Sports Medicine

, Volume 48, Issue 8, pp 1781–1797 | Cite as

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group

  • Dominique Hansen
  • Josef Niebauer
  • Veronique Cornelissen
  • Olga Barna
  • Daniel Neunhäuserer
  • Christoph Stettler
  • Cajsa Tonoli
  • Eugenio Greco
  • Robert Fagard
  • Karin Coninx
  • Luc Vanhees
  • Massimo F. Piepoli
  • Roberto Pedretti
  • Gustavo Rovelo Ruiz
  • Ugo Corrà
  • Jean-Paul Schmid
  • Constantinos H. Davos
  • Frank Edelmann
  • Ana Abreu
  • Bernhard Rauch
  • Marco Ambrosetti
  • Simona Sarzi Braga
  • Paul Beckers
  • Maurizio Bussotti
  • Pompilio Faggiano
  • Esteban Garcia-Porrero
  • Evangelia Kouidi
  • Michel Lamotte
  • Rona Reibis
  • Martijn A. Spruit
  • Tim Takken
  • Carlo Vigorito
  • Heinz Völler
  • Patrick Doherty
  • Paul Dendale
Review Article


Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.


Author Contributions

DH, JN, VC, OB, DN, CS, CT, EG, RF, KC, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, PD, and PD contributed to the conception or design of the work. DH, JN, VC, OB, DN, CS, CT, EG, RF, KC, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, PD, and PD contributed to the acquisition, analysis, or interpretation of data for the work. DH, PD and KC drafted the manuscript. JN, VC, OB, DN, CS, CT, EG, RF, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, and PD critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Compliance with Ethical Standards


The realisation of the proof of concept of the EXPERT tool was supported by an UHasselt IOF PoC project.

Conflicts of interest

Dominique Hansen, Josef Niebauer, Veronique Cornelissen, Olga Barna, Daniel Neunhäuserer, Christoph Stettler, Cajsa Tonoli, Eugenio Greco, Robert Fagard, Karin Coninx, Luc Vanhees, Massimo Piepoli, Roberto Pedretti, Gustavo Rovelo Ruiz, Ugo Corrà, Jean-Paul Schmid, Constantinos Davos, Frank Edelmann, Ana Abreu, Bernhard Rauch, Marco Ambrosetti, Simona Sarzi Braga, Paul Beckers, Maurizio Bussotti, Pompilio Faggiano, Esteban Garcia-Porrero, Evangelia Kouidi, Michel Lamotte, Rona Reibis, Martijn Spruit, Tim Takken, Carlo Vigorito, Heinz Völler, Patrick Doherty and Paul Dendale declare that they have no conflicts of interest relevant to the content of this review.

Supplementary material

40279_2018_930_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 14 kb)


