Research sheds new light on occupation-specific rehabilitation

After cardiac surgery, should a farmer and an attorney take the same physical test to be found fit for work? They do now. But new research from Jenny Adams, PhD, at Baylor Health Care System's Baylor Hamilton Heart and Vascular Hospital, could change that.

Dr. Adams is conducting a pair of unique studies related to occupation-specific rehabilitation. The theory that blue-collar and white-collar workers face different physical demands is not a new one, yet the exercise model for cardiac rehab programs has virtually remained the same for the past three decades. While the general training program used by most cardiac rehabs follows national guidelines, it often doesn't meet the various physical requirements of specific workplaces.

"Typically, patients ride a stationary bike for 20 minutes, walk on a treadmill for 20 to 30 minutes and perform light hand-weights until week five of their cardiac rehab stay," Dr. Adams said. "For a lot of people, this training may work to get them back on their feet for the activities of daily living - but this training is much too conservative for some occupations that require carrying heavy equipment, sprinting, climbing stairs or wrestling suspects."

The current return-to-work process requires that physicians fill out a form to certify whether a patient is able to go back to work. This often puts physicians in a difficult position - on one hand, they want to provide their patients the opportunity to resume working, but on the other, they do not want to risk the health of rehabilitated patients by placing them in high-intensity workplaces when they may not be ready.

With an eye on shifting that process to a more patient-centric model, Dr. Adams' new research explores the concept of occupation-guided rehab programs. Her efforts have already made significant progress in providing physicians the information they need to return patients back to work safely.

"We already knew that the training was too conservative, but we felt as though our hands were tied by standard procedure," Dr. Adams said. "We disagreed with those guidelines and received approval to adapt the policy to train the patients at higher intensities, as their jobs required them to do. The research was driven by the logic that we would rather train rehab patients more effectively while in the safety of our program than have them return to work after limited training."

Dr. Adams' early foray into job-specific programs came in 2008 when she analyzed the physical requirements of police officers and firefighters to shape specific rehab programs for each. The study sought to design future cardiac rehabilitation based on the obvious stresses found in specific lines of work.

The latest installment of Adams' occupational studies is a 2011 piece focusing on farmers, a career very different from officers of public service but similar in its physical demands. Farming is no doubt a strenuous career, with constant pushing, pulling, exerting force and heavy lifting. The standard rehab model of treadmill exercise would likely do little - if anything - for cardiac patients looking to return to the farm to work.

"We chose to focus on farming to make people aware of the great diversity of industrial athletes that could come through rehab on any given day," Dr. Adams said. "Farming is a high-intensity job requiring workers to build fences, dig holes and pick up heavy loads, so it was a perfect match to showcase an occupation with high physical demands."

Investigators mined the Kansas State University Agronomy Farm for their subjects, selecting 40 men and women ages 20 to 64. They designed an obstacle course of tasks central to the profession, such as hay bale loading, pole hole digging, and loading and shoveling feed and seed. Participants wear harnesses that measure their vitals as they complete each task. The researchers will collect data on oxygen consumption (VO2), anaerobic threshold and heart rate to form conclusions.

While the results are still far from complete, the research sheds new light on the possibilities of adapting rehabilitation programs based on very specific careers, which in the future could formulate the "norm" of cardiac rehab care.

"I want the 'cookie cutter' rehab guidelines to go away and for us to train our patients according to their needs," Dr. Adams said. "I believe this research will help people safely and more confidently return to work after rehab."