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Exercise Training in Cardiac Rehabilitation

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Cardiac Rehabilitation Manual

Abstract

Physical activity counseling and individually prescribed and supervised exercise training are core components of a comprehensive cardiac rehabilitation program, compromising 30–50% (up to >70%) of all cardiac rehabilitation activities. This applies to phase II as well as to phase III cardiac rehabilitation for patients post acute coronary syndrome (ACS) and post primary coronary angioplasty (PCI), post cardiac surgery (coronary artery bypass, valve heart surgery, cardiac transplantation), as well as in chronic heart failure patients.

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References

  1. Jolliffe JA, Rees K, Taylor RS, Thompson D, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database Syst Rev Update. 2001;(1):CD001800:Update Software.

    Google Scholar 

  2. Taylor RS, Brown A, Ebrahim S, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med. 2004;116(10):682-692.

    Article  PubMed  Google Scholar 

  3. Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with coronary artery disease. Ann Intern Med. 2005;143(9):659-672.

    Article  PubMed  Google Scholar 

  4. Thompson PD, Buchner D, Pina IL, et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity). Circulation. 2003;107(24):3109-3116.

    Article  PubMed  Google Scholar 

  5. U.S. Department of Health and Human Services. Rdt. Physical activity and health: a report of the surgeon general. Atlanta: U.S Department of Health and Human Services. Centers for Disease Control and Prevention National Center for Chronic Disease and Health Promotion; 1996.

    Google Scholar 

  6. Hollmann W, Hettinger TH. Sportmedizin. Grundlagen für Arbeit, Training und Präventivmedizin. 4., völlig neu bearbeitete und erweiterte Auflage ed. Stuttgart: Schattauer; 2000.

    Google Scholar 

  7. Gielen S. Trainingstherapie – theoretische Grundlagen und Evidenz. In: Rauch B, Middeke M, Bönner G, Karoff M, Held K, eds. Kardiologische Rehabilitation. Stuttgart: Thieme; 2007:77.

    Google Scholar 

  8. Deutscher Verband für Gesundheitssport und Sporttherapie. www.dvgs.de. (Web Page) 2009.

  9. Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2007;115(20):2675-2682.

    Article  PubMed  Google Scholar 

  10. Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale PAC, Gaita D, McGee H, Mendes M, Niebauer J, Olsen-Zwisler AD, Schmid JP. Secondary Prevention Through Cardiac Rehabilitation. 2008 Update. From Knowledge to Implementation. A Position Paper from the Cardiac Rehabilitation Section of the European Association of Cardiac Rehabilitation and Prevention. Eur J Cardiop Prev and Rehab. 2010;17(1);1-17.

    Google Scholar 

  11. Leon AS, Franklin BA, Costa F, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scientific statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collaboration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation. 2005;111(3):369-376.

    Article  PubMed  Google Scholar 

  12. Bjarnason-Wehrens B, Schulz O, Gielen S, Halle M, Dürsch M, Hambrecht R, Lowis H, Kindermann W, Schulze R, Rauch B. Leitlinie körperliche Aktivität zur Sekundärprävention und Therapie kardiovaskulärer Erkrankungen. Clin Res Cardiol. 2009;4 (4 Suppl):1-44.

    Google Scholar 

  13. Bjarnason-Wehrens B, Held K, Hoberg E, Karoff M, Rauch B. Deutsche Leitlinie zur Rehabilitation von Patienten mit Herz-Kreislauferkrankungen (DLL-KardReha). Clin Res Cardiol. 2007;Suppl 2-III/1-III/54.

    Google Scholar 

  14. Corra U, Giannuzzi P, Adamopoulos S, et al. Executive summary of the position paper of the working group on cardiac rehabilitation and Exercise Physiology of the European Society of Cardiology (ESC): core components of cardiac rehabilitation in chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2005;12(4):321-325.

    Article  PubMed  Google Scholar 

  15. Pina IL, Apstein CS, Balady GJ, et al. Exercise and heart failure: a statement from the American Heart Association Committee on exercise, rehabilitation, and prevention. Circulation. 2003;107(8):1210-1225.