  1. 1.
    Lin X, Zhang X, Guo J, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e002014.PubMedPubMedCentralGoogle Scholar
  2. 2.
    Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43.PubMedCrossRefGoogle Scholar
  3. 3.
    Pattyn N, Cornelissen VA, Eshghi SR, et al. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: a meta-analysis of controlled trials. Sports Med. 2013;43:121–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Lavie CJ, Arena R, Swift DL, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015;117:207–19.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Kachur S, Chongthammakun V, Lavie CJ, et al. Impact of cardiac rehabilitation and exercise training programs in coronary heart disease. Prog Cardiovasc Dis. 2017;60:103–14.PubMedCrossRefGoogle Scholar
  6. 6.
    Kondamudi N, Haykowsky M, Forman DE, et al. Exercise training for prevention and treatment of heart failure. Prog Cardiovasc Dis. 2017;60:115–20.PubMedCrossRefGoogle Scholar
  7. 7.
    Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. 2016;23:NP1–96.Google Scholar
  8. 8.
    Eckel RH, Jakicic JM, Ard JD, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960–84.Google Scholar
  9. 9.
    Karlsen T, Aamot IL, Haykowsky M, et al. High intensity interval training for maximizing health outcomes. Prog Cardiovasc Dis. 2017;60:67–77.PubMedCrossRefGoogle Scholar
  10. 10.
    Vanhees L, Geladas N, Hansen D, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors. Recommendations from the European Association for Cardiovascular Prevention and Rehabilitation (Part II). Eur. J Prev Cardiol. 2012;19:1005–33.CrossRefGoogle Scholar
  11. 11.
    Bjarnasons-Wherens B, McGee H, Zwisler AD, et al. Cardiac rehabilitation in Europe: results from the European cardiac rehabilitation inventory survey. Eur J Cardiovasc Prev Rehabil. 2010;17:410–8.CrossRefGoogle Scholar
  12. 12.
    Hansen D, Rovelo Ruiz G, Doherty P, et al. Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey. Eur J Prev Cardiol. 2018; (accepted for publication).Google Scholar
  13. 13.
    Hansen D, Dendale P, Coninx K, et al. The EAPC EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur. J Prev Cardiol. 2017;24:1017–31.CrossRefGoogle Scholar
  14. 14.
    Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334–6.PubMedPubMedCentralCrossRefGoogle Scholar
  15. 15.
    Myers J, Arena R, Franklin B, et al. American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention of the Council on Clinical Cardiology, the Council on Nutrition, Physical Activity, and Metabolism, and the Council on Cardiovascular Nursing. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009;119:3144–61.PubMedCrossRefGoogle Scholar
  16. 16.
    British Association for Cardiovascular Prevention and Rehabilitation Exercise Professionals Group. Core Competences for the Physical Activity and Exercise Component for Cardiovascular Disease Prevention and Rehabilitation Services. British Cardiovascular Society, 2012: Accessed 1 Mar 2018.
  17. 17.
    Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035–87.PubMedCrossRefGoogle Scholar
  18. 18.
    Yumuk V, Tsigos C, Fried M, et al. Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts. 2015;8:402–24.PubMedPubMedCentralCrossRefGoogle Scholar
  19. 19.
    Donnelly JE, Blair SN, Jakicic JM, American College of Sports Medicine. American College of Sports Medicine Position Stand, et al. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.PubMedCrossRefGoogle Scholar
  20. 20.
    Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755–67.PubMedCrossRefGoogle Scholar
  21. 21.
    Shaw K, Gennat H, O’Rourke P, et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817.Google Scholar
  22. 22.
    Thorogood A, Mottillo S, Shimony A, et al. Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. Am J Med. 2011;124:747–55.PubMedCrossRefGoogle Scholar
  23. 23.
    Ismail I, Keating SE, Baker MK, et al. A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat. Obes Rev. 2012;13:68–91.PubMedCrossRefGoogle Scholar
