Heart, lung games show value of cardiac, pulmonary rehab

The athletes march in to the gymnasium bursting with pride. Some have oxygen tanks on their backs. Others walk with canes -- periodically raising them with defiance. A flaming torch is passed from one to the next while Olympic-style music plays in the background.

This fanfare marked the kick-off of last month's Second International Heart and Lung Games at Harper College, a community college in suburban Chicago. The event boasted 150 participants, all of whom also are patients in cardiac and pulmonary rehabilitation programs located all over the United States and in several European countries. They competed for medals in sports ranging from the energetic, such as volleyball, to others that are less so, such as shuffleboard.

"[Their] efforts represent the triumph of the human spirit," said F. Stuart Sanders, MD, the lead organizer and past president of the Heart and Lung Foundation, the charity arm of the American Assn. of Cardiovascular and Pulmonary Rehabilitation.

Dr. Sanders built these international games on the success of similar, state-level games. They are also modeled after the World Transplant Games, which have grown over the past 25 years to include thousands of athletes competing in winter and summer sports. And, like the Transplant Games, which aim to demonstrate the benefits of organ transplantation, the Heart and Lung Games have a message: People with heart and lung disease can live full lives.

"More people have heart disease and lung disease than have had transplants. The potential is really huge," said Dr. Sanders, director of Cardiac Disease Reversal and Rehabilitation and Pulmonary Rehabilitation programs at Habersham County Medical Center in Demorest, Ga. He also has been a U.S. Olympic team physician.

An overlooked resource

Organizers say, however, that cardiac and pulmonary rehabilitation programs, which generally include medically supervised exercise along with education about healthy lifestyle changes, continue to be underutilized. Several studies have found that rehabilitation can reduce mortality and hospitalizations, but most research also finds that less than 20% of patients take part. The reason why, according to experts, is that physicians do not always refer patients in this direction.

Specialists suspect that the rehab programs sometimes might get lost in the shuffle of dealing with the numerous medications and tests that many heart and lung patients usually need. Also, the programs are often not covered by insurance, although this circumstance could be changing.

In March, the Centers for Medicare & Medicaid Services issued a decision expanding the list of conditions for which cardiac rehabilitation would be covered under Medicare. Heart valve repair or replacement, percutaneous transluminal coronary angioplasty, coronary stenting or a heart transplant were added to a list that formerly included only acute myocardial infarction, coronary artery bypass graft and stable angina pectoris. Congestive heart failure was not added, and reimbursement for pulmonary rehabilitation remains less than certain.

"Doctors forget to refer patients to exercise programs because they get stuck on these Medicare rules," said Marjorie King, MD, president of the American Assn. of Cardiovascular and Pulmonary Rehabilitation. She is also director of cardiac rehabilitation services at Helen Hayes Hospital in West Haverstraw, N.Y.

Those who competed in the games see significant benefits. Many say they are in better shape and more dedicated to staying healthy than ever before. They also consider the games a thrill.

"It's something that lifts our spirits and gives us encouragement," said Charlena Cunningham, a 61-year-old retired art teacher with chronic obstructive pulmonary disease from Springfield, Va. She competed in swimming and horseshoes. "I know what my limits are, but I have been challenged to do the best I can do."