Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

Abstract

Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients’ groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for “distress management” and “lifestyle changes”. PE is able to increase patients’ knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients’ groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.

High-Load and Low-Load Resistance Exercise in Patients with Coronary Artery Disease: Feasibility and Safety of a Randomized Controlled Clinical Trial

“…Each training session consisted of a general warm-up (10 min dynamic flexibility exercises followed by calisthenics using elastic bands and/or LL dumbbells and balance exercises), AE (35-40 min) and RE (5-10 min) and cool down (5 min static stretching and breathing exercises). In the main part of each session, all patients performed aerobic interval cycling (3-5 min workload cycling separated by 2 min unloaded cycling) starting from the initial 50% of maximal workload achieved at baseline cardiopulmonary exercise test and progressively increasing every two weeks to 80% maximal workload [1,25]. Duration of workload interval during AE decreased from 5 min to 4 min after 6 weeks (on 19th session), and from 4 min to 3 min after 10 weeks (on 30th session).…”

Outpatient Cardiac Rehabilitation Closure and Home-Based Exercise Training During the First COVID-19 Lockdown in Austria: A Mixed-Methods Study

“…In the long term, it is anticipated that the COVID-19 pandemic will act as a catalyst for telehealth, telerehabilitation, and digital technologies, enabling more consistent incorporation of remote delivery modes for CR and rehabilitation in other clinical specialities ( Scherrenberg et al, 2020 ; Laoutaris et al, 2021 ). There is high-quality evidence for the efficacy of telehealth interventions within CR settings ( Gruska et al, 2020 ; Thomas et al, 2020 ; Schwaab et al, 2021 ), which should reassure providers that remote CR modalities may be offered safely to supplement centre-based CR according to current evidence-based clinical guidelines ( Gruska et al, 2020 ; Schwaab et al, 2021 ).…”

“…Heart-healthy exercise, in this context, refers to the medically recommended amount and intensity of regular physical activity (PA) to achieve a positive effect in the secondary prevention of CVD. This includes leisure activities and activities of daily living (e.g., walking, hiking, gardening) as well as targeted endurance and strength training ( Niebauer et al, 2013 ; Schwaab et al, 2021 ).…”

Heart-Focused Anxiety Affects Behavioral Cardiac Risk Factors and Quality of Life: A Follow-Up Study Using a Psycho-Cardiological Rehabilitation Concept

“…The referral to the program was reviewed by independent physicians, ensuring that only patients with comorbid psycho-cardiological disorders were admitted. The program comprises elements of both cardiac ( 39 ) and psychosomatic rehabilitation ( 40 ), combining joint efforts of trained specialists in both disciplines. It includes interdisciplinary diagnostics and a focus on exercise therapy as well as concurrent psychotherapy ( 41 ).…”