The Haywood Regional Medical Center’s cardiopulmonary rehabilitation program offers a hospital-based fitness center, which provides patients with supervised aquatic exercises, education, and confidence.

By Carol Daus

It does not take long for cardiopulmonary rehabilitation patients at Haywood Regional Medical Center in Clyde, NC, to realize that the staff practices what it preaches when it comes to fitness. Many patients work out side by side with the employees in the hospital’s large state-of-the-art fitness center, which is open to the public as well as to patients in hospital-based programs.

As patients participate in the program, they quickly realize that the cardiopulmonary rehabilitation staff has a strong commitment for fitness. The department’s respiratory therapist is a devoted jogger, two nurses are ardent cyclists, and the medical director works out at least three times a week in the fitness center.

“One of the primary differences between our cardiopulmonary rehabilitation program and others is that most of the patients who graduate from the program find it easy to continue exercising because of their access to our fitness center,” explains Harry Lipham, MD, a pulmonologist and medical director of the cardiopulmonary rehabilitation program. “It’s great to see former pulmonary rehabilitation patients still coming to the fitness center and using the exercise equipment beside me.”

Nestled in the rolling hills of the Smoky Mountains, the Haywood Regional Health and Fitness Center is one of a select group of facilities in the country that are members of the Richmond, Va-based Medical Fitness Association. This association was created to support hospitals in their development and operation of fitness centers that offer dynamic, safe and medically supervised fitness programs. Unlike commercial health clubs, these hospital-based fitness centers serve communities with a high level of medical accountability, resources, and monitoring.

Lipham had been a practicing pulmonologist in Haywood County for 15 years at the time hospital administrators—including his wife, Eileen, the vice president of support services—started thinking about establishing a hospital-based fitness center. “At that time, evidence-based guidelines were developed for pulmonary rehabilitation and it became clear that Haywood Regional Medical Center needed its own pulmonary rehabilitation program,” he says. As a result, hospital administrators integrated cardiac and pulmonary rehabilitation into a coordinated service that was launched at the same time the fitness center opened in 1998.

Setting It Up

Some might think only an urban area could support a 54,000-square-foot fitness center, complete with six-lane, 25-yard pool, indoor track, racquetball courts, Cardio-Theater, and amenities such as massage therapy, yoga, and aerobics. How does such a facility flourish in a rural town with a population of just over 1,000 and a county that tops out at 55,000? It is clearly a testament to both the hospital’s administrators and the community, since both have supported the fitness center from its initial planning stage to the present. The construction of the fitness center was funded heavily by community donations. “The fitness center has become a part of the social fabric of Haywood County,” Lipham stresses. “People enjoy meeting up with other people and taking part in something that’s good for their health.”

Although cardiac rehabilitation had been offered by the medical center since 1992, pulmonary rehabilitation was a new service when the department was formed. Heath Sutton, RRT, director of cardiology services, was appointed to head up the cardiopulmonary rehabilitation program in 1999. At that time, Sutton’s primary objective was to hire four experienced staff members who enjoyed working as a team since they would be working closely with both cardiac and pulmonary patients. Sutton’s hiring instincts were on target because the group—consisting of Betty Crowley, RN, cardiopulmonary rehabilitation coordinator; Scott Cochran, RRT, pulmonary rehabilitation respiratory therapist; Robin Street, RN, cardiac rehabilitation nurse; and Alicia Goelz, ACSM, exercise specialist—collaborates effectively to help patients with cardiac and pulmonary problems.

Sutton works closely with his team and fills in with patient care when the staff is short of help. Staff meetings are held twice a month and each employee is closely involved in strategic and budget planning. Cochran notes that the department functions well due to the strong teamwork between the employees and medical director. “If one of us lacks knowledge or expertise in a specific area, there’s always somebody else who can provide information or direction,” Cochran says.

Unlike other hospital-based cardiopulmonary rehabilitation programs, staff turnover is not a problem. A major reward for the employees is developing long-term relationships with patients as they progress through the program and continuing to see many of them in the fitness center after they graduate. “You actually get the opportunity to develop friendships with many of these patients and it’s amazing to see how fast some of them improve,” Cochran says.