    Article  PubMed  Google Scholar 

  16. Bjarnason-Wehrens B. Trainingsmaßnahmen. In: Rauch B, Middeke M, Bönner G, Karoff M, Held K, eds. Kardiologische Rehabilitation. Stuttgart: Thieme; 2007:77.

    Google Scholar 

  17. Eden KB, Orleans CT, Mulrow CD, Pender NJ, Teutsch SM. Does counseling by clinicians improve physical activity? A summary of the evidence for the U.S. preventive services task force. Ann Intern Med. 2002;137(3):208-215.

    Article  PubMed  Google Scholar 

  18. Godin G, Desharnais R, Jobin J, Cook J. The impact of physical fitness and health-age appraisal upon exercise intentions and behavior. J Behav Med. 1987;10(3):241-250.

    Article  PubMed  CAS  Google Scholar 

  19. Kavanagh T, Mertens DJ, Hamm LF, et al. Peak oxygen intake and cardiac mortality in women referred for cardiac rehabilitation. J Am Coll Cardiol. 2003;42(12):2139-2143.

    Article  PubMed  Google Scholar 

  20. Kavanagh T, Mertens DJ, Hamm LF, et al. Prediction of long-term prognosis in 12,169 men referred for cardiac rehabilitation. Circulation. 2002;106(6):666-671.

    Article  PubMed  Google Scholar 

  21. Valeur N, Clemmensen P, Saunamaki K, Grande P. The prognostic value of pre-discharge exercise testing after myocardial infarction treated with either primary PCI or fibrinolysis: a DANAMI-2 sub-study. Eur Heart J. 2005;26(2):119-127.

    Article  PubMed  Google Scholar 

  22. Lund LH, Aaronson KD, Mancini DM. Validation of peak exercise oxygen consumption and the heart failure survival score for serial risk stratification in advanced heart failure. Am J Cardiol. 2005;95(6):734-741.

    Article  PubMed  Google Scholar 

  23. O‘Neill JO, Young JB, Pothier CE, Lauer MS. Peak oxygen consumption as a predictor of death in patients with heart failure receiving beta-blockers. Circulation. 2005;111(18):2313-2318.

    Article  PubMed  Google Scholar 

  24. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346(11):793-801.

    Article  PubMed  Google Scholar 

  25. Ades PA, Savage PD, Brawner CA, et al. Aerobic capacity in patients entering cardiac rehabilitation. Circulation. 2006;113(23):2706-2712.

    Article  PubMed  Google Scholar 

  26. Karmisholt K, Gotzsche PC. Physical activity for secondary prevention of disease. Systematic reviews of randomised clinical trials. Dan Med Bull. 2005;52(2):90-94.

    PubMed  Google Scholar 

  27. Smart N, Marwick TH. Exercise training for patients with heart failure: a systematic review of factors that improve mortality and morbidity. Am J Med. 2004;116(10):693-706.

    Article  PubMed  Google Scholar 

  28. Piepoli MF, Flather M, Coats AJ. Overview of studies of exercise training in chronic heart failure: the need for a prospective randomized multicentre European trial. Eur Heart J. 1998;19(6):830-841.

    Article  PubMed  CAS  Google Scholar 

  29. Rees K, Taylor RS, Singh S, Coats AJ, Ebrahim S. Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev. 2004;(3):CD003331.

    Google Scholar 

  30. Ades PA. Cardiac rehabilitation and secondary prevention of coronary heart disease. N Engl J Med. 2001;345(12):892-902.

    Article  PubMed  CAS  Google Scholar 

  31. Wenger NK, Froelicher ES, Smith LK, et al. Cardiac rehabilitation as secondary prevention. agency for health care policy and research and national heart, lung, and blood institute. Clin Pract Guidel Quick Ref Guide Clin. 1995;17:1-23.

    PubMed  Google Scholar 

  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(7):493-503.

    Article  PubMed  Google Scholar 

  33. Fagard RH, Cornelissen VA. Effect of exercise on blood pressure control in hypertensive patients. Eur J Cardiovasc Prev Rehabil. 2007;14(1):12-17.

    Article  PubMed  Google Scholar 

  34. Pan XR, Li GW, Hu YH, et al. Effects of diet and exercise in preventing NIDDM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study Diabetes Care. 1997;20(4):537-544.