  24. 24.
    Baillot A, Romain AJ, Boisvert-Vigneault K, et al. Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis. PLoS One. 2015;10:e0119017.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Clark JE. Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18–65 years old) who are overfat, or obese; systematic review and meta-analysis. J Diabetes Metab Disord. 2015;14:31.PubMedPubMedCentralCrossRefGoogle Scholar
  26. 26.
    Kuo CH, Harris MB. Abdominal fat reducing outcome of exercise training: fat burning or hydrocarbon source redistribution? Can J Physiol Pharmacol. 2016;94:695–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.PubMedCrossRefGoogle Scholar
  28. 28.
    Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens. 2013;31:639–48.PubMedCrossRefGoogle Scholar
  29. 29.
    Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473.PubMedPubMedCentralCrossRefGoogle Scholar
  30. 30.
    Kelley GA, Kelley KS. Efficacy of aerobic exercise on coronary heart disease risk factors. Prev Cardiol. 2008;11:71–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure regulating mechanisms and cardiovascular risk factors. Hypertension. 2005;46:667–75.PubMedCrossRefGoogle Scholar
  32. 32.
    Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized controlled trials. Ann Intern Med. 2002;136:493–503.PubMedCrossRefGoogle Scholar
  33. 33.
    Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33:S484–92.PubMedCrossRefGoogle Scholar
  34. 34.
    Kelley GA, Kelley KS, Tran ZV. Walking and resting BP in adults: a meta-analysis. Prev Med. 2001;33:120–7.PubMedGoogle Scholar
  35. 35.
    Tjonna AE, Lee SJ, Stolen TO, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118:346–54.PubMedPubMedCentralCrossRefGoogle Scholar
  36. 36.
    Molmen-Hansen HE, Stolen T, Tjonna AE, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol. 2012;19:151–60.PubMedCrossRefGoogle Scholar
  37. 37.
    Guimaraes GV. Effect of continuous vs interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertension Res. 2010;33:627–32.CrossRefGoogle Scholar
  38. 38.
    Ciolac EG, Bocchi EA, Bortolotto LA, et al. Effects of high-intensity aerobic interval training vs moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertension Res. 2010;33:836–43.CrossRefGoogle Scholar
  39. 39.
    Cornelissen VA, Arnout J, Holvoet P, et al. Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age. J Hypertens. 2009;27:753–62.PubMedCrossRefGoogle Scholar
  40. 40.
    Dalleck LC, Allen BA, Hanson BA, et al. Dose-response relationship between moderate-intensity exercise duration and coronary heart disease risk factors in postmenopausal women. J Womens Health. 2009;18:105–13.CrossRefGoogle Scholar
  41. 41.
    Murphy MH, Blair SN, Murtagh EM. Accumulated versus continuous exercise for health benefits. Sports Med. 2009;39:29–43.PubMedCrossRefGoogle Scholar
  42. 42.
    Pescatello LS, Kulikowich JM. The aftereffects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc. 2001;33:1855–61.PubMedCrossRefGoogle Scholar
  43. 43.
    Anunciacao PG, Polito MD. A review on post-exercise hypotension in hypertensive individuals. Arq Bras Cardiol. 2011;96:e100–9.CrossRefGoogle Scholar
  44. 44.
    Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2000;35:838–43.PubMedCrossRefGoogle Scholar
  45. 45.
    Cornelissen VA, Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2005;23:251–9.PubMedCrossRefGoogle Scholar
  46. 46.
    Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood pressur: a meta-analysis of randomized controlled trials. J Hypertens. 2010;28:411–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Owen A, Wiles J, Swaine I. Effect of isometric exercise on resting blood pressure: a meta-analysis. J Hum Hypertens. 2010;24:796–800.PubMedCrossRefGoogle Scholar
  48. 48.
    The Task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). ESH/ESC guidelines for the management of arterial hypertension. J Hypertens. 2013;2013(31):1281–357.Google Scholar
