Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline

Abstract

RationaleTo improve the quality of exercise-based cardiac rehabilitation (CR) in patients with chronic heart failure (CHF) a practice guideline from the Dutch Royal Society for Physiotherapy (KNGF) has been developed.Guideline developmentA systematic literature search was performed to formulate conclusions on the efficacy of exercise-based intervention during all CR phases in patients with CHF. Evidence was graded (1–4) according the Dutch evidence-based guideline development criteria.Clinical and research recommendationsRecommendations for exercise-based CR were formulated covering the following topics: mobilisation and treatment of pulmonary symptoms (if necessary) during the clinical phase, aerobic exercise, strength training (inspiratory muscle training and peripheral muscle training) and relaxation therapy during the outpatient CR phase, and adoption and monitoring training after outpatient CR.Applicability and implementation issuesThis guideline provides the physiotherapist with an evidence-based instrument to assist in clinical decision-making regarding patients with CHF. The implementation of the guideline in clinical practice needs further evaluation.ConclusionThis guideline outlines best practice standards for physiotherapists concerning exercise-based CR in CHF patients. Research is needed on strategies to improve monitoring and follow-up of the maintenance of a physical active lifestyle after supervised CR.

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

“…(1,3) Therefore, ECR is recommended in both national and international guidelines for patients with coronary artery disease and patients with chronic heart failure. (4)(5)(6)(7)(8)(9)(10) ECR guidelines provide recommendations for training types, modalities, duration, frequency and intensity based on several patient characteristics. (7-10) Furthermore, current Dutch guidelines recommend tailoring of training programs to individual rehabilitation goals.…”

“…(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…”

Surviving critical illness: what is next? An expert consensus statement on physical rehabilitation after hospital discharge

“…In the absence of established care pathways or evidence-based guidelines, physical therapists involved in the treatment of patients after hospital discharge conceivably draw on clinical expertise with patients within the cardiopulmonary scope of practice, for which such evidence does exist [11]. However, because the recovery process of survivors of critical illness is explicitly different to the aforesaid group—due to the consequences of critical illness, medical interventions, and persistent systemic inflammation [12]— rehabilitation needs likely extend beyond the physical domain.…”

What are physiotherapists and occupational therapists doing in services that replace acute hospital admission? A systematic review

“…The variation in inpatient therapy input for different patient groups, in response to different patient requirements, may offer one explanation for the variability in therapists’ interventions across different services that replace hospital admission. This may also apply among teams managing similar patient groups, as guidelines may support a range of treatment options in a given group, or there may be a lack of consensus on best treatment options …”