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

Abstract

BackgroundTo 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.MethodsA systematic literature search was performed to formulate conclusions on the efficacy of exercise-based interventions during all CR phases in patients with CHD. Evidence was graded (1–4) according the Dutch evidence-based guideline development (EBRO) criteria. In case of insufficient scientific evidence, recommendations were based on expert opinion. This guideline comprised a structured approach including assessment, treatment and evaluation.ResultsRecommendations for exercise-based CR were formulated covering the following topics: preoperative physiotherapy, mobilisation during the clinical phase, aerobic exercise, strength training, and relaxation therapy during the outpatient rehabilitation phase, and adoption and monitoring of a physically active lifestyle after outpatient rehabilitation.ConclusionsThere is strong evidence for the effectiveness of exercise-based CR during all phases of CR. The implementation of this guideline in clinical practice needs further evaluation as well as the maintenance of an active lifestyle after supervised rehabilitation.

Impact of Exercise Training in Aerobic Capacity and Pulmonary Function in Children and Adolescents After Congenital Heart Disease Surgery: A Systematic Review with Meta-analysis

“…Exercise training is a well-established and important non-pharmacologic therapy in adult patients with heart diseases and is endorsed by the main guidelines around the world [1,8]. However, exercise training in children and adolescents after CHD surgery is still little explored.…”

Caracterização De Pacientes Reinternados No Setor De Cardiologia

“…Uma medida que pode ser discutida é a implantação de um centro de Reabilitação Cardiovascular, onde seria feito o acompanhamento adequado e especializado que demanda essa população. Estudos demonstram eficácia maior quando o paciente é submetido aos programas de visitas domiciliares e intervenções ambulatoriais multidisciplinares após alta hospitalar, com diminuição significativa de readmissões e morte (21)(22) . Esses programas incluem orientações e suporte estruturado via telefone com objetivo de monitorar os cuidados.…”

“…Tal conclusão mostra que essas ações devem receber maior consideração dos serviços que buscam implementar intervenções de cuidados para pacientes com IC (20) . A reabilitação cardiovascular multidisciplinar reduz a mortalidade em 32% (21) e a inserção do paciente no programa de reabilitação cardiovascular é considerada Classe I, nível A de indicação na prática clínica pelos guidelines (22) . A atenção ao paciente com doenças cardiovasculares deve ser realizada por equipe multidisciplinar, tanto na fase hospitalar quanto após a alta.…”

Cardiac Rehabilitation Prevents Recurrent Revascularization in Patients With Coronary Heart Disease

“…In addition, evidence-based CR practice guidelines in the Netherlands have emphasized the benefits of CR during hospitalization. 10 The various benefits of CR include improved exercise capacity, increased cardiac respiratory fitness, reduced coronary atherosclerosis, inhibition of thrombotic atherogenesis, an improved lipid profile, reduced obesity and metabolic syndrome, an increased ischemic threshold, attenuated inflammation processes, and increased autonomic function, which reduce the risk of subsequent cardiac Figure 2. Kaplan-Meier estimates of recurrence-free survival in both study groups: CR, patients who underwent CR within 3 months after first revascularization; and non-CR, patients who did not undergo CR.…”

“…CR programs included preintervention education, early mobilization, inspiratory muscle training, breathing techniques, functional exercises, training in activities of daily living (ADL), walking, and stair climbing to achieve functional improvement. 10 The endpoint was defined as receiving a composite of the 2 revascularization procedures, CABG and PCI. In addition, subgroup analyses were performed by categorizing the patients according to their sex and age (elderly: aged ≥ 65 years; nonelderly: aged < 65 years).…”