  49. 49.
    Fagard RH, Björnstad HH, Borjesson M, et al. ESC study group of sports cardiology recommendations for participation in leisure-time physical activities and competitive sports for patients with hypertension. Eur J Prev Cardiol. 2005;12:326–31.CrossRefGoogle Scholar
  50. 50.
    Sharman JE, Stowasser M. Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport. 2009;12:252–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Pescatello LS, Franklin BA, Fagard R, American College of Sports Medicine, et al. Exercise and hypertension. Position stand. Med Sci Sports Exerc. 2004;36:533–53.PubMedCrossRefGoogle Scholar
  52. 52.
    Badrov MB, Bartol CL, DiBartolomeo MA, et al. Effect of isometric handgrip training dose on resting blood pressure and resistance vessel endothelial function in normotensive women. Eur J Appl Physiol. 2013;113:2091–100.PubMedCrossRefGoogle Scholar
  53. 53.
    Millar PJ, Levy AS, McGowan CL, et al. Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients. Scand J Med Sci Sports. 2013;23:620–6.PubMedGoogle Scholar
  54. 54.
    Wen H, Wang L. Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: a meta-analysis. Medicine. 2017;96:e6150.PubMedPubMedCentralCrossRefGoogle Scholar
  55. 55.
    Niewiadomski W, Pilis W, Laskowska D, et al. Effects of a brief Valsalva manoeuvre on hemodynamic response to strength exercises. Clin Physiol Funct Imaging. 2012;32:145–57.PubMedCrossRefGoogle Scholar
  56. 56.
    Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–e164.Google Scholar
  57. 57.
    Poli A, Marangoni F, Paoletti R, et al. Non-pharmacological control of plasma cholesterol levels. Nutr Metab Cardiovasc Dis. 2008;18:S1–16.PubMedCrossRefGoogle Scholar
  58. 58.
    Hayashino Y, Jackson JL, Fukumori N, et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60.PubMedCrossRefGoogle Scholar
  59. 59.
    Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058.PubMedCrossRefGoogle Scholar
  60. 60.
    Kelley GA, Kelley KS, Roberts S, et al. Comparison of aerobic exercise, diet or both on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Clin Nutr. 2012;31:156–67.PubMedCrossRefGoogle Scholar
  61. 61.
    Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Prev Med. 2009;48:9–19.PubMedCrossRefGoogle Scholar
  62. 62.
    Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials. J Cardiopulm Rehabil. 2006;26:131–9.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    Kelley GA, Kelley KS, Vu Tran Z. Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Obes. 2005;29:881–93.CrossRefGoogle Scholar
  64. 64.
    Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167:999–1008.PubMedCrossRefGoogle Scholar
  65. 65.
    Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011;34:1228–37.PubMedPubMedCentralCrossRefGoogle Scholar
  66. 66.
    American Diabetes Association. Standards of medical care in diabetes, 2017. Diabetes Care. 2017;40:S1–135.CrossRefGoogle Scholar
  67. 67.
    International Diabetes Federation. Recommendations for managing type 2 diabetes in primary care, 2017. Accessed 1 Mar 2018.
  68. 68.
    Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42.PubMedCrossRefGoogle Scholar
  69. 69.
    Colberg SR, Sigal RJ, Fernhall B, et al. American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33:2692–6.PubMedPubMedCentralCrossRefGoogle Scholar
  70. 70.
    Egger A, Niederseer D, Diem G, et al. Different types of resistance training in patients with type 2 diabetes mellitus: effects on glycemic control, muscle mass and strength. Eur J Prev Cardiol. 2013;20:1051–60.PubMedCrossRefGoogle Scholar
  71. 71.
    Marwick TH, Hordern MD, Miller T, et al. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119:3244–62.PubMedCrossRefGoogle Scholar
  72. 72.
    Niebauer J, Mayr K, Harpf H, et al. Long-term effects of outpatient cardiac rehabilitation in Austria: A nationwide registry. Wien Klin Wochenschr. 2014;126:148–55.PubMedCrossRefGoogle Scholar
