Pulmonary Rehabilitation in the Era of Multimorbidity and Multiple Disabilities (MMD).
The increasing number of patients with MMD has resulted in increased needs for rehabilitation.3 Especially, the number of persons with internal organ impairments had rapidly increased, with the majority of cases having disabilities related to cardiac function. Moreover, the number of the patients with co-occurrence of multiple internal organ impairments, including cardiac, respiratory, and renal disorders, has increased.5 According to a previous study using the lower-limb ergometer test, conducted in 382 patients undergoing stroke rehabilitation, 18% of subjects showed co-occurrence of cardiovascular disorders; 15% also had ischemic heart disease, 2% effort angina, and 1% old myocardial infarction.
In the follow-up prognosis research conducted three years later, 51 of 285 patients who could be
followed-up were deceased due to stroke, cancer, or heart disease; 33% of those older than 65
years with heart failure (HF) also had chronic obstructive pulmonary disease (COPD), and 25%
of elderly patients with COPD also had HF.7 COPD coexisting with heart disease and/or kidney
disease may have a significant impact on predicting the prognosis.
In contrast, cardiac rehabilitation (CR) improves exercise capacity; associates with improved prognosis, such as reduced cardiac death and all-cause mortality; and can increase the QoL by reducing the symptoms of impaired activities of daily living in ischemic heart failure patients.
In the era of MMD, the rehabilitation moreover needs to consider the existing principle of “Frequency, Intensity, Type, Time (FITT)”in patients with internal organ impairments.3,9 In
addition, not only problems of each internal organ, but also the relationship between the internal organs.
Pulm Res Respir Med Open J. 2017; SE(2): S20-S22. doi: 10.17140/PRRMOJ-SE-2-103