    Article  CAS  Google Scholar 

  35. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344(18):1343-1350.

    Article  PubMed  CAS  Google Scholar 

  36. Boule NG, Haddad E, Kenny GP, Wells GA, Sigal RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA. 2001;286(10):1218-1227.

    Article  PubMed  CAS  Google Scholar 

  37. 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(10):999-1008.

    Article  PubMed  CAS  Google Scholar 

  38. Halverstadt A, Phares DA, Wilund KR, Goldberg AP, Hagberg JM. Endurance exercise training raises high-density lipoprotein cholesterol and lowers small low-density lipoprotein and very low-density lipoprotein independent of body fat phenotypes in older men and women. Metabolism. 2007;56(4):444-450.

    Article  PubMed  CAS  Google Scholar 

  39. Kelley GA, Kelley KS. Aerobic exercise and HDL2-C: a meta-analysis of randomized controlled trials. Atherosclerosis. 2006;184(1):207-215.

    Article  PubMed  CAS  Google Scholar 

  40. 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(3):131-139.

    Article  PubMed  Google Scholar 

  41. DiPietro L. Physical activity in the prevention of obesity: current evidence and research issues. Med Sci Sports Exerc. 1999;31(11 Suppl):S542-S546.

    PubMed  CAS  Google Scholar 

  42. Garrow JS, Summerbell CD. Meta-analysis: effect of exercise, with or without dieting, on the body composition of overweight subjects. Eur J Clin Nutr. 1995;49(1):1-10.

    PubMed  CAS  Google Scholar 

  43. Borg G. Perceived exertion as an indicator of somatic stress. Scand J Rehabil Med. 1970;2(2):92-98.

    PubMed  CAS  Google Scholar 

  44. Ilarraza H, Myers J, Kottman W, Rickli H, Dubach P. An evaluation of training responses using self-regulation in a residential rehabilitation program. J Cardiopulm Rehabil. 2004;24(1):27-33.

    Article  PubMed  Google Scholar 

  45. Wassermann K, Hansen JE, Sue DY, Casaburi R, Whipp BJ. Principles of Exercise Testing and Interpretation. 3rd ed. Baltimore: Lippincott Williams & Wikins; 1999.

    Google Scholar 

  46. Gitt AK, Wasserman K, Kilkowski C, et al. Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death. Circulation. 2002;106(24):3079-3084.

    Article  PubMed  Google Scholar 

  47. Dubach P, Sixt S, Myers J. Exercise training in chronic heart failure: why, when and how. Swiss Med Wkly. 2001;131(35–36):510-514.

    PubMed  CAS  Google Scholar 

  48. Nechwatal RM, Duck C, Gruber G. [Physical training as interval or continuous training in chronic heart failure for improving functional capacity, hemodynamics and quality of life – a controlled study]. Z Kardiol. 2002;91(4):328-337.

    Article  PubMed  CAS  Google Scholar 

  49. Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115(24):3086-3094.

    Article  PubMed  Google Scholar 

  50. Meyer K, Samek L, Schwaibold M, et al. Interval training in patients with severe chronic heart failure: analysis and recommendations for exercise procedures. Med Sci Sports Exerc. 1997;29(3):306-312.

    Article  PubMed  CAS  Google Scholar 

  51. Kelley GA, Kelley KS, Tran ZV. Walking and resting blood pressure in adults: a meta-analysis. Prev Med. 2001;33(2 Pt 1):120-127.

    PubMed  CAS  Google Scholar 

  52. Kelley GA, Kelley KS, Tran ZV. Walking and Non-HDL-C in adults: a meta-analysis of randomized controlled trials. Prev Cardiol. 2005;8(2):102-107.

    Article  PubMed  Google Scholar 

  53. Murphy MH, Nevill AM, Murtagh EM, Holder RL. The effect of walking on fitness, fatness and resting blood pressure: a meta-analysis of randomised, controlled trials. Prev Med. 2007;44(5):377-385.

    Article  PubMed  Google Scholar 

  54. Church TS, Earnest CP, Morss GM. Field testing of physiological responses associated with Nordic walking. Res Q Exerc Sport. 2002;73(3):296-300.

