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

Bernhard Schwaab,Heike Buhr-Schinner,Christian Albus,Oliver Razum,Sarah Eichler,Ronja Westphal,Regina Max,Eike Langheim,Matthes Metz,Gerd Bönner,Gabriele Karger,Harry Hahmann,Daniel Saure,Nils Reiss,Werner Benzer,Anne-Kathrin Exner,Ursula Härtel,Clemens Von Schacky,Johannes Glatz,Ernst Knoglinger,Josef Niebauer,Ulrich Kiwus,Heiner Vogel,Patrick Brzoska,Albrecht Charrier,Axel Preßler,Konrad Schultz,Marthin Karoff,Heinz Völler,Roland Nebel,Birna Bjarnason-Wehrens,Annett Salzwedel,Hansueli Tschanz,Stephan Gielen,Gesine Dörr,Marco Streibelt,Martin Stüttgen,Eva-Maria Skoda,Bernhard Rauch,Michaela Stüttgen,Katrin Jensen,Maurizio Grilli,Carsten Cordes,Martin Teufel,C Krusch ,Johannes F.e Mann ,Maria‐Inti Metzendorf ,D B Gysan ,M Schütt ,Hans‐Georg Predel ,B Fromm ,K Meng ,D Steube ,H Gohlke ,Christoph Herrmann‐Lingen ,Jean‐Paul Schmid

doi:10.3390/jcm10143071

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.

Highlights

Exercise based cardiac rehabilitation is a well-accepted treatment for secondary prevention of cardiovascular diseases
Indications for exercise training (ET) in patients with cardiovascular diseases have been described in Part 1 [1]
Physical activity and exercise training are the cornerstones of cardiac rehabilitation (CR) with evidence for reduction in mortality in patients with coronary artery disease and with evidence for improvements of morbidity, exercise capacity, and quality of life in patients with congestive heart failure, valve surgery, or intervention, after Ventricular Assist Device (VAD)-implantation or heart transplantation, in adults with congenital heart disease and peripheral arterial disease

Summary

Introduction

Exercise based cardiac rehabilitation (ebCR) is a well-accepted treatment for secondary prevention of cardiovascular diseases. Implementation and delivery of ebCR, still considerably differ between countries. Evidence-based guidelines for ebCR in clinical practice of Germany, Austria and Switzerland were updated and harmonized. The condensed version of these guidelines (LLKardReha-D-A-CH) in English language are presented in two parts. Part 1 [1], describes the methodology of guideline development and the evidence of ebCR for a broad spectrum of clinical indications. Part 2, as presented in this review, concentrates on most important contents of ebCR, such as exercise training, psychological interventions and patient education, with their application in clinical practice. Particular needs of special patients and the potential of upcoming forms of ebCR, such as tele-rehabilitation and home-based CR, are discussed in Part 2 as well

Methods

Results

Conclusion