Physiotherapists with a special interest in the field of Cardiorespiratory Rehabilitation 🫀🫁
31/01/2025
The facilities at our main Cardiorespiratory Unit at the Sports Science Institute () are world class 🙌🏻
One of our favourites, is the track in the fitness centre. Here, our patients in the pulmonary rehabilitation program can practice their ground based walking and we can give supervised input as they go.
We focus on pace, intensity, cadence breathing and recovery breathing strategies, all while the patient is closely monitored and vitals are tracked throughout the entire session.
These sessions are suitable for patients both on and off oxygen. Learning how to move safely in a supervised environment empowers our patients to continue the work at home.
Grateful to work in such an incredible space, which is also home to an ever expanding multidisciplinary team!
21/01/2025
|BETTER BREATHING FOR CHILDREN|
As a physiotherapy practice, we are passionate about teaching people to breathe appropriately for the activities they regularly engage in and enjoy doing. We have seen the difference this skill makes in the lives of those living with chronic illnesses, as well as those who want to improve their performance in sports.
So, how do we teach children to breathe well, in a fun and engaging manner?
Our full team is back at both cardiorespiratory units this week and ready for an action-packed year!
We can not wait to see you and optimize your cardiac and respiratory health 🫁🫀
If you're new to our page, welcome!
You can find more information about what we do on www.nhhphysio.co.za (follow the cardiorespiratory rehabilitation tabs).
Let's go, 2025 🥳
08/10/2024
Double the fun 🌬🫁
Pulmonary rehabilitation in full swing at our branch!
Don't let the fact that you need permanent oxygen to support your ventilatory needs make you think you should do less. With a supervised pulmonary rehabilitation program, you can significantly improve on your current functional level and quality of life.
17/07/2024
|RESPIRATION AS A LIMITING FACTOR|
2. Blood stealing 🩸
Diaphragmatic breathing positively affects blood shifting between the trunk and the extremities during exercise.
At sustained high intensities the diaphragm fatigues; demanding up to 14%–20% of cardiac output and 10%–16% of VO2, on top of concurrent accessory and expiratory muscle fatigue.
Ventilatory muscle fatigue at high intensities triggers the metaboreflex, which ensures that the ventilatory pump maintains adequate perfusion, by shunting blood from the working muscles.
This competition for oxygen-rich blood is termed “blood stealing.”
12/07/2024
|PHYSIO 🤝🏻 BIO|
We had a blast chatting to yesterday, about cardiorespiratory physiotherapy, what we do and our role in the breathless patient. Such great questions and stimulating clinical conversations. Thanks for having us 🩺👩🏻💻
has created such a unique space where the multidisciplinary team comes together, with the main aim of patient-centered care, always. Fantastic to share this space with such like-minded clinicians and clinical teams 🫶🏻
10/07/2024
|RESPIRATION AS A LIMITING FACTOR|
📈 Dynamic Hyperinflation
Exercise breathing pattern (BP) may fail to provide the “just right” response in the presence of flow limitation.
During high intensity exercise, large increases in ventilatory flow may cause narrowing of the airway.
This is termed “exercise-induced largyngeal obstruction,” and it is particularly common in elite athletes who generate large minute ventilations (VE) at high intensities.
Up to 20% of elite athletes, females, adolescents and overweight individuals may experience this during low-intensity activity. Dysfunctional breathing (DB) phenotypes, including upper-thoracic-dominant breathing and core muscle hypertonicity (such as in low back pain compensation) are also risk factors.
Flow limitation could lead to “breath stacking,” a negative consequence when subsequent breaths have slightly larger inspiratory than expiratory flow. Breath stacking causes end-inspiratory lung volume (EILV) and end-expiratory lung volume (EELV) to progressively increase, leading to dynamic hyperinflation. At these higher lung operating volumes, the lungs are stiffer, less compliant and require more muscle work to expand.
