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Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group

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Abstract

Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.

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Authors and Affiliations

  1. Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium

    Dominique Hansen & Paul Dendale

  2. UHasselt, BIOMED (Biomedical Research Institute) and REVAL (Rehabilitation Research Centre) (REVAL/BIOMED), Hasselt University, Agoralaan Building A, 3590, Diepenbeek, Belgium

    Dominique Hansen, Paul Dendale & Martijn A. Spruit

  3. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium

    Paul Beckers

  4. Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium

    Paul Beckers

  5. Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy

    Daniel Neunhäuserer

  6. Department of Preventive and Rehabilitative Sport and Exercise Medicine, Institute for Cardiology and Sports Medicine, German Sports University, Cologne, Germany

    Birna Bjarnason-Wehrens

  7. Clinical Cardiology, IRCCS Policlinico San Donato, Milan, Italy

    Massimo F. Piepoli

  8. Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

    Massimo F. Piepoli

  9. Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein/Zentrum für Ambulante Rehabilitation, ZAR Trier, Trier, Germany

    Bernhard Rauch

  10. Department of Cardiology, Klinik am See, Rüdersdorf, Germany

    Heinz Völler

  11. Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany

    Heinz Völler

  12. Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy

    Ugo Corrà

  13. Cardiology Service of Complejo Hospitalario, Universitario de León, Léon, Spain

    Esteban Garcia-Porrero

  14. Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland

    Jean-Paul Schmid

  15. CUB Erasme Hospital, Brussels, Belgium

    Michel Lamotte

  16. Department of Health Sciences, University of York, York, UK

    Patrick Doherty

  17. Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany

    Rona Reibis

  18. Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Rehab-Center Salzburg, Ludwig Boltzmann Institute for Digital Health and Prevention, Paracelsus Medical University Salzburg, Salzburg, Austria

    Josef Niebauer

  19. Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece

    Constantinos H. Davos

  20. Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelia Kouidi

  21. Department of Research & Education; CIRO+, Centre of Expertise for Chronic Organ Failure, Horn/Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

    Martijn A. Spruit

  22. Research Group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium

    Luc Vanhees & Véronique Cornelissen

  23. Department Rehabilitation Sciences, University Leuven, Leuven, Belgium

    Luc Vanhees & Véronique Cornelissen

  24. Department of Cardiology, Angiology and Intensive Care, Deutsches Herzzentrum der Charité (DHZC), Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany

    Frank Edelmann

  25. Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine

    Olga Barna

  26. Division of Endocrinology, Diabetes and Clinical Nutrion, University Hospital/Inselspital, Bern, Switzerland

    Christoph Stettler

  27. Movement Control and Neuroplasticity Research Group, Department of Movement Sciences, Faculty of Movement and Rehabilitation Sciences, KU Leuven, Leuven, Belgium

    Cajsa Tonoli

  28. Fuscaldo, CS, Italy

    Eugenio Greco

  29. Cardiovascular Department, IRCCS MultiMedica, Milan, Italy

    Roberto Pedretti & Simona Sarzi Braga

  30. Centre of Cardiovascular RehabilitationCardiology Department, Centro Universitário Hospitalar Lisboa Norte & Faculdade de Medicina da Universidade Lisboa/Instituto Saúde Ambiental & Instituto Medicina Preventiva, Faculdade Medicina da Universidade Lisboa/CCUL/CAML, Lisbon, Portugal

    Ana Abreu

  31. Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy

    Marco Ambrosetti

  32. Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, IRCCS, Institute of Milan, Milan, Italy

    Maurizio Bussotti

  33. Cardiovascular Department, Fondazione Poliambulanza, Brescia, Italy

    Pompilio Faggiano

  34. Division of Pediatrics, Child Development & Exercise Center, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands

    Tim Takken

  35. Department of Translational Medical Sciences, Internal Medicine and Cardiac Rehabilitation, University of Naples Federico II, Naples, Italy

    Carlo Vigorito

  36. Curschmann Clinic, Rehabilitation Center for Cardiology, Vascular Diseases and Diabetes, Timmendorfer Strand/Medical Faculty, University of Lübeck, Lübeck, Germany

    Bernhard Schwaab

  37. UHasselt, Faculty of Sciences, Human-Computer Interaction and eHealth, Hasselt University, Hasselt, Belgium

    Karin Coninx

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  1. Dominique Hansen
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  2. Paul Beckers
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  3. Daniel Neunhäuserer
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  4. Birna Bjarnason-Wehrens
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  5. Massimo F. Piepoli
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  6. Bernhard Rauch
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  7. Heinz Völler
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  8. Ugo Corrà
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  9. Esteban Garcia-Porrero
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  10. Jean-Paul Schmid
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  11. Michel Lamotte
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  13. Rona Reibis
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  14. Josef Niebauer
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  15. Paul Dendale
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  16. Constantinos H. Davos
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  17. Evangelia Kouidi
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  18. Martijn A. Spruit
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  19. Luc Vanhees
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  20. Véronique Cornelissen
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  21. Frank Edelmann
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  22. Olga Barna
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  23. Christoph Stettler
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  24. Cajsa Tonoli
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  25. Eugenio Greco
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  26. Roberto Pedretti
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  27. Ana Abreu
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  28. Marco Ambrosetti
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  31. Pompilio Faggiano
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  32. Tim Takken
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Contributions

All authors contributed to the conception or design of the work, contributed to the acquisition, analysis or interpretation of data for the work drafted the manuscript, and critically revised the manuscript. All authors gave final approval and agree to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Dominique Hansen.

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Funding

The realisation of the proof of concept of the EXPERT tool was supported by an UHasselt Industrial Research Fund (IOF) Proof of Concept (PoC) project. This work was supported by the Flemish Research Fund (FWO, FWO-ICA: G0F4220N).

Conflict of interest

The authors disclose that there are no financial or non-financial interests that are directly or indirectly related to the work submitted for publication.

Additional information

EXPERT stands for ‘EXercise Prescription in Everyday practice & Rehabilitative Training’. This working group is endorsed by the European Association of Preventive Cardiology (EAPC).

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Supplementary file1 (DOCX 14 KB)

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Hansen, D., Beckers, P., Neunhäuserer, D. et al. Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group. Sports Med 53, 2013–2037 (2023). https://doi.org/10.1007/s40279-023-01909-x

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