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Electrotherapy and therapeutic exercise in cardiovascular and respiratory conditions
Wound-healing modalities were asked four times (S16, S22, S24, S25), and exercise for circulation runs through the PAD, venous and mastectomy answers. This card collects the electrotherapy and exercise that the syllabus lists for heart, lung and vascular patients, with the precautions that matter most in them (pacemakers, ischaemic limbs, anticoagulants).
- Syllabus
- Ch 4(h) Electrotherapeutic modalities for pain, swelling and wound healing; 4(i) Therapeutic exercise to alleviate pain, achieve mobility, correct posture and improve peripheral circulation
- Priority
- Moderate. Wound-healing modalities in 4 papers; exercise for circulation inside PAD, venous and mastectomy answers.
- Asked as
- 7m S24S25 3m S16S22
- Usual split
- 3-mark modalities with parameters; 7-mark modalities or exercise programmes
- Checked against
- Systematic review of TENS after thoracic surgery (2012); reviews of neuromuscular electrical stimulation in COPD (2014, 2016); compression thresholds by ABPI used in venous ulcer care; International Society of Lymphology consensus (2020). Full list under Sources.
- Content checked
- 19 October 2026. Next review due October 2027.
- My revision
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1Pain
- TENS after chest surgery: electrodes on either side of and parallel to a thoracotomy, sternotomy or abdominal wound (not on it); conventional (high-frequency, about 80–100 Hz, short pulses, strong comfortable tingling) during breathing exercises and coughing. A systematic review of 11 trials found TENS gave better pain relief after thoracic surgery than standard pain relief alone; it is an add-on to medicines, not a replacement.
- Supported cough and positioning: a pillow over the wound, side-lying with the wound uppermost, relaxed upright sitting.
- Cold for acute musculoskeletal chest-wall pain and after minor trauma; superficial heat for muscle spasm in the neck, shoulders and back of breathless patients, with care (see precautions).
- Relaxation and breathing control lower pain-related muscle guarding and anxiety.
2Swelling
| Method | Use | Care |
|---|---|---|
| Elevation and muscle-pump exercise | Post-operative, venous and lymphatic swelling | Not elevation in severe arterial disease (worsens rest pain) |
| Compression bandages, stockings and garments | Venous disease and ulcers, lymphoedema, after DVT, burns scars | Check ABPI first: full compression usually needs an ABPI of about 0.8 or more; reduced compression with specialist advice between about 0.5 and 0.8; none below about 0.5 |
| Intermittent pneumatic compression | DVT prevention in bed-bound patients; add-on in lymphoedema; some arterial disease (specialist devices) | Not over a known untreated DVT, infection or uncontrolled heart failure |
| Manual lymph drainage and decongestive therapy | Lymphoedema after mastectomy | Details on the mastectomy page |
| Cold | Acute traumatic swelling | Not on numb or ischaemic skin |
3Wound healing (S16, S22, S24, S25)
Electrical stimulation (high-voltage pulsed current), therapeutic ultrasound, ultraviolet and low-level laser, with typical parameters and effects, are tabulated on the diabetes and wound page, together with the factors that affect healing and pressure-sore care. Electrical stimulation has the best evidence of these for slow-healing pressure ulcers.
4Electrical stimulation of weak muscles
- Neuromuscular electrical stimulation (NMES) of the quadriceps produces visible contractions without breathlessness, so it suits very breathless or bed-bound patients: severe COPD, heart failure, ICU and after major surgery.
- Evidence is mixed: a 2016 meta-analysis of nine trials found better quadriceps strength and exercise capacity in moderate to severe COPD, while a 2014 review found no clear benefit; a 2023 review after heart and abdominal surgery found a small gain in leg strength. Use it as a bridge to active exercise.
- Practical: electrodes over the quadriceps; a frequency that gives a smooth, strong contraction; on–off cycles; about 20–30 minutes, several times a week; progress intensity as tolerated.
5Precautions for electrotherapy in these patients
Check before every modality
- Pacemakers and ICDs: no shortwave or microwave diathermy; TENS and other stimulation only away from the chest and device, with the device team's advice.
- Ischaemic limbs (PAD, diabetes): no heat (the skin cannot lose heat and burns); check sensation and circulation first.
- Anticoagulants and bleeding: gentle handling; avoid vigorous percussion and deep massage.
