Position paper of the Belgian Working Group on Cardiovascular Prevention and Rehabilitation: cardiovascular rehabilitation

A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?

“…25 The EACPR guidelines specify the use of ECG monitoring during the initial sessions of the rehabilitation programme and for patients experiencing new symptoms. 21 The European countries France 28 and Germany 31 follow the recommendation of the EACPR, while the guidelines for Belgium 38 and The Netherlands 34 advise ECG monitoring only for high-risk patients, including implantable cardioverter–defibrillator (ICD) recipients and those with heart failure and a history of arrhythmias.…”

“…25 In comparison, the guidelines from Australia 22 and Japan 29 recommend that aerobic training sessions within the cardiac rehabilitation programmes should consist of light-to moderate-intensity exercise, with a maximum of 60% of the VO 2max or HRR specified in Japan. 29 Aerobic interval training is proposed as an alternative to continuous aerobic exercise in the national guidelines for France, 28 The Netherlands, 34 Belgium, 38 South America 25 and Canada. 20 However, there is no consensus on the optimal work-to-rest ratios for this type of training.…”

“…All guidelines recommend that assessment prior to resistance training is via a multiple-repetition maximum test, which is less likely to lead to abdominal straining or blood pressure elevations than a singlerepetition maximal strength test, but will still provide a baseline in order to guide prescription. 31 Resistance load is prescribed either as a percentage of the patient's maximum strength as determined by their estimated one-repetition maximum, with this load varying between 30% and 80%, 5,20,26,28,31,38,39,41 or based on the patient's level of fatigue within the exercise set. 19,25,27 The German recommendations (which are also incorporated into the Irish guidelines 5 ) include prescriptions for improving both muscular endurance and hypertrophy.…”

“…38 Specialised maintenance exercise programmes contribute to long-term cardiac health care and, in Germany, 17 Canada 20 and the US, 19 may be conducted in rehabilitation facilities or hospitals with reduced supervision and monitoring, rather than what occurs in outpatient rehabilitation programmes. Otherwise, they might occur in community settings, as recommended in the UK 30,32,33,36,39 and Australasia.…”

Cardiac rehabilitation availability and delivery in Europe: How does it differ by region and compare with other high-income countries?

“…3 Based on substantive evidence that participation is also associated with 20% reductions in cardiovascular mortality and morbidity, 4,5 clinical practice guidelines 6 for CVD revascularisation and heart failure patients, among others, recommend referral to CR. Many European countries have CR guidelines, 7–16 as does the European Association of Preventive Cardiology, 6 a branch of the European Society of Cardiology, which specify the core components (e.g. initial assessment, structured exercise training, and risk factor management, including stress) which are to be delivered by a multidisciplinary team of healthcare professionals with expertise in all the secondary prevention recommendations.…”