Exercise based rehabilitation for heart failure

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

https://journals.sagepub.com/doi/pdf/10.1177/2047487317702042

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

Aims To assess the effects of multi-disciplinary cardiac rehabilitation (CR) on survival in the full population of patients with an acute coronary syndrome (ACS) and patients that underwent coronary revascularization and/or heart valve surgery.

Methods and results Population-based cohort study in the Netherlands using insurance claims database covering ∼22% of the Dutch population (3.3 million persons). All patients with an ACS with or without ST elevation, and patients who underwent coronary revascularization and/or valve surgery in the period 2007–10 were included. Patients were categorized as having received CR when an insurance claim for CR was made within the first 180 days after the cardiac event or revascularization. The primary outcome was survival time from the inclusion date, limited to a total follow-up period of 4 years, with a minimum of 180 days. Propensity score weighting was used to control for confounding by indication. Among 35 919 patients with an ACS and/or coronary revascularization or valve surgery, 11 014 (30.7%) received CR. After propensity score weighting, the adjusted hazard ratio (HR) associated with receiving CR was 0.65 (95% CI 0.56–0.77). The largest benefit was observed for patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery (HR = 0.55, 95% CI 0.42–0.74).

Conclusion In a large and representative community cohort of Dutch patients with an ACS and/or intervention, CR was associated with a substantial survival benefit up to 4 years. This survival benefit was present regardless of age, type of diagnosis, and type of intervention.

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Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients

Background
To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) the CR guideline from the Dutch Royal Society for Physiotherapists (KNGF) has been updated This guideline can be considered an addition to the 2011 Dutch Multidisciplinary CR guideline, as it includes several novel topics

/pdf/exercise-based-cardiac-rehabilitation-in-patients-with-3m4cvelxja.pdf

Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline

BackgroundAlthough disease-specific exercise guidelines for cardiovascular disease (CVD) are widely available, it remains uncertain whether these different exercise guidelines are integrated proper...

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Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey.

To assess methods for determination of exercise intensity, and to investigate practice variation with respect to the contents, volume and intensity of exercise training programs in Dutch cardiac rehabilitation (CR) centres. A paper questionnaire was sent to all Dutch CR centres, consisting of 85 questions for patients with an acute coronary syndrome (ACS) or after coronary revascularisation (Group 1) and for patients with chronic heart failure (CHF, Group 2). CR professionals from 45 centres completed the questionnaires (58 %). Symptom-limited exercise testing was used to determine exercise capacity in 76 % and 64 % of the CR centres in group 1 and group 2, respectively; in these centres, a percentage of the maximum heart rate was the most frequently used exercise parameter (65 % and 56 %, respectively). All CR centres applied aerobic training and the majority applied strength training (64 % in group 1 and 92 % in group 2, respectively). There was a considerable variation in training intensity for both aerobic and strength training, as well as in training volume (1–20 h and 1–18 h respectively). Among Dutch CR centres, considerable variation exists in methods for determination of exercise intensity. In addition, there is no uniformity in training volume and intensity.

/pdf/exercise-training-programs-in-dutch-cardiac-rehabilitation-1rppw4nqqr.pdf

Exercise training programs in Dutch cardiac rehabilitation centres

Background
In 2004, the Netherlands Society of Cardiology released the current guideline on cardiac rehabilitation. Given its complexity and the involvement of various healthcare disciplines, it was supplemented with a clinical algorithm, serving to facilitate its implementation in daily practice. Although the algorithm was shown to be effective for improving guideline adherence, several shortcomings and deficiencies were revealed. Based on these findings, the clinical algorithm has now been updated. This article describes the process and the changes that were made.

https://link.springer.com/content/pdf/10.1007%2Fs12471-011-0104-6.pdf

M. M. van Engen-Verheul

Papers

Exercise training programs in Dutch cardiac rehabilitation centres

Improving guideline adherence for cardiac rehabilitation in the Netherlands

Participatory research method to assess patients' needs for web-based self-management services: a pilot study