- DVT: no massage or heat over the affected limb until treated.
- Cancer: no heat, ultrasound or stimulation over a known tumour.
- Never over the front of the neck (carotid sinus), the pregnant abdomen, broken or numb skin, or in a confused patient who cannot report discomfort.
6Therapeutic exercise programmes
| Aim | Examples |
|---|---|
| Relieve pain | Gentle active range of motion, relaxation, breathing control, posture correction, graded activity |
| Mobility | Shoulder range after thoracotomy, mastectomy and CABG (within sternal and drain precautions); thoracic mobility exercises (see the breathing exercises card); scar stretching after burns |
| Correct posture | COPD: rounded shoulders and forward head; after thoracotomy: leaning to the operated side; after mastectomy: raised, protracted shoulder; kyphosis: thoracic extension, scapular retraction, pectoral stretches, mirror feedback |
| Arterial circulation | Supervised walking to moderate claudication pain, rest, repeat (30–45 minutes, 3 times a week, for at least 12 weeks; see the PAD page); Buerger–Allen exercises (below) |
| Venous circulation | Ankle pumps and heel raises (calf pump), walking, leg elevation, ankle range to free a stiff ankle; with compression |
| Lymphatic circulation | Gentle rhythmic exercise of the swollen limb with compression on, deep breathing, then slowly progressive resistance training |
Buerger–Allen exercises (classic, for arterial disease)
- Lie with the legs raised (about 45° or more on a support) until the feet go pale, usually 1–3 minutes.
- Sit with the legs hanging down until the feet turn pink, about 2–5 minutes, moving the ankles and toes.
- Lie flat with the legs level, covered, for about 5 minutes.
- Repeat the cycle several times, a few times a day.
These postural exercises are traditional and still asked about, but the evidence for them is weak; supervised walking has strong evidence and is the first-line exercise for claudication. Avoid them in severe rest pain, ulceration or gangrene.
7Exam corner
Past questions (MUHS, 2016–2026)
- 3-mark questionsThree electrotherapy modalities to treat an infected wound (S16). Three modalities with parameters for wound healing (S22).
- 7-mark questionsModalities used for wound healing (S24). Factors affecting wound healing and modalities (S25). See the diabetes page.
- RelatedPhysiotherapy in Buerger's disease (S17, S22) and claudication (S19) on the PAD page; DVT and venous ulcers on the venous page.
Test yourself
3 mHow would you use TENS after a posterolateral thoracotomy?
Electrodes on either side of and parallel to the incision, not on the wound or drain site; conventional high-frequency TENS at a strong, comfortable tingle during breathing exercises and coughing; alongside analgesia. Check for a pacemaker and intact sensation first.
MCQBefore applying compression bandaging for a leg ulcer you must check:A. Blood sugarB. ABPIC. Peak flowD. Body temperature
B. Arterial disease must be ruled out; compression on an ischaemic leg can cause ulcers or worse.
MCQHeat is contraindicated over:A. A tight trapezius in COPDB. An ischaemic foot in PADC. Normal skinD. A healed scar with normal sensation
B. Ischaemic skin cannot dissipate heat and burns easily.
Sources
- MUHS BPTh syllabus (2012) and MUHS IV BPTh question papers 2016–2026 (muhsonline.com, unofficial archive; Dhole Patil College of Physiotherapy past-paper page).
- Sbruzzi G, et al. Transcutaneous electrical nerve stimulation after thoracic surgery: systematic review and meta-analysis of 11 randomized trials. Rev Bras Cir Cardiovasc 2012.
- Meta-analyses of neuromuscular electrical stimulation in COPD: Respirology 2014 (no clear benefit) and Int J Chron Obstruct Pulmon Dis 2016 (improved quadriceps strength); thoracic and abdominal surgery review (2023).
- International Society of Lymphology. The diagnosis and treatment of peripheral lymphedema: 2020 consensus document.
- Venous ulcer guidance on ABPI thresholds for compression (for example SIGN and wound-care consensus documents).
- Structure and classical content: Watson T, Electrotherapy: Evidence-Based Practice; Frownfelter & Dean (2022); Kisner & Colby, Therapeutic Exercise.
Educational notes for exam preparation. Not medical advice.
Version 1. Content checked 19 October 2026. Next review October 2027.