Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group
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.
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.
- 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.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
- 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
- 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.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
- 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.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: http://www.bacpr.com/resources/BACPR_Core_Comp_PA_Exercise_web_FINAL_NOV_12_2.pdf. Accessed 1 Mar 2018.
- 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
- 21.Shaw K, Gennat H, O’Rourke P, et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817.Google Scholar
- 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
- 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
- 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
- 67.International Diabetes Federation. Recommendations for managing type 2 diabetes in primary care, 2017. http://www.idf.org/managing-type2-diabetes. Accessed 1 Mar 2018.
- 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.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
- 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
- 95.American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care. 2004;27(Suppl 1):S58–62.Google Scholar