    Article  PubMed  Google Scholar 

  55. Willson J, Torry MR, Decker MJ, Kernozek T, Steadman JR. Effects of walking poles on lower extremity gait mechanics. Med Sci Sports Exerc. 2001;33(1):142-147.

    PubMed  CAS  Google Scholar 

  56. Schwameder H, Roithner R, Muller E, Niessen W, Raschner C. Knee joint forces during downhill walking with hiking poles. J Sports Sci. 1999;17(12):969-978.

    Article  PubMed  CAS  Google Scholar 

  57. Kreamer WJ, Frey AC. Strength testing: development and evaluation of methodology. In: Maud PJ, Foster C, eds. Physiological Assessment of Human Fitness. Champaign: Human Kinetics; 1995:121.

    Google Scholar 

  58. Narici MV, Reeves ND, Morse CI, Maganaris CN. Muscular adaptations to resistance exercise in the elderly. J Musculoskelet Neuronal Interact. 2004;4(2):161-164.

    PubMed  CAS  Google Scholar 

  59. Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004;59(1):48-61.

    Article  PubMed  Google Scholar 

  60. Pu CT, Johnson MT, Forman DE, et al. Randomized trial of progressive resistance training to counteract the myopathy of chronic heart failure. J Appl Physiol. 2001;90(6):2341-2350.

    PubMed  CAS  Google Scholar 

  61. Williams AD, Carey MF, Selig S, et al. Circuit resistance training in chronic heart failure improves skeletal muscle mitochondrial ATP production rate – a randomized controlled trial. J Card Fail. 2007;13(2):79-85.

    Article  PubMed  CAS  Google Scholar 

  62. Braith RW, Magyari PM, Pierce GL, et al. Effect of resistance exercise on skeletal muscle myopathy in heart transplant recipients. Am J Cardiol. 2005;95(10):1192-1198.

    Article  PubMed  Google Scholar 

  63. Braith RW, Magyari PM, Fulton MN, Aranda J, Walker T, Hill JA. Resistance exercise training and alendronate reverse glucocorticoid-induced osteoporosis in heart transplant recipients. J Heart Lung Transplant. 2003;22(10):1082-1090.

    Article  PubMed  Google Scholar 

  64. Hunter GR, Treuth MS, Weinsier RL, et al. The effects of strength conditioning on older women’s ability to perform daily tasks. J Am Geriatr Soc. 1995;43(7):756-760.

    PubMed  CAS  Google Scholar 

  65. Hunter GR, Wetzstein CJ, Fields DA, Brown A, Bamman MM. Resistance training increases total energy expenditure and free-living physical activity in older adults. J Appl Physiol. 2000;89(3):977-984.

    PubMed  CAS  Google Scholar 

  66. Brooks N, Layne JE, Gordon PL, Roubenoff R, Nelson ME, Castaneda-Sceppa C. Strength training improves muscle quality and insulin sensitivity in Hispanic older adults with type 2 diabetes. Int J Med Sci. 2007;4(1):19-27.

    Article  CAS  Google Scholar 

  67. Kim HJ, Lee JS, Kim CK. Effect of exercise training on muscle glucose transporter 4 protein and intramuscular lipid content in elderly men with impaired glucose tolerance. Eur J Appl Physiol. 2004;93(3):353-358.

    Article  PubMed  CAS  Google Scholar 

  68. Holten MK, Zacho M, Gaster M, Juel C, Wojtaszewski JF, Dela F. Strength training increases insulin-mediated glucose uptake, GLUT4 content, and insulin signaling in skeletal muscle in patients with type 2 diabetes. Diabetes. 2004;53(2):294-305.

    Article  PubMed  CAS  Google Scholar 

  69. Fiatarone MA, Marks EC, Ryan ND, Meredith CN, Lipsitz LA, Evans WJ. High-intensity strength training in nonagenarians. Effects on skeletal muscle. JAMA. 1990;263(22):3029-3034.

    Article  PubMed  CAS  Google Scholar 

  70. King PA, Savage P, Ades PA. Home resistance training in an elderly woman with coronary heart disease. J Cardiopulm Rehabil. 2000;20(2):126-129.

