Cardiorespiratory Physiotherapy

Cardiorespiratory Physiotherapy

Cardiorespiratory (or "cardiopulmonary") physiotherapy is the branch of physiotherapy concerned with the heart, the lungs and the muscles of breathing. It uses hands-on techniques, breathing training, airway clearance and carefully prescribed exercise to help people breathe more easily, clear their chest, move more, and recover after illness or surgery. Every programme is individualised and grounded in current evidence.¹

Who it helps

We work with people who have long-term lung conditions (such as COPD, bronchiectasis, cystic fibrosis, asthma and pulmonary fibrosis), heart conditions (such as heart failure and coronary artery disease), and those recovering from chest infections, surgery or critical illness. We also help people whose main problem is breathlessness, a persistent cough, or an altered breathing pattern — even when the lungs themselves are structurally normal.

A problem-based approach

Rather than treating a diagnostic label, cardiorespiratory physiotherapy targets the physiological problem in front of us:

• Retained secretions — too much mucus, or mucus that is too thick or too poorly cleared.
• Loss of lung volume — collapsed or under-inflated lung (atelectasis).
• Increased work of breathing / breathlessness — breathing that takes too much effort.
• Respiratory muscle weakness — weak inspiratory muscles, or a weak cough.
• Reduced exercise tolerance / deconditioning — limited capacity for activity.
• Impaired airway protection — an ineffective cough and the risk of aspiration.

Identifying which problem (or combination) is present is what allows the right technique to be matched to the right patient.²

How we work: assess, treat, review

Care begins with a thorough assessment — your history, symptoms and goals, plus examination of your breathing, chest, cough and exercise tolerance. From this we agree a plan, teach the techniques, and then review and adjust at each visit. Adherence — performing the technique regularly and correctly — is the single most important predictor of benefit, so we prioritise approaches you can sustain at home.³

Techniques a cardiorespiratory physiotherapist may offer

A cardiorespiratory physiotherapist may offer the full range of evidence-based techniques.⁴ Each links to a detailed guide:

• Airway clearance — the science of the mucociliary tract, airway hydration, and nebulised mucolytics (hypertonic saline, dornase alfa).
• Active Cycle of Breathing Technique (ACBT) — our primary, equipment-free airway clearance method.
• PEP and oscillating PEP devices — Acapella, Aerobika and Flutter.
• Autogenic drainage — a refined, breath-controlled clearance technique.
• Cough assist (MI-E) — mechanical insufflation–exsufflation for a weak cough.
• Inspiratory muscle training (IMT) — strengthening the breathing muscles.
• Breathing retraining — pursed-lip and diaphragmatic breathing, positions of ease, and the handheld fan.
• Gravity-assisted (postural) positioning to optimise drainage — used alongside the techniques above.

Rehabilitation

For people whose main limitation is reduced exercise tolerance, your cardiorespiratory physiotherapist may provide cardiorespiratory rehabilitation — structured, supervised exercise and education, including pulmonary rehabilitation, cardiac rehabilitation, and an integrated hybrid programme for people living with combined heart and lung disease.⁵

When to seek urgent help

Physiotherapy is for stable and recovering conditions. If you develop sudden severe breathlessness, chest pain, coughing up blood, or a rapid deterioration, seek urgent medical care rather than waiting for an appointment.

References & evidence base

1. Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 2009;64(Suppl 1):i1–i52.
2. McIlwaine M, Bradley J, Elborn JS, Moran F. Personalising airway clearance in chronic lung disease. Eur Respir Rev 2017;26(143):160086.
3. Hill AT, Sullivan AL, Chalmers JD, et al. British Thoracic Society guideline for bronchiectasis in adults. Thorax 2019;74(Suppl 1):1–69.
4. Strickland SL, Rubin BK, Drescher GS, et al. AARC clinical practice guideline: effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care 2013;58(12):2187–2193.
5. Spruit MA, Singh SJ, Garvey C, et al. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188(8):e13–e64.

References are numbered in citation order (Vancouver/BMJ style) and were current at the time of writing. Guidelines are living documents — verify against the latest version before clinical use.