Introduction
Methods
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Acute coronary syndrome, including ST and non-ST-elevation myocardial infarction and unstable angina pectoris;
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Stable angina pectoris;
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Acute or elective percutaneous coronary intervention;
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Coronary artery bypass grafting and/or valve surgery;
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Chronic heart failure (persistent reduction of left ventricular ejection fraction < 40 %) [20].
Selection and prioritisation of guidelines and position statements
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First national guidelines were consulted, then ESC position statements.
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General CR guidelines were consulted prior to disease-specific guidelines.
Selection of training goals
Data extraction and synthesis
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Variables to set training modalities;
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Training volume and intensity;
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Contents of training programs;
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Evaluation instruments.
Construction of clinical algorithms
Results
Selection and prioritisation of guidelines and position statements
1. Dutch multidisciplinary guideline for cardiac rehabilitation. Netherlands Society of Cardiology (NVVC). 2011 [20] |
2. Dutch algorithm for patients needs in cardiac rehabilitation. Netherlands Society of Cardiology (NVVC). 2012 [21] |
4. Dutch national guideline for occupational medicine and labor physicians dealing with employees with coronary artery disease. Netherlands Society of Occupational Medicine (NVAB). 2006 [31] |
5. Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation (EACPR). 2010 [12] |
6. Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the EACPR, the American Association of Cardiovascular and Pulmonary Rehabilitation (AACPR) and the Canadian Association of Cardiac Rehabilitation (CACR). 2013 [11] |
7. Exercise training in heart failure: from theory to practice. A consensus document of the Heart Failure Association (HFA) and the European Association for Cardiovascular Prevention and Rehabilitation (EACPR). 2011 [13] |
Selection of training goals
Original goals from needs assessment | Cluster |
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Overcoming anxiety for exercise | Reducing exercise-related anxiety |
Regaining emotional balance | |
Optimising exercise capacity | Optimising exercise capacity |
Exploring physical limits | Exploring physical limits and coping with physical limitations |
Coping with physical limitations | |
Functionally managing the heart disease | |
Optimal resumption of leisure activities | Developing (and maintaining) a physically active lifestyle and optimising cardiovascular risk factors |
Familiarity with the nature of the disease and risk factors | |
Quit smoking | |
Developing and maintaining and active lifestyle | |
Developing a healthy diet | |
Optimising weight | |
Optimising blood pressure | |
Optimising diabetes management | |
Optimising lipid profile | |
Regaining emotional balance within relationship, family and/or social environment and work | Optimal work resumption |
Optimal resumption of role within relationship, family and/or social environment and work | |
Regaining emotional balance through caregiver and preventing negative effects on patients health |
Data extraction and synthesis
Construction of clinical algorithms
Training goal | Training modalities | Timing and frequency | Intensity and session duration | Evaluation instruments |
---|---|---|---|---|
Reducing exercise-related anxiety | Aerobic training (CT or HIT) | Week 0–4 CT or HIT: 2–3/week | CT: 50–80 % pVO2/HRR, 20–60 min | Cardiac Anxiety Questionnaire [24] at baseline, 4 weeks and 8 weeks |
Relaxation program | Week 4–8 CT at home: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/ HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Education | Week 0–8 RP: 2–8 sessions | CT at home: 45–59 % pVO2/HRR or RPE-scale 11–13, 45–60 min | ||
