Physiotherapy in Cardiovascular and Respiratory Conditions

Base Knowledge

Anatomy and physiology of respiratory and cardiovascular systems.

Assessment and prescription of specialized interventions in respiratory and cardiovascular cases

Clinical reasoning oriented to maximize functioning.

Teaching Methodologies

Teaching methodologies will include interactive lectures to introduce core concepts and frame key clinical issues, promote inquiry, and guide student engagement with the content. Diverse clinical cases will be integrated to illustrate and contextualize theoretical topics, fostering deeper understanding. Active learning strategies are central, with a particular focus on flipped classroom and case-based learning models.

Small group discussions will be used to analyse clinical cases in-depth, requiring students to engage in research, literature review, and problem-solving. This approach aims to develop critical thinking and enable students to select and justify appropriate physiotherapy assessment and intervention techniques for patients with cardiovascular and respiratory pathologies. Learners will collaboratively construct, evaluate, and present clinical cases, employing clinical reasoning to determine SMART objectives, intervention strategies, and reassessment plans. This cycle of case formulation, discussion, and reflection is designed to enhance both subject mastery and professional decision-making skills. The overall methodology is grounded in student-centred, flip-based learning principles.

Learning Results

Practical-instrumental (psychomotor performance);

Cognitive: reflective mental performance and knowledge;

Affective: growth of emotional/behavioral and attitude areas.

After completing the curricular unit, the student should know, understand and be able to:

Apply the principles of assessment, diagnosis, programming and intervention in conditions and problems associated with the cardiovascular and respiratory system, as well as to elaborate adequate records, based on Functionality/Disability;

Organize the elements associated to Physiotherapy procedures according to the components Structures, Functions, Activities/Participation and Contextual Factors

Develop strategies centered in the education/counselling of patients/patients and relatives and of the knowledge of the contribution of the different members of the health team so that the physiotherapist has a global vision of the patient/user

Critically analyze the models and practical strategies in the different contexts where the physiotherapist works

Evaluate the evidence of practice in the context of cardiovascular and respiratory conditions.

Program

Assessment According to ICF:
Deepen the strategies for assessing components of functioning and disability, including body structures and functions, activities, and participation, as well as contextual factors in patients with cardiovascular and respiratory conditions. Utilize internationally validated instruments and recommended scales. Encourage the use of practical examples and simulations to train multidimensional assessment skills.

Prognosis and Goal Setting:
Explore not only biomedical prognosis but also the psychoemotional and social impact of the conditions in setting SMART goals. Reinforce critical analysis of factors influencing adherence, therapeutic success, and session planning. Develop skills in dynamic management and planning of session frequency and duration, considering the patient’s community context and available resources.

Evidence-Based and Innovative Interventions:
Promote analysis of international guidelines, national standards, and clinical decision algorithms. Include interdisciplinary approaches in collaboration with other health professionals, emphasizing teamwork for managing complex cases. Encourage teaching and practice of advanced techniques (e.g., inspiratory muscle training, functional gait assessment, exercise prescription based on individual response, personalized rehabilitation models). Incorporate modules dedicated to new technologies, including artificial intelligence, machine learning in rehabilitation, wearables, sensors, and telerehabilitation. Develop competencies in implementing health promotion and secondary prevention projects. Stimulate practice and discussion on person-centered rehabilitation in real and simulated environments.

Innovative Teaching and Learning Strategies:
Implement active learning systematically, including case studies, clinical simulations, flipped classrooms, and problem-based learning. Use digital environments for discussion, training, and assessment as complements to face-to-face sessions (e.g., collaborative platforms, digital simulations, e-portfolios). Provide continuous formative evaluation with objective and constructive feedback.

Focus on Evaluation and Continuous Improvement:
Integrate moments of self-reflection and self-assessment for students. Promote continuous professional development, emphasizing the importance of up-to-date scientific knowledge and evidence-based practice throughout the course.

Curricular Unit Teachers

Paula Susana Gonçalves Lopes

Internship(s)

NAO

Bibliography

Principal Bibliography

Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C,
Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P,
Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler AO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020 Mar 30:2047487320913379. doi:10.1177/2047487320913379. Epub ahead of print. PMID: 32223332.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 10th edition, 2018;

APFisio. “Registo, logo existo!”: Registo Clínico de Fisioterapia, 2018. Disponível em: http://www.apfisio.pt/wp-ontent/uploads/2018/10/RLE__2018_008_31__Registo_logo_existo.pdf

Secondary Bibliography:

 

Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C,
Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P,
Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler AO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol. 2020 Mar 30:2047487320913379. doi:10.1177/2047487320913379. Epub ahead of print. PMID: 32223332.

American College of Sports Medicine. ACSM’s Guidelines for Exercise Testing and Prescription. Lippincott Williams & Wilkins, 10th edition, 2018;

APFisio. “Registo, logo existo!”: Registo Clínico de Fisioterapia, 2018. Disponível em: http://www.apfisio.pt/wp-ontent/uploads/2018/10/RLE__2018_008_31__Registo_logo_existo.pdf

Bibliografia Secundária

– Chartered Society of Physiotherapy. Inspire Respiratory Guidelines. 2015;

– Dowman L, Hill CJ, May A, Holland AE. Pulmonary rehabilitation for interstitial lung disease. Cochrane Database Syst Rev. 2021 Feb 1;2(2):CD006322.

