Cardiopulmonary Rehabilitation: Basic Theory and Application, 2d ed.

Brannon FJ, Foley MW, Starr JA, Black MG, eds. Philadelphia, PA 19103-1493, FA Davis Co, 1993, hardback, 450 pp, illus, $39.

In the 5 years since the publication of the first edition of this book, clinicians engaged in cardiopulmonary rehabilitation have become more involved in clinical decision making, and students have become more astute and inquisitive in studying the cardiopulmonary system. The editors, therefore, have expanded the problem-solving chapters, revised existing chapters on the cardiac system, and increased the scope of this text to emphasize the pulmonary system. The first chapter presents an overview of both cardiac and pulmonary rehabilitation programs.

The book follows a logical progression of the learning process with basic theory covered first, as a foundation for practice. Three chapters review cardiac and pulmonary anatomy in conjunction with exercise and respiratory physiology. Illustrations complement the text. Simple case studies are presented at the end of the chapter on respiration to assist the reader in analyzing arterial blood gases. The next two chapters discuss cardiopulmonary pathophysiology. The pathogenesis of the atherosclerotic process is presented along with clinical manifestations, symptoms, and major complications. Pulmonary disorders that comprise chronic obstructive pulmonary disease classification are outlined by definition, etiology, pathophysiology, clinical course, and prognosis. Restrictive lung diseases encountered in pulmonary rehabilitation settings are presented. Acute pulmonary conditions are beyond the scope of this text. Chapter 7 emphasizes medical (pharmacological) management of cardiopulmonary disease along with a brief discussion of surgical procedures for cardiac disease. Figures and tables in this chapter aid in understanding this complicated topic.

Clinical assessment of the patient with cardiopulmonary problems is presented in the three subsequent chapters. Chapter 8 focuses on the basics of and interpretation of the electrocardiogram. Rhythm strips and written explanations assist the reader in interpreting common dysrhythmias. Review questions and a rhythm-strip review at the end of this chapter facilitate self-evaluation of skills. Rather than focusing on sophisticated tests, clinical assessment is presented as a series of basic tests that are performed in most cardiopulmonary rehabilitation settings. The cardiac assessment includes detailed information regarding the patient's medical status and laboratory assessment (informed consent, pulmonary function testing, physical measurements such as body composition, and graded exercise testing).

Various methods for calculating percentage of body fat and for administering and interpreting tests of exercise tolerance are easy to understand. Examples of patient application forms, informed consent forms, referring physician forms, and lists of emergency procedures are placed in appendixes and do not interrupt the flow of the material.

The pulmonary assessment includes brief overviews of observation, inspection, palpation, and auscultation, but mediate percussion is not mentioned. Although providing a good review of pulmonary assessment for the clinician, these explanations do not contain enough detail for the novice. The most common tests of pulmonary function are explained well. Case studies for patients with cardiac and pulmonary problems are introduced at the end of each chapter and summarize the individual's medical history and raw data from the graded exercise test. The case studies begin with simple medical histories and end with more complex and interrelated problems.

The remaining chapters deal with treatment procedures for the patient undergoing cardiopulmonary rehabilitation. One chapter describes guidelines for writing safe and effective exercise prescriptions utilizing the case studies. Detailed explanations of calculating intensity of exercise are presented using several methods. Implementation of the exercise therapy session and exercise progression is described in the next chapter. Again, case studies are used as examples. Modification of exercise for special populations, environmental considerations, and motivation and compliance issues complete this discussion. The next chapter is devoted to modification of risk factors for the patient with cardiac problems. Assessment, pathophysiologic effects, and methods of modification are presented for each risk factor. The final chapter outlines additional components of a pulmonary rehabilitation program including methods of airway clearance, ventilatory muscle training, breathing reeducation, energy-saving techniques, and nutritional modifications. More illustrations and more detailed explanations of these topics would assist the beginning learner, but experienced clinicians would find this material adequately presented.

Throughout the text, material is presented in a concise, yet accurate and logical, progression. The overall style is very readable. Summaries and contemporary bibliographies follow each chapter. This book is not meant to be used as a manual for acute pulmonary conditions or for intensive care settings. Students, educators, and clinicians, therefore, who are involved with the practice of cardiopulmonary physical therapy may want to supplement this text with other references that cover acute care situations in more detail.

In conclusion, this book does accomplish the authors' intent and is an excellent resource for physical therapists and others in health care involved with existing cardiopulmonary rehabilitation programs or for those beginning new programs.