Development of evidence-based clinical algorithms for prescription of exercise-based cardiac rehabilitation

Abstract

BackgroundGuideline adherence with respect to exercise-based cardiac rehabilitation (CR) is hampered by a large variety of complex guidelines and position statements, and the fact that these documents are not specifically designed for healthcare professionals prescribing exercise-based CR programs. This study aimed to develop clinical algorithms that can be used in clinical practice for prescription and evaluation of exercise-based CR in patients with coronary artery disease (CAD) and chronic heart failure (CHF).MethodsThe clinical algorithms were developed using a systematic approach containing four steps. First, all recent Dutch and European cardiac rehabilitation guidelines and position statements were reviewed and prioritised. Second, training goals requiring a differentiated training approach were selected. Third, documents were reviewed on variables to set training intensity, modalities, volume and intensity and evaluation instruments. Finally, the algorithms were constructed.ResultsThree Dutch guidelines and three European position statements were reviewed. Based on these documents, five training goals were selected and subsequently five algorithms for CAD patients and five for CHF patients were developed.ConclusionsThis study presents evidence-based clinical algorithms for exercise-based CR in patients with CAD and CHF according to their training goals. These algorithms may serve to improve guideline adherence and the effectiveness of exercise-based CR.

Physical Activity in the Prevention and Treatment of Coronary Artery Disease

“…The vast number of possible combinations makes absolute recommendations difficult to mandate in every situation. Furthermore, different goals, depending on patient needs (primary prevention, treatment of risk factors, such as obesity, hypertension, or diabetes mellitus, or treatment of CAD), may require an individually tailored exercise prescription 14, 120, 121. The European Association of Preventive Cardiology recently aimed to improve exercise prescription in patients with overt CAD or CAD risk factors (diabetes mellitus types 1 and 2, obesity, hypertension, and hypercholesterolemia) on the basis of current evidence.…”

“…Furthermore, different goals, depending on patient needs (primary prevention, treatment of risk factors, such as obesity, hypertension, or diabetes mellitus, or treatment of CAD), may require an individually tailored exercise prescription. 14,120,121 The European Association of Preventive Cardiology recently aimed to improve exercise prescription in patients with overt CAD or CAD risk factors (diabetes mellitus types 1 and 2, obesity, hypertension, and hypercholesterolemia) on the basis of current evidence. Therefore, the Exercise Prescription in Everyday Praxis and Rehabilitative Training tool, an interactive, digital training, and decision support system, was designed to assist healthcare professionals with prescribing effective and safe exercise training programs for patients with CAD (risk).…”

Practice Variations in Exercise Training Programs in Dutch Cardiac Rehabilitation Centers: Prospective, Observational Study

“…(7-10) Furthermore, current Dutch guidelines recommend tailoring of training programs to individual rehabilitation goals. (5,7,8,11) Also, based on previous studies (12)(13)(14)(15)(16)(17)(18)(19)(20) showing that an exact determination of training intensity is needed to minimize training-related risks and to improve effectiveness and adherence, these guidelines advocate the use of a symptom limited exercise test for prescription of a training program. (4,7,8) Despite these recommendations, a national survey in Dutch…”

Therapist Driven Rehabilitation Protocol for Patients with Chronic Heart and Lung Diseases: A Real-Life Study

“…In previous decision support systems [13,14] the authors proposed only training, as main outcome measure referring to specific diseases. A therapist driven protocol like that produced by CREMA might allow better adherence to guidelines, and individually tailored programs with multiple evaluations and outcomes.…”

“…In cardiac field, therapist driven protocols, including tools to evaluate the main targets of exercise-based cardiac rehabilitation, have recently been proposed and decision support systems assisting healthcare professionals to prescribe training programs has been developed [13,14]. In these decision support systems [13,14], the authors have proposed only training as the main outcome measure referring to specific disease. Potential limitations of this approach have generated our hypothesis: to propose a new therapist driven protocol for patients with chronic heart and lung diseases including multiple outcomes.…”