Anderson L, Oldridge N, Thompson DR, Zwisler AD, Rees K, Martin N, Taylor. RS. Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. J Am Coll Cardiol 2016;67(1):1–12

Anderson L, Nguyen TT, Dall CH, Burgess L, Bridges C, Taylor RS. Exercise-based cardiac rehabilitation in heart transplant recipients. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No.: CD012264. DOI: 10.1002/14651858.CD012264.pub2. Accessed 13 May 2021.

Atkinson HL & Nixon-Cave K. A Tool for Clinical Reasoning and Reflection Using the International
Classification of Functioning, Disability and Health (ICF) Framework and Patient Management Model. Physical Therapy, 2016;91(3):416-430.

Bott J, Blumenthal S, Buxton M, Ellum S, Falconer C, Garrod R, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax. 2009;64(SUPPL. 1).

Calabrese M, Garofano M, Palumbo R, Di Pietro P, Izzo C, Damato A, Venturini E, Iesu S, Virtuoso N, Strianese A, Ciccarelli M, Galasso G, Vecchione C. Exercise Training and Cardiac Rehabilitation in COVID-19 Patients with Cardiovascular Complications: State of Art. Life (Basel).2021 Mar 21;11(3):259. doi:10.3390/life11030259. PMID: 33801080; PMCID: PMC8004041.

Chartered Society of Physiotherapy. Inspire Respiratory Guidelines. 2015 

Chatwin M, Toussaint M, Gonçalves MR, Sheers N, Mellies U, Gonzales-Bermejo J, et al. Airway clearance techniques in neuromuscular disorders: A state of the art review. Respir Med [Internet]. 2018;136
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Consortium for Spinal Cord Medicine. Respiratory management following spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med. 2005;28(3):259-93. doi:
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Edwards I, Jones M, Carr J, Braunack-Mayer A, Jensen G. Clinical Reasoning Strategies in Physical Therapy. Physical Therapy 2004 April;4(84):312-330;

European Society of Cardiology. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Heart Journal, 2017; 00: 1–60. https://doi.org/10.1093/eurheartj/ehx391.

eviCore healthcare. SMART Goals in Physical and Occupational Therapy: Overview, Writing Tips, and Resources. 2018. Disponível em: https://www.securityhealth.org/-/media/Provider/S-M-A-R-T-GoalsOverview-Writing-Tips-and-Resources_PT-OT-FINAL.pdf.

Global initiative for chronic obstructive lung disease. 2023 report.

Gloeckl R, Zwick RH, Fürlinger U, Jarosch I, Schneeberger T, Leitl D, et al.. Prescribing and adjusting exercise training in chronic respiratory diseases – Expert-based practical recommendations. Pulmonology. 2022 Oct 20:S2531-0437(22)00215-X

Hill K, Jenkins SC, Cecins N, Philippe DL, Hillman DR, Eastwood PR. Estimating maximum work rate during incremental cycle ergometry testing from six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2008 Sep;89(9):1782-7

Hill AT, Sullivan AL, Chalmers JD, De Soyza A, Stuart Elborn J, Andres Floto R, et al. British thoracic society guideline for bronchiectasis in adults. Thorax. 2019;74(Suppl 1).

Hoffman M, Chaves G, Ribeiro-Samora GA, Britto RR, Parreira VF. Effects of pulmonary rehabilitation in lung transplant candidates: a systematic review. BMJ Open. 2017 Feb 3;7(2):e013445

Holland AE, Cox NS, Houchen-Wolloff L, Rochester CL, Garvey C, ZuWallack R, et al. Defining Modern Pulmonary Rehabilitation. An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc. 2021 May;18(5):e12-e29.

Jette D, Ardleigh K, Chandler K, McShea L. Decision-Making Ability of Physical Therapists: Physical Therapy Intervention or Medical Referral. Physical Therapy, 2006;12(86):1619-1629;

Jenkins S, Hill K, Cecins NM. State of the art: how to set up a pulmonary rehabilitation program. Respirology. 2010 Nov;15(8):1157-73
McCarthy, B., Casey, D., Devane, D., Murphy, K., Murphy, E., & Lacasse, Y. (2015). Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane database of systematic reviews, (2).

Reid WD; Chung F; Hill K. Cardiopulmonary physical therapy: management and case studies. 2nd ed. Slack Incorporated, 2014;

Rochester CL, Vogiatzis I, Holland AE, Lareau SC, Marciniuk DD, Puhan MA, et al.; ATS/ERS Task Force on Policy in Pulmonary Rehabilitation. An Official American Thoracic Society/European Respiratory Society Policy Statement: Enhancing Implementation, Use, and Delivery of Pulmonary Rehabilitation. Am J Respir Crit Care Med. 2015 Dec 1;192(11):1373-86.

Steiner WA, Ryser Huber L, et al. Use of the ICF Model as a Clinical Problem-Solving Tool in Physical Therapy and Rehabilitation Medicine. Physical Therapy, 2002;82(11): 1098-1107;

Spruit MA, Wouters EFM. Organizational aspects of pulmonary rehabilitation in chronic respiratory diseases. Respirology. 2019 Sep;24(9):838-843

WHO. ICF Browser. Disponível em: https://apps.who.int/classifications/icfbrowser/