The Effects of a Circuit-Training Program in the Home
on a Patient with CHF and COPD
by Andrew Bartlett, PT, Ph.D., MPA; Rachel Waugh, PT, DPT; Eric Tatar, Student Physical Therapist
Background and Purpose
The Patient Protection and Affordable Care Act, also known as Obamacare, was passed on March 23rd, 2010. This act implements financial penalties for hospitals that have high hospital readmission rates for a number of diseases including congestive heart failure (HF) and chronic obstructive pulmonary disorder (COPD), which have a comorbidity rate of greater than 20%.1,2
Heart failure continues to be one the main causes of hospital readmissions with a 30-day readmission rate between 20-30%, equivalent to just under $40 billion per year. 3 COPD is not far behind, costing Americans approximately $29.5 billion in direct healthcare costs with a readmission rate of just under 20%.4.5 Due to this, healthcare providers across the country have made it a focus to reduce hospital readmission rates in patients with HF and COPD.6
Circuit training has been one of the approaches in treating individuals with heart failure, both in the home setting and outpatient clinic. Circuit training is defined as an aerobic and resistive exercise program designed to build strength and muscular endurance with the amount ofexercises varying based on purpose. One method of treatment that has been shown to reduce
hospital readmission in patients with HF and COPD is a combination of resistive and aerobic exercises.7 In a randomized control trial conducted by Bouchla et al, 20 stable HF patients participated in a rehabilitation program consisting of either aerobic or combined aerobic and strengthening exercises. Both groups significantly improved 2-rep max, peak oxygen uptake, and
peak work load with there being a significant difference between groups in favor of the combined rehabilitation group. 10 In addition, a combination of strength and aerobic exercises has improved the 6-minute walk test (6MWT) and the Chronic Respiratory Disease Questionnaire in patients with COPD. 8
The purpose of this case report is to describe the implementation of a circuit-training program in the home that is safe and effective for a patient with HF and COPD, which may reduce the risk of hospital readmission.
Case Description
Medical History/Demographics:
The patient was a 78 year-old African American female being treated in a home care setting for an exacerbation of COPD and a secondary diagnosis of HF. Other diagnoses include: chronic kidney disease stage II, type II diabetes mellitus, gastroesophogeal reflux disease (GERD), obesity, and bilateral shoulder and knee arthritis. She was recently discharged from hospital with physical therapy (PT) orders to improve endurance and independence with mobility and transfers. Before the current episode of care the patient had been treated on and off within the homecare setting for approximately three years with seven readmissions during that time-frame. Currently, the patient uses 2L of continuous O,. Other services include a home health aide, nursing,
and telehealth to monitor vitals, oxygen saturation, and weight.
Medications:
Overall, patient is taking 35 medications daily, including but not limited to the following: alb-
uterol sulfate, amlodipine, atorvastatin, budesonide formoterol, furosemide, insulin, isosorbide mononitrate, metolazone, metoprolol sucinate, and oxycodone.
Social History/Home Environment:
Patient is retired and lives on the upper Aoor of a 2-story home, has three stairs to enter the home, and uses a stair glide to get to the upper Aoor. Patient lives with a supportive family.
Prior Level of Function:
Prior to this episode of care, patient was able to ambulate distances of approximately 20 feet with a standard walker and used a stair glide indoors.
Patient Goals:
Her goals consist of being able to go to church 3 times per week, which was her routine prior
to her original diagnoses. She would also like to work on increasing the distance she can walk before having to rest as well as decrease the amount of time she has to use her O,.
Fall 2017 - 19