Patients likely to experience cardiovascular symptoms in ambulatory rehabilitation can be identified by their medical history and perceived exertion.

The purpose of the present study was to compare muscular strength of knee extensors and arm flexor muscles of cardiac patients (n = 638) and healthy controls (n = 961) in different age groups. Isometric torques were measured in a sitting position with the elbow, hip, and knee flexed to 900. For statistical analysis, age groups were pooled in decades from the age of 30 to 90 years. Additionally, the influence of physical lifestyle prior to disease on muscular strength was obtained in the patients. For statistical analysis three-way ANOVA (factors age, gender, and physical activity level) was used.Both in patients and in controls a significant age-dependent decline in maximal torque could be observed for arm flexors and knee extensors. Maximal leg extensor muscle showed statistically significant differences between healthy controls and cardiac patients as well as between subgroups of patients: Physically inactive patients showed lowest torques (male: 148 ± 18 Nm; female: 82 ± 25 Nm) while highest values were measured in control subjects (male: 167 ± 16 Nm; female: 93 ± 17 Nm). In contrast, arm flexor muscles did not show any significant influence of health status or sports history.This qualitative difference between weight-bearing leg muscles and the muscle group of the upper extremity suggest that lower skeletal muscle strength in heart patients is mainly a consequence of selective disuse of leg muscles rather than any pathological skeletal muscle metabolism. Since a certain level of skeletal muscle strength is a prerequisite to cope with everyday activities, strength training is recommended as an important part of cardiac rehabilitation.

Ein körperlich-aktiver Lebensstil zählt zu den wichtigsten Zielen der kardiologischen Rehabilitation, um die zahlreichen evidenzbasierten Gesundheitswirkungen körperlichsportlicher Aktivitäten langfristig zu nutzen. Angesichts optimierungsbedürftiger Effekte kardiologischer Rehabilitationsmaßnahmen in Hinblick auf die Veränderung des bewegungsbezogenen Lebensstils wurde das Interventionsprogramm VIN-CET (Volitional Interventions within Cardiac Exercise Therapy) ent wickelt, das auf die Förderung sportlicher Aktivitäten im Alltag abzielt. Dabei handelt es sich um ein theoriegeleitetes Interventionsprogramm, das die üblichen motivierenden Maßnahmen (z. B. Wissensvermittlung, Vermittlung von Ausführungskompetenzen und positiven Körpererfahrungen) durch sog. volitionale Interventionsformen ergänzt, die Aspekte der häufig schwierigen Umsetzung von " guten" Absichten zur Veränderung der inaktiven Lebensgewohnheiten fokussieren. Stichworte: Gesundheitsverhalten, Volition, Intervention, Sporttherapie, kardiologische Rehabilitation ä Verhaltenswirkungen kardiologischer Rehabilitationsprogramme Der m odern e Kan on kardiologisch er Reh abilitation sm aß n ah m en zielt au f Basis ei-

The main objective of cardiovascular disease (CVD) prevention is to reduce morbidity and mortality. Despite recommendations on evidence-based pharmacological treatment and lifestyle changes, the control of CV risk factors such as hypertension or dyslipidaemia is not optimal. The use of a CV polypill, including guideline-recommended drugs, as a baseline therapy, may contribute to improving risk factors control either by improving the treatment adherence or by the synergistic effect of its components. The CNIC-Polypill is the first CV polypill approved in Europe as an effective strategy for secondary prevention, which contains acetylsalicylic acid, atorvastatin (in two optional doses), and ramipril (in three optional doses) in a single pill. The present practical clinical document aims to provide a guide for patient management after an acute coronary syndrome (ACS) or with chronic CVD (CCVD) with a strategy based on the CNIC-Polypill, also considering the need to add other therapies for a personalized treatment. The most suitable clinical scenarios for the CNIC-Polypill use are discussed: (a) in patients after an ACS at discharge, (b) in patients with CCVD (chronic coronary syndrome, stroke, or peripheral artery disease) with uncontrolled low-density lipoprotein cholesterol (LDL-c) and/or blood pressure levels and (c) in patients with CCVD with well-controlled risk factors to simplify treatment and reduce polypharmacy in the context of CCVD prevention.

Zusammenfassung Die Mehrzahl der Herzinfarkte entsteht aufgrund einer koronaren Herzkrankheit (KHK). F?r die Sekund?rpr?vention spielt neben risikoreduzierenden Lebensstil?nderungen k?rperliches Training eine zentrale Rolle. Die Teilnahme an einer ambulanten Herzgruppe bietet eine sichere Form der Bewegung f?r KHK-Patienten, sie wird ?rztlich ?berwacht und von geschulten ?bungsleitern durchgef?hrt. Der Artikel fasst die aktuellen Daten zum Thema Sport bei KHK-Patienten zusammen, anhand eines Praxisbeispiels werden wichtige Aspekte der Trainingsberatung f?r die Praxis nachvollzogen.