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Alyssa Diaz: Hello listeners, and thanks for tuning into the Well Within Reach podcast. I'm your host, Alyssa Diaz. And today we're going to learn more about a common therapy that many heart and lung patients experience in their lives and that's cardiopulmonary rehab. But first we'll introduce today's guest. I'd like to welcome Amy Hornbuckle to the Well Within Reach podcast. Amy, thanks for jumping on with us today.

Amy Hornbuckle: Oh, you're welcome. Good afternoon.

Host: And Amy is the Team Leader of our Cardiopulmonary Rehabilitation Program here at Riverside Healthcare. Amy, tell us a little bit about yourself and your role at Riverside.

Amy Hornbuckle: I'm a BSN nurse. I've been working in cardiopulmonary rehab for four years now. I have my BSN and I'm also a certified professional for cardiac rehab through our certification organization. I am the team leader for the department, which means I not only care for the patients, but I am onboard to make sure that we are following our evidence based practices and protocols and just following up to make sure we're where we need to be for Medicare components as well.

Host: Great. And it's a really important thing to keep on top of, and we're glad to have you here at Riverside. So today's topic, cardiopulmonary rehabilitation is something that a lot of people will either experience themselves or have a loved one who experienced in their lifetime. And so let's just start at the basics and Amy tell us what cardiopulmonary rehab is?

Amy Hornbuckle: Cardiopulmonary rehab, it's a very long word. It has multiple components. So we actually in one department run two different programs. Our cardiac program is geared towards patients with chronic heart disease and then our pulmonary program is geared towards patients with chronic pulmonary disease. So we treat both the heart and lungs and we do that through a program of exercise that is combined with education counseling and also support. When you're going through those learning about that condition as a new patient, or if you've had it for a while, we just reiterate how to care for yourself with chronic heart lung conditions.

Host: And what are some of the things that we can do in these programs that maybe address individual risk factors that goes along with the education portion?

Amy Hornbuckle: The number one risk factors we like to address, and basically is the major component of the program is the prescribed exercise sessions. When you enter the program, you usually get anywhere up to 36 prescribed exercise sessions by your doctor. And what we do with those programs is work with you on an individualized basis to set an exercise prescription that is monitored by your doctor and by multiple disciplinary staff that we have on board. And then while we're doing that, we're also educating you on your diabetes and we work with you on smoking cessation or reduction. We work on how to follow a heart healthy or a long healthy diet. We work on some weight loss management and basically it's along the lines of components of more activity watching your caloric intake. We do have registered dietician that helps in the program in educating our patients on nutrition. So it's a multifaceted program that we look at a different avenues of your personal health.

Host: Exactly. And for those who are unfamiliar with the environment of a cardiopulmonary rehabilitation program is you walk into the suite and there are treadmills going and music playing and weights being lifted and team members practicing one-on-one with patients. And it's a very upbeat environment and hopefully a very good healing environment for our patients. And speaking of our patients, what are some of the types of patients and conditions they might have that are treated with this type of therapy?

Amy Hornbuckle: So, for our cardiac program, we usually get a referral on a patient after they have been in the hospital for either a heart attack or they've had coronary bypass surgery, open heart surgery. They may have had a stent or a valve replacement or repair our cardiac patients as well, may be a patient with a disease called congestive heart failure, which is a chronic condition of a weak heart. So our other patients that we do see that are kind of chronic besides congestive heart failure are those patients that have what we consider stable angina. They continue to have chest pain, even though they've had something done to repair something in their heart. And so we exercise them to help manage that chest pain and then help their heart heal more with that as well.

Host: Okay. And tell us about the pulmonary patient?

Amy Hornbuckle: Pulmonary patients are patients with what we call chronic restrictive lung disease. So any type of lung disease, such as COPD or emphysema, chronic bronchitis, a new disease that we're seeing more often called bronchiectasis where it's a combination of restriction and then a lot of phlegm or mucus production. So we work a lot on training the patients on how to get rid of that excess of mucus. And we work on them to build them back up after they have an exacerbation. That's something you often hear as a patient goes to the hospital who has chronic lung disease with an exacerbation. And we're there when they get out of the hospital to help them recover from that and then to prevent further hospitalizations whenever we can.

Host: And are there other types of pulmonary patients that you see pretty regularly?

Amy Hornbuckle: We do see either pre and post lung transplant patients. They come to exercise before their transplant because they need to be built up before that. And then after their recovery, after they get their lungs or even heart transplant in the cardiac side, after they get back to their outpatient setting, they do come for additional visits to exercise and build themselves back up. We see patients that are being treated for lung cancer, have had lung reduction surgery to improve their symptoms with either lung cancer or COPD. So we see a variety of patients in both of our programs.