  73. 73.
    Niebauer J, Mayr K, Tschentscher M, et al. Outpatient cardiac rehabilitation—the Austrian model. Eur J Prev Cardiol. 2013;20:468–79.PubMedCrossRefGoogle Scholar
  74. 74.
    Umpierre D, Ribeiro PAB, Schaan BD, et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56:242–51.PubMedCrossRefGoogle Scholar
  75. 75.
    Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9.PubMedCrossRefGoogle Scholar
  76. 76.
    van Buuren F, Mellwig KP, Horstkotte D, et al. Electrical myostimulation improves glucose metabolism and oxygen uptake in type 2 diabetes mellitus patients—results from the exEMS study. Diabetes Technol Ther. 2015;17:413–9.PubMedCrossRefGoogle Scholar
  77. 77.
    Hansen D, Peeters S, Zwaenepoel B, et al. Exercise assessment and prescription in patients with type 2 diabetes in the private and home care setting: clinical recommendations from AXXON (Physical Therapy Association Belgium). Phys Ther. 2013;93:597–610.PubMedCrossRefGoogle Scholar
  78. 78.
    Sixt S, Peschel T, Halfwassen U, et al. 6 months multifactorial intervention with focus on exercise training in patients with diabetes mellitus type 2 and coronary artery disease improves cardiovascular risk factor profile and endothelial dysfunction. Eur Heart J. 2010;31:112–9.PubMedCrossRefGoogle Scholar
  79. 79.
    Desch S, Sonnabend M, Niebauer J, et al. Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetes. Diabetes Obes Metab. 2010;12:825–8.PubMedCrossRefGoogle Scholar
  80. 80.
    Sixt S, Rastan A, Desch S, et al. Exercise training but not rosiglitazone improves endothelial function in pre-diabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil. 2008;15:473–8.PubMedCrossRefGoogle Scholar
  81. 81.
    Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39:2065–79.PubMedCrossRefGoogle Scholar
  82. 82.
    Mendes R, Sousa N, Reis VM, et al. Prevention of exercise-related injuries and adverse events in patients with type 2 diabetes. Postgrad Med J. 2013;89:715–21.PubMedCrossRefGoogle Scholar
  83. 83.
    Wallberg-Henriksson H, Gunnarsson R, Rossner S, et al. Long-term physical training in female type 1 (insulin-dependent) diabetic patients: absence of significant effect on glycaemic control and lipoprotein levels. Diabetologia. 1986;29:53–7.PubMedCrossRefGoogle Scholar
  84. 84.
    Ebeling P, Tuominen JA, Bourey R, et al. Athletes with IDDM exhibit impaired metabolic control and increased lipid utilization with no increase in insulin sensitivity. Diabetes. 1995;44:471–7.PubMedCrossRefGoogle Scholar
  85. 85.
    Galassetti P, Mann S, Tate D, et al. Effects of antecedent prolonged exercise on subsequent counterregulatory responses to hypoglycemia. Am J Physiol Endocrinol Metab. 2001;280:E908–17.PubMedCrossRefGoogle Scholar
  86. 86.
    Lehmann R, Kaplan V, Bingisser R, et al. Impact of physical activity on cardiovascular risk factors in iddm. Diabetes Care. 1997;20:1603–11.PubMedCrossRefGoogle Scholar
  87. 87.
    Moy CS, Songer TJ, LaPorte RE, et al. Insulin-dependent diabetes mellitus, physical activity, and death. Am J Epidemiol. 1993;137:74–81.PubMedCrossRefGoogle Scholar
  88. 88.
    Zinman B, Ruderman N, Campaigne BN, et al. Physical activity/exercise and diabetes. Diabetes Care. 2004;27:S58–62.CrossRefGoogle Scholar
  89. 89.
    Horton ES. Role and management of exercise in diabetes mellitus. Diabetes Care. 1988;11:201–11.PubMedCrossRefGoogle Scholar
  90. 90.
    Henriksson J. Effects of physical training on the metabolism of skeletal muscle. Diabetes Care. 1992;15:1701–11.PubMedCrossRefGoogle Scholar
  91. 91.
    Jenni S, Oetliker C, Allemann S, et al. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus-a prospective single-blinded randomised crossover trial. Diabetologia. 2008;51:1457–65.PubMedCrossRefGoogle Scholar
  92. 92.
    Jenni S, Christ ER, Stettler C. Exercise-induced growth hormone response in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus. Diabet Med. 2010;27:230–3.PubMedCrossRefGoogle Scholar
