To the Editor,

The basic aim of cardiopulmonary rehabilitation (CPR) is to improve the cardiac fitness and enhance the quality of life1. Worldwide enormous number of patients has been suffering from cardiopulmonary problem show ever, seek appropriate care. CPR is considered an important component of care for the patients suffering with cardiac problems1. For past few years I have been observing the lack of awareness and unavailability of facilities creating a major obstacle in progress of CPR in the country. Pakistani researchers and professionals need to pay attention on the aspect of CPR especially in the tertiary care hospitals where the facilities can easily be provided.

Cardiac diseases are the leading cause of deaths for Whites, Blacks, Asians, American Indians, and Hispanics2. Different studies suggest that prevalence of patients with Hypertrophic Cardiomyopathy (HCM) is about 25%3, Coronary Artery Bypass Graft (CABG) 12.4%4 and 12.5% for Atrial Fibrillation (AF)5. Moreover, patients with different cardiopulmonary complications experience psychological stress, anxiety and depression6.

In Pakistan, only a few hospitals entertain patients and implicate CPR but unfortunately, they only consider standard Phase I and II7 while the rest of the phases are neither applied nor available in most of the tertiary care hospitals. Moreover, among all the cardiac patients; particularly females’ dropouts from the rehabilitation plan when compared with the males6.

Different modalities, exercise and rehabilitative strategies are used to treat the patients with cardiopulmonary diseases. Professionals, those who are working in the field of rehabilitation need improve their skills and vigilance on the advancement of CPR for its appropriate application. Another positive aspect of CPR is to provide home–base intervention which increases the physical activity throughout the day and patient can perform moderate intensity physical activity8 and increase functional capacity to meet the requirement of life.

To improve the scope of CPR in the tertiary care hospitals; awareness, availability, promotion, expertise and evidence base practices are required. Moreover, the team work of cardiac clinician’s and physical therapists can improve the quality of practice of CPR. I would recommend the readers of this letter to encourage patients who have gone through and are at the risk of cardiopulmonary conditions to corporate and ask for better rehabilitation to improve quality of life.


Sr. Lecturer

Ziauddin College of Physical Therapy

Ziauddin University


  1. Nanette K, Wenger. Current Status of Cardiac Rehabilitation. J Am Coll Cardiol 2008; 51(17):1619-1631.
  2. American Heart Association: Heart and stroke facts1995 Statistic Supplement. AHA, Dallas,1995
  3. Shah JS, Esteban R, Thaman R, Sharma BM, Pantazis A, Ward D, Kohli SK. Prevalence of exercise-induced left ventricular outflow tract obstruction in symptomatic patients with non-obstructive hypertrophic cardiomyopathy Heart 2008;9(10)4:1288-1294
  4. Serruys PW, Morice MC, Kappetein AP, Colombo A, Holmes DR, Mack MJ, et al Percutaneous Coronary Intervention versus Coronary-Artery Bypass Grafting for Severe Coronary Artery Disease. N Engl J Med 2009;360:961-972
  5. Goto S, Bhatt DL, Röther J, Alberts M, Hill MD, Ikeda Y. Prevalence, clinical profile, and cardiovascular outcomes of atrial fibrillation patients with atherothrombosis. American heart Journal 2008;156(5):855-863
  6. McGrady A, McGinnis R, Badenhop D, Bentle M, Rajput M. Effects of Depression and Anxiety on Adherence to Cardiac Rehabilitation Journal of Cardiopulmonary Rehabilitation & Prevention 2009;29(6):358–364
  7. O’Sullivan SB, Schmitz JT. Physical Rehabilitation 5th edition 2007;618-619
  8. Oliveira J, Ribeiro F, Gomes H. Effects of a Home-Based Cardiac Rehabilitation Program on the Physical Activity Levels of Patients With Coronary Artery Disease Journal of Cardiopulmonary Rehabilitation &Prevention 2008;28(6):392-396