Host: It's a lot of hard work and a huge dedication from your team. We're here today, talking about cardiopulmonary rehabilitation at Riverside Healthcare with Amy Hornbuckle, the team lead of the program. Amy, what type of training do your team members undergo to be able to provide such a vast variety of services to your patients?

Amy Hornbuckle: Our program is led by a medical director, but medical director for both programs. Dr. Winn one of our cardiologist is our program medical director for cardiac. And then Dr. Almeida, one of our pulmonologist is for our pulmonary program. As I said, it's a prescribed program, so we do have to have a physician available. The staff that are there, as Alyssa said, one-on-one with you on the treadmill or the new step or whatever piece of equipment we're exercising you on. We have a combination of nurses and we have a respiratory therapist that works very closely with our pulmonary patients and is paramount to a lot of the education because there are the medications for lung disease are constantly changing. So that's something that is very helpful to have an, a program at cardiac and pulmonary rehab program. But we also, as I said, we do nutritional counseling with a registered dietician. We work closely with the heart failure clinic at Riverside. If you're a patient with heart failure, you also work closely with the dieticians for diabetes management as well. The staff that work in the gym all have a background in some form of cardiac or pulmonary inpatient care at some point in their careers, this isn't one of those careers that you come right out of training into. You usually get a background taking care of the acute patient before you move to the outpatient side.

Host: Sure. I'm sure that gives your team a really good understanding of what these patients have experienced. So maybe it helps more in the healing process.

Amy Hornbuckle: Definitely. It definitely does.

Host: And I want to follow up on the patient's journey. Obviously it's different depending on the patient's condition or diagnosis, but how long do patients undergo therapy? Is it weeks or months or somewhere in between?

Amy Hornbuckle: That's usually the first question we get from the patient is how long am I in this program? And usually we go based off of what your insurance is going to cover because it is a prescribed program, but most patients will get 36 sessions and what we tell our patients first day. So they have an idea of what that means is finishing the program anywhere from nine to 12 weeks. They're generally happy with that. And really any style of behavior change that you'll be able to do for long-term. It takes time to learn. It doesn't take one or two sessions. So that's why we get so many sessions with our patients.

Host: Absolutely. And your team just earned a new certification. So tell us more about the AAC VPR and what that means for your program?

Amy Hornbuckle: The American Association of Cardiovascular and Pulmonary Rehabilitation, AAC VPR is our national organization made up of peers and medical professionals with the passion of cardiac and pulmonary rehabilitation. We have that passion getting our patients back on their feet. So they are an organization that nationally looks at evidence based practice. They look at research in the field, making sure that we are up to date with the most current strategies and exercise, prescriptions and protocols that will help the patient improve. So with that organization, they have created certification. It's been out for quite a few years. AAC VPR has been around since 1985 that they offer to programs that meet the highest standard and highest quality of care. The programs that apply for this certification of course have to show documentation that they're following evidence-based care and the best practices, and then also show positive patient outcomes.

So, what we do is we spend a year applying for both programs because we were renewing our pulmonary program. We had already achieved that certification and it just happened to come up the same year that we were trying for our cardiac rehab. Then we submitted one year's worth of documentation. And after our peer review board, again, as I said, it's professionals in the field, people that are working in and out and doing the research projects for cardiac and pulmonary rehabilitation, they review it and then they decide whether or not you are the best. And they decided that Riverside's Cardiopulmonary Rehab, both programs did meet what was needed to achieve certification.

Host: A dual certification, what a big deal that is. And it's something that pushes our team to give our patients the best care. But it also is reassuring to our patients and their families that our team is pushing to provide the best care.

Amy Hornbuckle: Correct. Correct. And this certification for those that aren't familiar, any certification, you usually had to renew it in three years. So, in three years, it's a constant, ongoing process of education to the staff and constant process improvement to make sure we're delivering that quality of care.

Host: Yeah. And always with the end goal of leading to better outcomes for our patients and helping them achieve the best quality of life that we can while they're in our care. And Amy, how might individuals seek more information on the Cardio Pulmonary Rehabilitation Program at Riverside?

Amy Hornbuckle: They can talk to their, either their cardiologist, if they are cardiac patient or their pulmonologist, if they're a pulmonary patient. Cause we do need a referral from them, have a conversation, see if it's the right fit for you. And then what your doctor will do is they'll let us know that you're interested, and we'll work with you to see when we can get you set up.

Host: Amy, thank you for joining us on the Well Within Reach Podcast. And for more information on this topic and others covered on our podcast, visit Riversidehealthcare.org.