The Program

The program is structured with patient care offered on Mondays, Wednesdays, and Fridays; cardiopulmonary rehabilitation is offered in the morning and pulmonary rehabilitation is offered in the afternoon. As with the majority of cardiopulmonary rehabilitation programs, patients go through three separate phases. The first phase occurs while the patient is still an inpatient, recovering from surgery or an illness. During this stage, Crowley meets with cardiac patients and Cochran meets with pulmonary patients. “By meeting the patients while they are still in the hospital, we are able to make a better connection with them and they are more likely to accept the program,” Sutton says.

The second phase of the program covers a 12-week period in which patients attend sessions three times a week. The sessions are typically 1 to 2 hours long. After an initial orientation, they meet one-on-one with a staff member, who determines their capabilities and limitations. On any particular day, there are patients at all different levels, depending on their diagnoses and the length of time they have been in the program. Patients in phase two utilize a variety of equipment, including treadmills, stationary bikes, arm ergometers, free weights, and weight machines.

On Fridays, patients are able to use the pool for supervised aquatic exercises. Many are emphysema patients who participate in the National Emphysema Trial, sponsored by the National Heart, Lung, and Blood Institute. Haywood Regional Medical Center is a satellite facility for Duke University Medical Center, Durham, NC, which is a site for the trial.

Exercise not only improves the patients’ physical health, it also provides emotional benefits, including greater confidence and a sense of independence. “Our goal is to get these patients discharged from our department feeling confident enough that they can go to the fitness center and work out without depending on us,” Sutton says.

The third phase of cardiopulmonary rehabilitation is a maintenance phase in which patients are given a free, 30-day membership to the fitness center. Before patients start exercising by themselves, a staff member accompanies them to the fitness center to introduce them to the other staff members and help them become familiar with the equipment. Because there are so many elderly patients on fixed incomes, the fitness center offers customers a sliding fee scale once their free membership expires. “Our institution is committed to the health of our patients and we never want patients to be denied services due to cost,” Sutton says.


Education also plays a significant role in the rehabilitation process for cardiac and lung patients. One program that has succeeded in keeping former cardiopulmonary rehabilitation patients enrolled at the fitness center is Great Beginnings, which meets 3 days a week and is taught by cardiopulmonary rehabilitation staff who discuss weight training and other exercise techniques. Pulmonary patients are able to participate in Better Breathers, a support group held every other month in a fitness center classroom. Guest speakers include pulmonologists and asthma specialists who discuss topics such as infection, postural drainage, and mucus clearance. “This has been a great program in our community since there are so many pulmonary patients who lack information about their conditions,” Sutton says. “Many have questions about their medications and what symptoms they should take seriously.”

It is no surprise that outcomes studies have revealed a high success rate for patients undergoing cardiopulmonary rehabilitation at Haywood Regional Medical Center. When it comes to recording outcomes, three specific areas are studied both when the patient is admitted and when they are discharged. Sutton also hopes that one day the department will be able to make follow-up calls to patients to determine long-term outcomes. “One of the difficulties we have is being able to quantify outcomes based on patients who end up not being hospitalized because they successfully completely our program,” Sutton explains. “We’re looking for ways to obtain this information and have considered making follow-up telephone calls 6 months after patients are discharged.”

Becoming Accredited

The cardiopulmonary department achieved another major accomplishment this year when it earned accreditation from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) for both its pulmonary and cardiac rehabilitation programs. The AACVPR is the only organization working exclusively to enhance the practice of cardiac and pulmonary rehabilitation. This stamp of approval guarantees that both services meet national standards. “The application process was challenging because we knew there were areas that needed to be improved,” Sutton says. “Everybody worked hard to ensure that we took the right steps to earn this credential.”

In just 4 years, the medical center’s cardiopulmonary rehabilitation program has made great strides in helping patients with cardiac and pulmonary problems live more healthy lives. Now with the program firmly established, Sutton continues to explore ways to extend services in the community.

“We know there are still many people in our county who have COPD (chronic obstructive pulmonary disease) and are not being reached,” Sutton says. “One of our goals is to connect with greater numbers of individuals through health fairs and physician visits.” Sutton feels strongly that simple spirometry tests should also be readily available just like electrocardiogram tests are available for cardiac patients.

Promoting the cardiopulmonary rehabilitation program, as well as the fitness center, should not be a problem—given the impressive nature of the building and all its services. As Sutton stresses, “I have lived here all my life and I still find it hard to believe that a facility like this exists.”


Carol Daus is a contributing writer for RT Magazine. For more info, contact [email protected].