    Article  PubMed  CAS  Google Scholar 

  71. Brochu M, Savage P, Lee M, et al. Effects of resistance training on physical function in older disabled women with coronary heart disease. J Appl Physiol. 2002;92(2):672-678.

    Article  PubMed  Google Scholar 

  72. Ades PA, Savage PD, Brochu M, Tischler MD, Lee NM, Poehlman ET. Resistance training increases total daily energy expenditure in disabled older women with coronary heart disease. J Appl Physiol. 2005;98(4):1280-1285.

    Article  PubMed  Google Scholar 

  73. Ades PA, Savage PD, Cress ME, Brochu M, Lee NM, Poehlman ET. Resistance training on physical performance in disabled older female cardiac patients. Med Sci Sports Exerc. 2003;35(8):1265-1270.

    Article  PubMed  Google Scholar 

  74. Lee IM, Hsieh CC, Paffenbarger RS Jr. Exercise intensity and longevity in men. The Harvard Alumni Health Study. JAMA. 1995;273(15):1179-1184.

    Article  PubMed  CAS  Google Scholar 

  75. Volaklis KA, Tokmakidis SP. Resistance exercise training in patients with heart failure. Sports Med. 2005;35(12):1085-1103.

    Article  PubMed  Google Scholar 

  76. Benton MJ. Safety and efficacy of resistance training in patients with chronic heart failure: research-based evidence. Prog Cardiovasc Nurs. 2005;20(1):17-23.

    Article  PubMed  Google Scholar 

  77. Bartlo P. Evidence-based application of aerobic and resistance training in patients with congestive heart failure. J Cardiopulm Rehabil Prev 2007. 2007;27(6):368-375.

    Google Scholar 

  78. Braith RW, Stewart KJ. Resistance exercise training: its role in the prevention of cardiovascular disease. Circulation. 2006;113(22):2642-2650.

    Article  PubMed  Google Scholar 

  79. Lind AR, McNicol GW. Muscular factors which determine the cardiovascular responses to sustained and rhythmic exercise. Can Med Assoc J. 1967;96(12):706-715.

    PubMed  CAS  Google Scholar 

  80. Sale DG, Moroz DE, McKelvie RS, MacDougall JD, McCartney N. Comparison of blood pressure response to isokinetic and weight-lifting exercise. Eur J Appl Physiol Occup Physiol. 1993;67(2):115-120.

    Article  PubMed  CAS  Google Scholar 

  81. Mitchell JH, Payne FC, Saltin B, Schibye B. The role of muscle mass in the cardiovascular response to static contractions. J Physiol. 1980;309:45-54.

    PubMed  CAS  Google Scholar 

  82. Fleck S, Falkel J, Harman E. Cardiovascular responses during resistance training. Med Sci Sports Exerc. 1989; 21:114.

    Google Scholar 

  83. Williams MA, Haskell WL, Ades PA, et al. Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation. 2007;116(5):572-584.

    Article  PubMed  Google Scholar 

  84. Graf C, Rost R. Herz und Sport. Balingen: Spitta Verlag; 2001.

    Google Scholar 

  85. Bjarnason-Wehrens B, Mayer-Berger W, Meister ER, Baum K, Hambrecht R, Gielen S. Recommendations for resistance exercise in cardiac rehabilitation. Recommendations of the german federation for cardiovascular prevention and rehabilitation. Eur J Cardiovasc Prev Rehabil. 2004;11(4):352-361.

    Article  PubMed  CAS  Google Scholar 

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  1. Institute for Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany

    Birna Bjarnason-Wehrens

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  1. Birna Bjarnason-Wehrens
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  2. Martin Halle
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Correspondence to Birna Bjarnason-Wehrens .

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  1. Privatuniversität, Universitätsinstitut für Präventive und, Paracelsus Medizinische, Lindhoffstr 20, Salzburg, 5020, Austria

    Josef Niebauer

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Bjarnason-Wehrens, B., Halle, M. (2010). Exercise Training in Cardiac Rehabilitation. In: Niebauer, J. (eds) Cardiac Rehabilitation Manual. Springer, London. https://doi.org/10.1007/978-1-84882-794-3_4

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