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

Hansen, Dominique; Beckers, Paul; Neunhäuserer, Daniel; Bjarnason-Wehrens, Birna; Piepoli, Massimo F.; Rauch, Bernhard; Völler, Heinz; Corrà, Ugo; Garcia-Porrero, Esteban; Schmid, Jean-Paul; Lamotte, Michel; Doherty, Patrick; Reibis, Rona; Niebauer, Josef; Dendale, Paul; Davos, Constantinos H.; Kouidi, Evangelia; Spruit, Martijn A.; Vanhees, Luc; Cornelissen, Véronique; Edelmann, Frank; Barna, Olga; Stettler, Christoph; Tonoli, Cajsa; Greco, Eugenio; Pedretti, Roberto; Abreu, Ana; Ambrosetti, Marco; Braga, Simona Sarzi; Bussotti, Maurizio; Faggiano, Pompilio; Takken, Tim; Vigorito, Carlo; Schwaab, Bernhard; Coninx, Karin

doi:10.1007/s40279-023-01909-x

Cited by 15 publications

(3 citation statements)

References 177 publications

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“… 8 , 31 In contrast, our lifestyle walking intervention was more natural, solely focused on increasing the daily number of steps; it was intentionally neither supervised nor structured, and did not require specific duration and intensity of PA. As a result, patients in our study could accumulate additional steps in very short bouts and at low intensities, differing from the approach of exercise-based rehabilitation programs, which typically prescribe walking or other exercise modalities in bouts of at least 20 minutes at an intensity >60% of heart rate reserve. 8 , 26 , 46 – 48 Our study observed an increase of 8 minutes of MVPA per day—equivalent to ≈800 steps—indicating that the intervention group did achieve some of their additional PA at higher intensities. However, the use of minutes of MVPA as a cut point–based measure has inherent limitations, 49 leaving it uncertain whether the patients reached the intensities typically prescribed in exercise-based cardiac rehabilitation programs.…”

Section: Discussionmentioning

confidence: 61%

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Vetrovsky,

Siranec,

Frybova

et al. 2024

Circulation

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Background: Physical activity is pivotal in managing heart failure with reduced ejection fraction (HFrEF), and walking integrated into daily life is an especially suitable form of such physical activity. This study aimed to determine if a 6-month lifestyle walking intervention combining self-monitoring and regular phone counseling improves functional capacity assessed by the six-minute walk test (6MWT) in stable patients with HFrEF compared to usual care. Methods: The WATCHFUL trial was a 6-month, multicenter, parallel-group, randomized, controlled trial recruiting HFrEF patients from six Czech cardiovascular centers. Eligible participants were ≥18 years old with left ventricular ejection fraction <40% and NYHA class II/III symptoms, on guidelines-recommended medication, excluding those exceeding 450m in the baseline 6MWT. Patients in the intervention group were equipped with a Garmin vívofit activity tracker and received monthly phone counseling from research nurses who encouraged them to employ behavior change techniques such as self-monitoring, goal-setting, and action planning to increase their daily step count. The control group patients continued usual care. The primary outcome was the difference between groups in the distance (in meters) walked during the 6MWT at 6 months. Secondary outcomes included daily step count and minutes of moderate-to-vigorous physical activity (MVPA) as measured by the hip-worn Actigraph wGT3X-BT accelerometer, NT-proBNP and hsCRP biomarkers, ejection fraction, anthropometric measures, depression score, self-efficacy, quality of life, and survival risk score. The primary analysis was conducted by intention-to-treat. Results: From 218 screened patients, 202 were randomized (65 years; 22.8% female; 90.6% NYHA II; left ventricular ejection fraction 32.5%; 6MWT 385m; 5071 steps/day; 10.9 minutes of MVPA per day). At six months, no between-group differences were detected for the 6MWT (7.4 m, 95% CI -8.0 to 22.7, p=0.345, N=186). The intervention group increased their average daily step count by 1420 (95% CI: 749; 2091) and daily minutes of MVPA by 8.2 (95% CI: 3.0; 13.3) over the control group. No between-group differences were detected for any other secondary outcomes. Conclusions: While the lifestyle intervention in patients with HFrEF improved daily steps by about 25%, it failed to demonstrate a corresponding improvement in functional capacity. Further research is needed to understand the disconnect between increased physical activity and functional outcomes.