Unfortunately, dynamic hyperinflation places the diaphragm in a suboptimal length for expanding the lungs and managing intrathoracic pressures, further fatiguing the ventilatory musculature 🫁🏃🏻♀️🌬
09/07/2024
|RESPIRATION AS A LIMITING FACTOR| 😮💨
At exercise around or above 80%–85% VO2max, 3 primary mechanisms cause the respiratory system to limit performance:
1. Exercise-induced arterial oxyhemoglobin desaturation
2. Excessive ventilatory muscle work
3. Intrathoracic pressure effects on cardiac output
Specific scenarios (e.g., hypoxia and cold/dry climates) expose respiratory system vulnerabilities at submaximal intensities, and certain populations (e.g., elite athletes, females and elderly) are especially susceptible. While the exact limiting mechanisms differ (structural / functional), these situations and individuals bring the respiratory system close to its physiological limits. However, physiological limits do not fully explain the prevalence of exercise-induced breathlessness (a.k.a dyspnoea, EID).
An estimated 20%–40% of otherwise healthy runners experience EID even at low absolute exercise intensities. This could be because deconditioned individuals may approach high levels of exertion and experience limb fatigue at low absolute workloads. It could also be related to mouth breathing, since mouth-only breathing at submaximal intensities causes airway irritation and possibly subsequent exercise-induced laryngeal obstruction (EILO).
While the majority of EID prevalence may be explained by physiological limitations and deconditioning, the other most likely cause is dysfunctional breathing. Distinct from pathology, dysfunctional breathing (DB) can cause otherwise healthy runners to experience premature onset of fatigue and subsequent EID.
Whether caused by physiological or psychological limits, fatigue and EID could contribute to cessation of exercise, increased rating of perceived exertion (RPE) or negative emotional states.
The study by Harbour et.al aims to identify 3 important shared phenomena that lead to respiration limiting exercise performance, tolerance and enjoyment:
1. Dynamic hyperinflation 📈
2. Blood stealing 🩸
3. Hyperventilation 🫁
*to be continued
📸
📝 A Synthesis of Evidence-Based Breathing Strategies to Enhance Human Running (Harbour et al.)
02/07/2024
|HANDHELD DYNAMOMETRY| (HHD)
HHD is increasingly utilized as part of the pulmonary rehabilitation initial assessment process. The aim is to determine peripheral muscle strength, which is crucial for overall physical function and exercise tolerance.
Benefits of using HHD:
📈 Objective Measurement: HHD provides objective and quantitative measurements of muscle strength in peripheral muscles. This helps in identifying muscle weakness and monitoring changes over time.
🤸🏻♀️ Functional Relevance: Peripheral muscle strength is vital for activities of daily living and exercise capacity. Assessing strength using HHD allows clinicians to target specific muscle groups that may be weak, due to deconditioning or disease-related factors.
👩🏻💻 Tailored Exercise Prescription: Based on HHD results, rehabilitation programs can be customized to include targeted strengthening exercises for peripheral muscles. This enhances overall physical function and endurance, which are essential for improving quality of life and reducing symptoms in pulmonary patients.
📊 Tracking Progress: Regular HHD assessments enable clinicians to track rehabilitation progress objectively. Improvement in peripheral muscle strength translates to better exercise tolerance and reduced fatigue during daily activities.
📝 Comprehensive Assessment: Incorporating HHD alongside other assessments, such as exercise capacity, provides a comprehensive view of a patient’s functional status and response to rehabilitation interventions.
🤝🏻 Patient Engagement: Objective data from HHD can motivate patients by showing measurable improvements in muscle strength, which encourages adherence to the rehabilitation program.
🧠 Research and Clinical Applications: HHD findings contribute to research on rehabilitation outcomes and guide evidence-based practice in pulmonary rehabilitation.
We are excited to join the team, enabling us to take our HHD assessments to the next level. Do you assess peripheral muscle strength using HHD, as part of your pulmonary rehabilitation program?
