Exercise training as an essential component of cardiac rehabilitation

Conraads, Viviane M.; Denollet, Johan; Maeyer, Cathérine De; Craenenbroeck, Emeline Van; Verheyen, Jef; Beckers, Paul

doi:10.1136/heartjnl-2012-301912

Cited by 7 publications

(8 citation statements)

References 4 publications

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“…This generated substantial debate within the scientific community (10)(11)(12), with speculation that low exercise training intensity and dose may be responsible (13). Moreover, metaanalyses have shown significant heterogeneity and lack of detail regarding exercise prescription methodology within CR programs (2,3).…”

Section: Introductionmentioning

confidence: 99%

Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Taylor

Bonikowske

Olson

2021

Front. Cardiovasc. Med.

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Exercise based cardiac rehabilitation (CR) is recognized internationally as a class 1 clinical practice recommendation for patients with select cardiovascular diseases and heart failure with reduced ejection fraction. Over the past decade, several meta-analyses have generated debate regarding the effectiveness of exercise-based CR for reducing all-cause and cardiovascular mortality. A common theme highlighted in these meta-analyses is the heterogeneity and/or lack of detail regarding exercise prescription methodology within CR programs. Currently there is no international consensus on exercise prescription for CR, and exercise intensity recommendations vary considerably between countries from light-moderate intensity to moderate intensity to moderate-vigorous intensity. As cardiorespiratory fitness [peak oxygen uptake (VO2peak)] is a strong predictor of mortality in patients with coronary heart disease and heart failure, exercise prescription that optimizes improvement in cardiorespiratory fitness and exercise capacity is a critical consideration for the efficacy of CR programming. This review will examine the evidence for prescribing higher-intensity aerobic exercise in CR, including the role of high-intensity interval training. This discussion will highlight the beneficial physiological adaptations to pulmonary, cardiac, vascular, and skeletal muscle systems associated with moderate-vigorous exercise training in patients with coronary heart disease and heart failure. Moreover, this review will propose how varying interval exercise protocols (such as short-duration or long-duration interval training) and exercise progression models may influence central and peripheral physiological adaptations. Importantly, a key focus of this review is to provide clinically-relevant recommendations and strategies to optimize prescription of exercise intensity while maximizing safety in patients attending CR programs.

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Section: Introductionmentioning

confidence: 99%

Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Taylor

Bonikowske

Olson

2021

Front. Cardiovasc. Med.

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“… 31 They argued that underdosage of exercise intensity and duration may have led to the inconclusive result. 58 Several other studies included in this review also fail to report on the intensity, modality and/or duration of the exercise intervention. Exercise and physical activity has a ‘dose–response’ relationship with cardiovascular disease risk.…”

Section: Discussionmentioning

confidence: 99%

Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence

et al. 2018

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ObjectivesTo determine the contemporary effectiveness of exercise-based cardiac rehabilitation (CR) in terms of all-cause mortality, cardiovascular mortality and hospital admissions.Data sourcesStudies included in or meeting the entry criteria for the 2016 Cochrane review of exercise-based CR in patients with coronary artery disease.Study eligibility criteriaRandomised controlled trials (RCTs) of exercise-based CR versus a no-exercise control whose participants were recruited after the year 2000.Study appraisal and synthesis methodsTwo separate reviewers independently screened the characteristics of studies. One reviewer quality appraised any new studies and assessed their risk of bias using the Cochrane Collaboration’s recommended risk of bias tool. Data were reported as the risk difference (95% CI).ResultsWe included 22 studies with 4834 participants (mean age 59.5 years, 78.4% male). We found no differences in outcomes between exercise-based CR and a no-exercise control at their longest follow-up period for: all-cause mortality (19 studies; n=4194; risk difference 0.00, 95% CI −0.02 to 0.01, P=0.38) or cardiovascular mortality (9 studies; n=1182; risk difference −0.01, 95% CI −0.02 to 0.01, P=0.25). We found a small reduction in hospital admissions of borderline statistical significance (11 studies; n=1768; risk difference −0.05, 95% CI −0.10 to −0.00, P=0.05).Conclusions and implications of key findingsOur analysis indicates conclusively that the current approach to exercise-based CR has no effect on all-cause mortality or cardiovascular mortality, when compared with a no-exercise control. There may be a small reduction in hospital admissions following exercise-based CR that is unlikely to be clinically important.PROSPERO registration numberCRD42017073616.

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“…Importantly, the CROS-II study also reinforced the need for standardization across different programmes, as to allow further assessments[ 9 , 51 ]. This point should be particularly taken into consideration when analysing data from studies which do not report on benefits in terms of outcomes[ 51 , 56 - 58 ], as differences in programme design, ET compliance and intensity could (at least partially) explain some of these discrepancies[ 59 - 63 ]. This latter point should be further considered, and it has also been explored when addressing different training methodologies[ 62 , 63 ].…”

Section: Current Evidence Concerning Crmentioning

confidence: 99%

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

Vilela¹,

Ladeiras-Lopes²,

João³

et al. 2021

WJC

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Ischaemic heart disease (IHD) is a major cause of morbidity and mortality worldwide. While there have been major advances in this field, these patients are still a higher risk subgroup. As such, strategies to mitigate risk and tailor secondary prevention measures are of the utmost relevance. Cardiac rehabilitation (CR), encompassing several domains including exercise training, cardiovascular risk factor optimization, nutritional and psychological assessments, as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with IHD. Indeed, CR is associated with several benefits in this population, ranging from functional capacity to improvements in outcomes. Whilst this, there are still several issues concerning the optimal application of CR which are still not fully ascertained, such as lack of referral and completion, as well as questions related to programme design (particularly among patients with multiple comorbidities). In this review, we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD, while also discussing some of the caveats in the current data, as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

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Exercise training as an essential component of cardiac rehabilitation

Cited by 7 publications

References 4 publications

Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Optimizing Outcomes in Cardiac Rehabilitation: The Importance of Exercise Intensity

Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence

Current role and future perspectives of cardiac rehabilitation in coronary heart disease

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