infarction, authored by Mayo Clinic investigators, supports benefits of cardiac rehabilitation. Patients who enrolled in a structured cardiac rehabilitation program enjoyed a 3-year 95% survival rate. Among nonparticipants during the same period, survival was 64%.

“This analysis not only reproduced the benefits of cardiac rehabilitation seen in previous studies for all age and gender subgroups analyzed, but also suggested cardiac rehabilitation confers a significant survival advantage even in the current era of aggressive revascularization and vigorous pharmacologic therapy,” she says.

While pulmonary rehabilitation has not been shown to offer a survival advantage for patients with lung disease, it does offer substantial benefits for other outcomes, Dr. Johnson says. “Studies have repeatedly shown that such patients have improvement in exercise tolerance and symptoms, such as shortness of breath, after a program of pulmonary rehabilitation. Services are designed to enhance each patient’s medical care by controlling symptoms, optimizing functional capacity, and improving quality of life for patients with a variety of lung problems,” he says.

CardioPulmonary rehabilitation combines exercise training, risk-factor modification, and education on making necessary lifestyle changes and self-management skills, Dr. Sanderson explains. “We begin with a patient assessment that helps us develop an individualized goal-directed treatment plan with short-term and long-term objectives for reducing risk factors, improving management of heart or lung disease, and improving quality of life,” she says.

Education and Research

While the main focus of the cardiopulmonary rehab programs is providing quality patient care, UAB’s team is committed to excellence in academic and research activities in cardiac and pulmonary rehabilitation. The results: established internships and clinical rotations for cardiology fellows, nurses, exercise specialists, psychologists, and other allied health professionals; manuscripts published in peer-reviewed scientific journals; abstracts and other professional presentations at regional, national, and international meetings; and funded research projects, including participation in the National Heart, Lung, and Blood Institute-funded trial of exercise in heart failure.

Despite the successes of cardiopulmonary rehabilitation, one of the biggest challenges is getting patients, physicians, and the community to recognize the value of the services and to increase participation rates. “Although benefits of cardiopulmonary rehabilitation are numerous and well-established, less than one third of eligible patients participate in these programs,” Dr. Bittner says. “Women and patients older than 70 years are least likely to attend.

“Many reasons for low participation in cardiac rehabilitation have been reported, but studies consistently show the strength of the referring physician’s recommendation is one of the most important factors in getting patients — men or women — to attend cardiac rehabilitation,” Dr. Bittner says.

During its 10th anniversary, UAB’s cardiopulmonary rehabilitation team is eager to share more information about their program services. If you would like to schedule a presentation for a professional meeting or discuss the programs in more detail, contact Dr. Sanderson at 934-9628 or bks@uabmc.edu.