Abstract
RationaleTo improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed.Guideline developmentA systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria.Clinical and research recommendationsRecommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR.Applicability and implementation issuesThis guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation.ConclusionThis guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.
Highlights
Rationale To improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed
Strong evidence is found for exercise-based CR in CHF patients, especially for aerobic exercise training during the outpatient rehabilitation, [4,5,6] and adopting training after supervised CR. [49,50,51] It can be assumed that treatment of pulmonary symptoms during the stay at the intensive care unit (ICU)/ coronary care unit (CCU) and early mobilisation in the clinical phase leads to a faster recovery, [20, 21] and that strength training, [5, 34] inspiration muscle training
This guideline and the guideline for exercise-based CR in patients with coronary artery disease [15] aims to reduce the considerable practice variation which has recently been reported in Dutch CR centres, [7] and thereby, to increase quality of exercise-based CR in the Netherlands [54]
Summary
Strong evidence is found for exercise-based CR in CHF patients, especially for aerobic exercise training (endurance, interval and HIT) during the outpatient rehabilitation, [4,5,6] and adopting training after supervised CR. [49,50,51] It can be assumed that treatment of pulmonary symptoms during the stay at the ICU/ CCU (if necessary) and early mobilisation in the clinical phase (if applicable) leads to a faster recovery, [20, 21] and that strength training, [5, 34] inspiration muscle training Strong evidence is found for exercise-based CR in CHF patients, especially for aerobic exercise training (endurance, interval and HIT) during the outpatient rehabilitation, [4,5,6] and adopting training after supervised CR. Further research is needed on strategies to improve monitoring and follow-up of the maintenance of a physically active lifestyle after supervised CR; for example by implementing activity monitoring devices combined with telemonitoring, or by web-based coaching platforms to guide patients. [55] Exercise-based CR may be followed by relatively brief maintenance programs and booster sessions, including behavioural techniques and focusing on incorporating lifestyle changes into daily life, in order to improve long-term adherence to lifestyle modifications. [56] more research is needed into characteristics and modalities of physical activity and exercise training in CHF in the long term Further research is needed on strategies to improve monitoring and follow-up of the maintenance of a physically active lifestyle after supervised CR; for example by implementing activity monitoring devices combined with telemonitoring, or by web-based coaching platforms to guide patients. [55] Exercise-based CR may be followed by relatively brief maintenance programs and booster sessions, including behavioural techniques and focusing on incorporating lifestyle changes into daily life, in order to improve long-term adherence to lifestyle modifications. [56] more research is needed into characteristics and modalities of physical activity and exercise training in CHF in the long term
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