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

Abstract

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.

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

“…The vast number of possible combinations makes absolute recommendations difficult to mandate in every situation. Furthermore, different goals, depending on patient needs (primary prevention, treatment of risk factors, such as obesity, hypertension, or diabetes mellitus, or treatment of CAD), may require an individually tailored exercise prescription 14, 120, 121. The European Association of Preventive Cardiology recently aimed to improve exercise prescription in patients with overt CAD or CAD risk factors (diabetes mellitus types 1 and 2, obesity, hypertension, and hypercholesterolemia) on the basis of current evidence.…”

“…The European Association of Preventive Cardiology recently aimed to improve exercise prescription in patients with overt CAD or CAD risk factors (diabetes mellitus types 1 and 2, obesity, hypertension, and hypercholesterolemia) on the basis of current evidence. Therefore, the Exercise Prescription in Everyday Praxis and Rehabilitative Training tool, an interactive, digital training, and decision support system, was designed to assist healthcare professionals with prescribing effective and safe exercise training programs for patients with CAD (risk) 120. This tool might have a major impact on the implementation of current guidelines on exercise training in CAD, which is insufficient to date, and might lead to the collection of data on exercise training in clinical practice.…”

Editor’s presentation

“…This tool underwent a preliminary validation by comparing its recommendation with those from 18 cardiologists and physiotherapists involved in rehabilitation. 10 …”

The role of cardiovascular rehabilitation in women with ischemic heart disease and rhythm disorders

“…Cardiovascular rehabilitation programs in women should be individualized, taking into account the particularities of cardiovascular risk factors, effort, aritmogenic risk, socio-economic status. They need to be adapted and diversified, and beside the physical training, to include as well a series of measures to ensure emotional, social and psychological support [1,13,15].…”

“…So, practically, these days of hospitalization will be dedicated to the implementation of life-changing measures, as well as those of secondary pharmacological prevention. Thus, patients will be trained on the importance of decreasing the blood presure values (<140/90 mmHg), maintaining a normal blood glucose and glycosylated hemoglobin, decreasing lipid (LDL-cholesterol <70 mg / dl) and BMI (<25 kg / m2) [1,8,12,15].…”