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Section: Discussionmentioning

confidence: 61%

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Vetrovsky,

Siranec,

Frybova

et al. 2024

Circulation

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“…Thus, patients with chronic heart failure are encouraged to participate in exercise-based rehabilitation programs [ 8 ]. On the other hand, even in patients with low functional capacity, who are candidates for implantable cardioverter defibrillators, left-ventricular assist devices, cardiac resynchronization devices, and heart transplantations, both endurance and resistance exercises with low cardiovascular demand should be offered [ 9 ].…”

Section: Theoretical Backgroundmentioning

confidence: 99%

The Attitudes of Patients with Cardiovascular Diseases towards Online Exercise with the Mobile Monitoring of Their Health-Related Vital Signs

Ntovoli,

Anifanti,

Koukouvou

et al. 2024

Sports

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The health care cost of cardiovascular diseases (CVD) in the EU is estimated to be today over 282 billion euros. It is well documented today that exercise training is one of the main strategies for secondary disease prevention and the follow-up integration of these patients. This study aimed to examine patients’ attitudes towards online exercise with mobile monitoring of their vital signs. More specifically, the research objectives were as follows: (a) to examine patients’ attitudes and expectations of online exercise, (b) cluster patients in high- and low-attitude groups and examine their intention to participate in online exercise, and (c) to examine age and gender differences in terms of their intention to exercise online. The final goal of this project was to develop a real application that could be of use to patients and professionals. Data were collected from fifty patients in the city of Thessaloniki, Greece. The results revealed that most patients were positive about exercising online if the programs were perceived as fun and, especially, safe. The use of an online monitoring application with the distant supervision of health professionals could both motivate them and strengthen their feeling of safety.

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“…These include frail elderly patients[ 20 ], the female population, with consideration for its unique characteristics (as women are less frequently referred to CR! )[ 21 ], individuals with multiple cardiovascular comorbidities, those who have undergone transcatheter implantation or valve repair, and particularly patients with chronic heart failure (HF) (CHF)[ 7 , 22 , 23 ].…”

Section: Specialized Patient Subgroupsmentioning

confidence: 99%

Quo vadis cardiac rehabilitation; the role of comprehensive cardiac rehabilitation in modern cardiology

Lakušić,

Sopek Merkaš

2023

World J Cardiol

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In accordance with the guidelines established by prominent European and global cardiology associations, comprehensive cardiac rehabilitation (CR) stands as an officially endorsed and highly recommended therapeutic approach (class I recommendations; level of evidence A) for a diverse spectrum of cardiac patients. Nevertheless, it is a cause for concern to observe that fewer than 50% of eligible patients are being effectively referred for CR, whether in an outpatient or inpatient setting. Concurrently, studies reveal that a substantial proportion of individuals with atherosclerotic cardiovascular disease maintain unhealthy lifestyles and exhibit suboptimal management of modifiable cardiovascular risk factors, including hypertension, lipid levels, and diabetes. Beyond the conventional patient profile encompassing those recovering from acute coronary syndrome with or without percutaneous coronary intervention, as well as patients who have undergone coronary or valvular surgery, contemporary CR now emphasizes specialized subgroups of patients. These include frail elderly patients, the female population with its unique considerations, individuals burdened by multiple cardiovascular comorbidities, those who have developed psychological consequences due to a cardiac illness and particularly those grappling with chronic heart failure. This editorial seeks to offer a state-of-the-art assessment of the significance and role of comprehensive CR within modern cardiology.

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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

Cited by 15 publications

References 177 publications

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

Lifestyle Walking Intervention for Patients With Heart Failure With Reduced Ejection Fraction: The WATCHFUL Trial

The Attitudes of Patients with Cardiovascular Diseases towards Online Exercise with the Mobile Monitoring of Their Health-Related Vital Signs

Quo vadis cardiac rehabilitation; the role of comprehensive cardiac rehabilitation in modern cardiology

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