Medicosnext
Ms. Subarna Thapa Chhetri
She is a Lecturer and Cardiopulmonary Physiotherapist at the Physiotherapy Program, KUSMS/Dhulikhel Hospital. She specializes in critical care, cardiopulmonary rehabilitation, exercise prescription, and health promotion. Her professional practice encompasses preventive, curative, and rehabilitative care for cardiovascular, pulmonary, and metabolic diseases, with a focus on evidence-based physiotherapy, early mobilization, functional recovery, and optimizing quality of life. She is actively engaged in clinical practice, academic teaching, research, and professional leadership, advocating for integrated physiotherapy services to improve patient outcomes and population health.
Cardiovascular diseases (CVDs), including heart disease and stroke, are among the greatest health challenges worldwide. Non-communicable diseases (NCDs) account for around three-quarters of deaths globally, and cardiovascular diseases are the largest contributor to this burden. In 2022, an estimated 19.8 million people died from CVDs, representing about 32% of all deaths worldwide. Approximately 85% of these deaths were due to heart attack and stroke. More than three-quarters of CVD deaths occur in low- and middle-income countries (LMICs).
The burden is particularly important in countries such as Nepal, where health systems are managing a rapid transition from communicable diseases to NCDs. In the WHO South-East Asia Region, NCDs account for 55% of all deaths, and cardiovascular diseases, including stroke, are the major contributors to premature NCD mortality.
CVD and stroke are not only causes of death. They can leave people with long-term disability, reduced physical capacity, emotional problems and dependence on family members. Therefore, prevention, early management and rehabilitation are essential.
How CVD and Stroke Affect Individuals, Families and Society
A heart attack, heart failure or stroke can significantly reduce a person’s ability to walk, work, exercise and participate in family and social activities. Stroke may result in weakness or paralysis, balance problems, difficulty walking, communication problems and reduced independence. Cardiovascular disease can cause fatigue, breathlessness, reduced exercise tolerance and fear of physical activity.
These limitations can affect quality of life (QOL). Individuals may experience anxiety, depression, loss of confidence, fear of another cardiac event or stroke, and social isolation. Family members may need to provide long-term physical, emotional and financial support.
The economic burden is also substantial. Treatment, hospitalization, medicines, rehabilitation and long-term care can create significant out-of-pocket expenses. In LMICs, CVDs may contribute to household poverty because of healthcare expenditure and loss of income. When patients become unable to work, families may lose an important source of income, while caregivers may also have to reduce their working hours. At the societal level, premature death, disability and reduced productivity create a major economic burden.
CVD and stroke have both modifiable and non-modifiable risk factors.
Non-modifiable risk factors include:
- Increasing age
- Family history and genetic factors
- Sex
- Previous cardiovascular disease or stroke
Modifiable risk factors include:
- Physical inactivity
- Tobacco use
- Unhealthy diet, particularly excessive salt, sugar and unhealthy fats
- Overweight and obesity
- High blood pressure
- Diabetes
- High cholesterol
- Harmful alcohol use
- Psychological stress
- Air pollution
WHO identifies tobacco use, physical inactivity, unhealthy diet and harmful alcohol use as major behavioural risk factors for CVD and stroke.
Therefore, many CVDs and strokes are preventable, or their risk can be substantially reduced through healthy lifestyles, early detection and appropriate management. Prevention does not mean that every cardiovascular event can be avoided, but controlling modifiable risk factors can greatly reduce risk.
What is Physiotherapy?
According to World Physiotherapy, the global body of physiotherapy, physiotherapy aims to develop, maintain and restore maximum movement and functional ability throughout life. Physiotherapists work in health promotion, prevention, treatment and rehabilitation, with attention to physical, psychological, emotional and social wellbeing.
World Physiotherapy also recognizes physiotherapists as experts in exercise and physical activity, with knowledge of movement, exercise, risk factors and the effects of disease on different body systems.
Thus, physiotherapy has an important role throughout the entire cardiovascular and stroke care pathway from preventing disease before it occurs to helping people regain independence after a major cardiovascular event.
What is Physical Activity?
Physical activity is any bodily movement produced by skeletal muscles that requires energy expenditure. It includes walking, cycling, household activities, recreational activities, occupational activities and structured exercise.
Regular physical activity helps prevent and manage heart disease, stroke, diabetes, hypertension and obesity. It can also improve mental health, quality of life and overall wellbeing.
Role of Physiotherapy and Physical Activity in Prevention of CVDs and Stroke
Physiotherapists help people identify physical inactivity, obesity, reduced fitness and other risk factors and can provide individualized exercise programs. They promote walking, aerobic exercise, strengthening, flexibility, balance training and active lifestyles according to an individual’s age, health status and ability.
In people at risk of CVD or stroke, regular physical activity can help control blood pressure, body weight, blood glucose and cholesterol, improve cardiovascular fitness and reduce the risk of future disease. In Nepal, this is especially important because the national STEPS survey found substantial levels of tobacco use, inadequate fruit and vegetable intake, overweight, raised blood pressure and other NCD risk factors.
CVDs
Physiotherapy is an essential component of cardiac rehabilitation. Physiotherapists assess exercise capacity, symptoms, functional limitations and cardiovascular responses and then develop safe, individualized exercise programs.
Cardiac rehabilitation include aerobic exercise, strengthening, flexibility, breathing exercises, education, lifestyle modification and strategies to improve self-management. It helps patients regain physical fitness, confidence and independence after conditions such as myocardial infarction, cardiac surgery, heart failure and other cardiovascular conditions.
Exercise-based cardiac rehabilitation can reduce cardiovascular mortality and hospitalization while improving physical function, general health, social functioning and mental health.
Stroke Rehabilitation
After stroke, physiotherapy focuses on restoring movement and function and helping individuals become as independent as possible.
Treatment may include: Strength and mobility training, Balance and coordination exercises, Walking and gait training, Upper-limb rehabilitation, Transfer and functional training, Cardiovascular fitness and endurance training, Fall prevention, Management of complications related to immobility, Education for patients and caregivers, Support for returning to community, recreation and work.
Regular physical activity and exercise can improve mobility, fitness, confidence and quality of life and may also help reduce the risk of another stroke. physiotherapy is central to stroke recovery and long-term independence.
Conclusion
CVD and stroke are major causes of death, disability and loss of quality of life worldwide, with a particularly large burden in LMICs such as Nepal. Their effects extend beyond the patient to families, workplaces, communities and the national economy.
However we need to keep it in our mind that many CVDs and strokes are preventable. Physical activity, healthy lifestyle, early identification of risk factors and appropriate medical care can significantly reduce risk. When disease occurs, physiotherapy and rehabilitation help people recover movement, improve physical fitness, regain independence and return to meaningful family, social and working lives.
Physiotherapists have a vital role not only in rehabilitation after disease, but also in prevention, health promotion, risk reduction, management and long-term recovery. Physiotherapy and Physical activity are powerful tools in the fight against cardiovascular disease and stroke.
