Cardiac and pulmonary rehabilitation

Domain IX · Biomedical, neuro & digital

What it is

Cardiac rehabilitation (CR) and pulmonary rehabilitation (PR) are structured, multidisciplinary programmes, not a psychotherapy. NICE describes CR as a coordinated, structured programme that removes or reduces the underlying causes of cardiovascular disease and provides the best possible physical,…

Format

• Identification, referral and recruitment. Eligible patients are identified and referred promptly, ideally during the inpatient stay; NICE's quality statement is referral before discharge after myocardial infarction (MI), and NG185 says to begin CR as soon as possible after admission and before…
• Initial assessment. NICE's quality statement is an assessment appointment within 10 days of discharge after MI, which may be an outpatient visit, home visit or telephone interview; NG185 says CR sessions should start within 10 days of discharge. BACPR's assessment covers demographics and social…

Who practises it, and how they are trained or regulated

• Audit and certification. Data to NACR; national certification.
• The Heart Manual (home-based CR)
• A registered practitioner assesses suitability; trained facilitators provide an initial assessment and a small number of follow-up contacts (face to face, telephone or video), then a final assessment and onward referral. Facilitators must complete the Heart Manual training course. It is not suitable for everyone (e.g. unstable conditions, very poor prognosis, complex comorbidities, severe cognitive impairment).

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• shame and concealment; drinking used to manage anxiety.
• forcing the topic; the client hearing it as a prognosis.
• embarrassment; financial strain driving premature return to work.
• silent stopping of medicines; the therapist being drawn into medical advice.
• role confusion; duplicate questionnaires; confidentiality limits not explained.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.