  93. 93.
    Jenni S, Wueest S, Konrad D, et al. Response of interleukin-6 during euglycaemic and hyperglycaemic exercise in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract. 2010;89:e27–9.PubMedCrossRefGoogle Scholar
  94. 94.
    Stettler C, Jenni S, Allemann S, et al. Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia. Diabetes Metab Res Rev. 2006;22:300–6.PubMedCrossRefGoogle Scholar
  95. 95.
    American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care. 2004;27(Suppl 1):S58–62.Google Scholar
  96. 96.
    Durak EP, Jovanovic-Peterson L, Peterson CM. Randomized crossover study of effect of resistance training on glycemic control, muscular strength, and cholesterol in type I diabetic men. Diabetes Care. 1990;13:1039–43.PubMedCrossRefGoogle Scholar
  97. 97.
    Ramalho AC, de Lourdes Lima M, Nunes F, et al. The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Res Clin Pract. 2006;72:271–6.PubMedCrossRefGoogle Scholar
  98. 98.
    Gibala MJ. High-intensity interval training: a time-efficient strategy for health promotion? Curr Sports Med Rep. 2007;6:211–3.PubMedGoogle Scholar
  99. 99.
    Bussau VA, Ferreira LD, Jones TW, et al. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care. 2006;29:601–6.PubMedCrossRefGoogle Scholar
  100. 100.
    Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care. 2005;28:1289–94.PubMedCrossRefGoogle Scholar
  101. 101.
    Bussau VA, Ferreira LD, Jones TW, et al. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007;50:1815–8.PubMedCrossRefGoogle Scholar
  102. 102.
    Guelfi KJ, Ratnam N, Smythe GA, et al. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab. 2007;292:E865–70.PubMedCrossRefGoogle Scholar
  103. 103.
    Maran A, Pavan P, Bonsembiante B, et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes Technol Ther. 2010;12:763–8.PubMedCrossRefGoogle Scholar
  104. 104.
    West DJ, Stephens JW, Bain SC, et al. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci. 2011;29:279–89.PubMedCrossRefGoogle Scholar
  105. 105.
    Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5:377–90.PubMedCrossRefGoogle Scholar
  106. 106.
    Yardley JE, Sigal RJ, Perkins BA, et al. Resistance exercise in type 1 diabetes. Can J Diabetes. 2013;37:420–6.PubMedCrossRefGoogle Scholar
  107. 107.
    Yardley JE, Hay J, Abou-Setta AM, et al. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014;106:393–400.PubMedCrossRefGoogle Scholar
  108. 108.
    Tonoli C, Heyman E, Roelands B, et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med. 2012;42:1059–80.PubMedCrossRefGoogle Scholar
  109. 109.
    Hansen D, Stevens A, Eijnde BO, et al. Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: a critical re-appraisal of current evidence. Sports Med. 2012;42:11–30.PubMedCrossRefGoogle Scholar
  110. 110.
    Murlasits Z, Radák Z. The effects of statin medications on aerobic exercise capacity and training adaptations. Sports Med. 2014;44:1519–30.PubMedCrossRefGoogle Scholar
  111. 111.
    Kawano Y, Takemoto M, Mito T, et al. Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease. Int J Cardiol. 2016;216:151–5.PubMedCrossRefGoogle Scholar
  112. 112.
    Hansen D, Coninx K, Dendale P. The EAPC EXPERT tool. Eur Heart J. 2017;38:2318–20.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Dominique Hansen
    • 1
    • 2
  • Josef Niebauer
    • 3
  • Veronique Cornelissen
    • 4
  • Olga Barna
    • 5
  • Daniel Neunhäuserer
    • 6
    • 7
  • Christoph Stettler
    • 8
  • Cajsa Tonoli
    • 9
  • Eugenio Greco
    • 10
  • Robert Fagard
    • 11
  • Karin Coninx
    • 12
  • Luc Vanhees
    • 4
  • Massimo F. Piepoli
    • 13
  • Roberto Pedretti
    • 14
  • Gustavo Rovelo Ruiz
    • 12
  • Ugo Corrà
    • 15
  • Jean-Paul Schmid
    • 16
  • Constantinos H. Davos
    • 17
  • Frank Edelmann
    • 18
    • 19
    • 20
  • Ana Abreu
    • 21
  • Bernhard Rauch
    • 22
  • Marco Ambrosetti
    • 23