18/06/2024
Last week, the hosted an intensive two day advanced pulmonary rehabilitation course. And it was phenomenal 🤓👩🏻💻🧠
The course content was world-class and presented by international experts in the field of pulmonary rehabilitation. What a privilege to have access to such relevant, cutting-edge research, as well as the opportunity to ask questions and engage in challenging discussions.
Following each day, we were allocated to small break out rooms to analyze case presentations. These discussions were facilitated by one of the expert panelists😅 Fantastic to hear how international colleagues in the field approach complex cohorts, as the case presentations were anything but straight forward (but that's how we like it!)
Learnt an incredible amount and cannot wait to put it all into practice. Honoured to be certified by the ERS Advanced Pulmonary Rehabilitation Academy 🫁
31/05/2024
|GENE'S DAY| 👖🫁
May is Cystic Fibrosis awareness month and today is Gene's Day. A day where we grab the opportunity to shine a bright light on Cystic Fibrosis, creating as much awareness around the condition as we can.
"Cystic Fibrosis is an inherited disorder affecting mainly the lungs, and occurs across all race groups.
Early diagnosis and proper treatment is critical and improves quality of life and survival age significantly."
So much has happened in the South African Cystic Fibrosis space over the last while. It has been incredible to see our patients finally gain access to the life-saving medication that EVERY patient with Cystic Fibrosis deserves. Still much to be done, but so proud of the massive strides that have been made!
Gain more insight and support the initiative by visiting 🌹🌬
26/04/2024
|AWARENESS| 🫀🫁
A few weeks ago, our respiratory rehabilitation team were approached by Netcare Christiaan Barnard Hospital, to deliver a talk on what we do as physiotherapists with a special interest in the field of cardiorespiratory physiotherapy.
Yesterday morning, we got to speak to a room (and online audience) filled with nurses, doctors, and specialists. What a privilege to raise awareness on what we can offer the breathless cohort, both in the in-patient and out-patient setting.
The main section of the talk was on a big passion field of ours, complex breathlessness. We, as cardiorespiratory physiotherapists, have a key role in the assessment, treatment, and ongoing management of these patients. It was a fantastic opportunity to make that known!
Honoured to have a fantastic team by my side 🥰
Address
(Southern Suburbs) Branch: Sports Science Institute Of SA, Boundary Road Newlands
(Northern Suburbs) Branch: 2 Kamp Street, Mabille Park, Kuilsriver Cape Town 7700
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Nel, Housego, Holtzhausen (NHH) Pulmonary Rehabilitation is a service offered by NHH Physiotherapists. The program is run by physiotherapists with a special interest in the field of Cardiopulmonary Physiotherapy - in other words, the heart and the lungs are our favourite! Our program is built on the foundation if ATS/ERS: We offer a comprehensive intervention, based on a thorough patient assessment, followed by patient tailored therapies; which include, but are not limited to; exercise training, education and behaviour change. The aim is to improve the physical and psychological condition of people with chronic respiratory disease and to promote the long term adherence to health enhance behaviours.
The inception of our program was on 20 October 2015 and since then, we have gone from strength to strength, all thanks to the dedication; determination and loyalty of our wonderful patients - the warriors fighting their fight on the daily. Our services have now expanded from increasing the quality of life of patients living with a chronic respiratory disease to pre/post rehabilitation of selected candidates for lung transplant surgery.
A big part of our Pulmonary Rehabilitation service are the awareness drives we run. We want to educate the public and raise as much awareness as we can, whenever we can. So we take every opportunity possible to engage people that don’t know about organ and tissue donation OR lung transplants OR respiratory conditions OR lung health etc. See some of our most recent awareness drives below:
The unique thing about Pulmonary Rehabilitation, is that it enables and empowers you (as a patient) to get busy living again. And isn’t that just magical? Learning to be in control of your condition, instead of being a slave to it?
Come and join our program, we would love to have you!
