Physiological basis of cardiopulmonary rehabilitation in patients with lung or heart disease

EDUCATIONAL AIMS To illustrate the common mechanisms limiting exercise tolerance in patients with chronic lung and heart diseaseTo highlight the impact of lung and heart disease on daily physical activity levelsTo outline the effects of cardiopulmonary rehabilitation on functional capacity in patients with chronic lung and heart diseaseTo discuss an innovative tele-rehabilitation intervention using information and communications technologies to improve functional capacity in patients with chronic lung and heart disease. SUMMARY Shortness of breath associated with cardiorespiratory abnormalities and peripheral muscle discomfort are the major factors that limit exercise capacity in patients with chronic obstructive pulmonary disease (COPD) and those with congestive heart failure (CHF). Both of these symptoms negatively impact on patients' daily physical activity levels. In turn, poor daily physical activity is commonly associated with increased rates of morbidity and mortality. Cardiopulmonary rehabilitation programmes partially reverse muscle weakness and dysfunction and increase functional capacity in both COPD and CHF. However, benefits gained from participation in cardiopulmonary rehabilitation programmes are regressing soon after the completion of these programmes. Moreover, several barriers limit access and uptake of cardiopulmonary rehabilitation programmes by eligible patients. A potential solution to the underutilisation of cardiopulmonary rehabilitation is the implementation of tele-rehabilitation interventions at home using information and communications technologies. Thus, tele-rehabilitation may be useful to encourage and educate patients with COPD or CHF on how best to maintain and/or further enhance daily physical activity levels.