  • Simona Sarzi Braga
    • 14
  • Paul Beckers
    • 24
    • 25
  • Maurizio Bussotti
    • 26
  • Pompilio Faggiano
    • 27
  • Esteban Garcia-Porrero
    • 28
  • Evangelia Kouidi
    • 29
  • Michel Lamotte
    • 30
  • Rona Reibis
    • 31
  • Martijn A. Spruit
    • 2
    • 32
    • 33
  • Tim Takken
    • 34
  • Carlo Vigorito
    • 35
  • Heinz Völler
    • 36
    • 37
  • Patrick Doherty
    • 38
  • Paul Dendale
    • 1
    • 2
  1. 1.Heart Centre HasseltJessa HospitalHasseltBelgium
  2. 2.UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research CentreHasselt UniversityDiepenbeekBelgium
  3. 3.Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Sports Medicine of the Olympic Center Salzburg-RifSalzburgAustria
  4. 4.Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation SciencesKU LeuvenLouvainBelgium
  5. 5.Family Medicine DepartmentNational O.O. Bogomolets Medical UniversityKievUkraine
  6. 6.Sport and Exercise Medicine Division, Department of MedicineUniversity of PadovaPaduaItaly
  7. 7.University Institute of Sports Medicine, Prevention and RehabilitationParacelsus Medical University of SalzburgSalzburgAustria
  8. 8.Division of Endocrinology, Diabetes and Clinical NutritionUniversity Hospital/InselspitalBernSwitzerland
  9. 9.Department of Rehabilitation Science and PhysiotherapyGhent UniversityGhentBelgium
  10. 10.FuscaldoItaly
  11. 11.Hypertension and Cardiovascular Rehabilitation UnitKU Leuven UniversityLouvainBelgium
  12. 12.UHasselt, Faculty of Sciences, Expertise Centre for Digital MediaHasselt UniversityHasseltBelgium
  13. 13.Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto HospitalAUSL PiacenzaPiacenzaItaly
  14. 14.Department of Medicine and Cardiorespiratory Rehabilitation, Istituti Clinici Scientifici MaugeriIRCCS TradateTradateItaly
  15. 15.Cardiologic Rehabilitation DepartmentIstituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCSVerunoItaly
  16. 16.Department of CardiologyClinic BarmelweidBarmelweidSwitzerland
  17. 17.Cardiovascular Research Laboratory, Biomedical Research FoundationAcademy of AthensAthensGreece
  18. 18.Department of Internal Medicine with CardiologyCharité-Universitaetsmedizin BerlinBerlinGermany
  19. 19.Department of Cardiology and PneumologyUniversity of GöttingenGöttingenGermany
  20. 20.German Center for Cardiovascular ResearchGöttingenGermany
  21. 21.Cardiology DepartmentHospital Santa MartaLisbonPortugal
  22. 22.Institut für Herzinfarktforschung LudwigshafenLudwigshafen Am RheinGermany
  23. 23.Cardiovascular Rehabilitation UnitLe Terrazze ClinicCunardoItaly
  24. 24.Department of CardiologyAntwerp University HospitalEdegemBelgium
  25. 25.Translational Pathophysiological ResearchAntwerp UniversityAntwerpBelgium
  26. 26.Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, Institute of MilanIRCCSMilanItaly
  27. 27.Cardiology DepartmentSpedali CiviliBresciaItaly
  28. 28.Cardiology Service of Complejo Hospitalario Universitario de LeónLéonSpain
  29. 29.Laboratory of Sports MedicineAristotle University of ThessalonikiThessalonikiGreece
  30. 30.CUB Erasme HospitalBrusselsBelgium
  31. 31.Cardiological Outpatient Clinics at the Park SanssouciPotsdamGermany
  32. 32.Department of Research and EducationCIRO + , Centre of Expertise for Chronic Organ FailureHornThe Netherlands
  33. 33.Department of Respiratory Medicine, Maastricht University Medical CentreNUTRIM School of Nutrition and Translational Research in MetabolismMaastrichtThe Netherlands
  34. 34.Division of Pediatrics, Child Development and Exercise CenterWilhelmina Children’s Hospital, UMC UtrechtUtrechtThe Netherlands
  35. 35.Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical SciencesUniversity of Naples Federico IINaplesItaly
  36. 36.Department of CardiologyKlinik am SeeRüdersdorfGermany
  37. 37.Center of Rehabilitation ResearchUniversity of PotsdamPotsdamGermany
  38. 38.Department of Health SciencesUniversity of YorkYorkUK

Personalised recommendations