Optimising exercise capacity | Aerobic training (CT or HIT) | Week 0–12: CT or HIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | Symptom-limited exercise test at baseline and final evaluation |
Resistance training | Week 0–12: RT: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Functional training | Week 0–4: FT: 2–3/week | RT: 30–80 % 1RM, 8–10 exercises using large muscle groups, 2–3 sets of 10–15 repetitions, 1–2 min rest (post-CABG/valve surgery: start after 6–8 weeks) | 1-RM-testing at baseline, after 2 weeks and from there on every 4 weeks [27] | |
Relaxation program | Week 0–12: RP: 2–8 sessions | |||
Education | ||||
Coping with physical limitations | Aerobic training (CT or HIT) | Week 0–4 CT or HIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | PSC [28] at baseline and final evaluation |
Functional training | Week 4–8: CT at home: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Relaxation program | Week 0–4: FT: 2–3/week | CT at home: 45–60 % HRR or RPE scale 11–13, 45–60 min | ||
Education | Week 0–8: RP: 2–8 sessions | |||
Developing a physically active lifestyle | Aerobic training (CT, at home)) | Week 0–4 CT: 2–3/week | CT: 50–80 % pVO2/HRR, 20–60 min | |
Functional training | Week 4–12 CT at home: 5–7/week | CT at home 45–59 % of pVO2/ HRR or RPE scale 11–13, 45–60 min | ||
Relaxation program | Week 0–4 FT: 2–3/week | |||
Education | Week 0–12 RP: 2–8 sessions | |||
Work resumption | Aerobic training (CT or HIT) | Week 0–12: CT/HIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | Symptom-limited exercise test at baseline and final evaluation |
Resistance traininga
| Week 0–12: RT: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Functional training | Week 0–4: FT: 2–3/week | RT: work specific | 1-RM-testing at baseline, after 2 weeks and from there on every 4 weeks [27] | |
Relaxation program | Week 0–12: RP 2–8 sessions | |||
Education |
Training goal | Training modalities | Timing and frequency | Intensity and session duration | Evaluation instruments |
---|---|---|---|---|
Reducing exercise-related anxiety | Aerobic training (CT, HIT or LIT) | Week 0–4: CT, HIT or LIT 2–3/week | CT: 50–80 % pVO2/HRR, 20–60 min | Cardiac Anxiety Questionnaire [24] at baseline, 4 weeks and 8 weeks |
Relaxation program | Week 4–8: CT at home: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/ HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Education | Week 0–8: RP: 2–8 sessions | LIT: 50 % maximal workload, 10–12 intervals 30 s, recovery 60 s | ||
CT at home: 45–60 % pVO2/HRR or RPE -scale 11–13, 45–60 min | ||||
Optimising exercise capacity | Aerobic training (CT, HIT or LIT) | Week 0–12 CT, HIT or LIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | Symptom-limited exercise test at baseline and final evaluation |
Resistance training | Week 0–12 RT: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/ HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| SWT [25] for interim evaluation | |
Functional training | Week 0–4 FT: 2–3/week | LIT: 50 % maximal workload, 10–12 intervals 30 s, recovery 60 s | 1-RM-testing [27] at baseline, after 2 weeks and from there on every 4 weeks | |
Inspiratory muscle training | Week 0–12 IMT: 3–4/week | RT: 30–65 % 1RM, 8–10 exercises using large muscle groups, 2–3 sets of 10–15 repetitions, 1–2 min rest (post- CABG/valve surgery: start after 6–8 weeks) | ||
Relaxation program | Week 0–12 RP: 2–8 session | IMT: inspiratory muscle training at 20–40 % of PiMax, 2 × 15 min/day | ||
Education | ||||
Coping with physical limitations | Aerobic training (CT, HIT or LIT) | Week 0–4 CT, HIT or LIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | PSC [28] at baseline and final evaluation |
Functional training | Week 4–8 CT at home: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/ HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| ||
Relaxation program | Week 0–4 FT: 2–3/week | LIT: 50 % maximal workload, 10–12 intervals 30 s, recovery 60 s | ||
Education | Week 0–8 RP: 2–8 sessions | CT at home: 45–60 % HRR or RPE scale 11–13, 45–60 min | ||
Developing a physically active lifestyle | Aerobic training (CT) | Week 0–4 CT 2–3/week | CT: 50–80 % pVO2/HRR, 20–60 min | |
Functional training | Week 4–12 CT at home: 5–7/week | CT at home 45–60 % of pVO2/HRR or RPE scale 11–13, 45–60 min | ||
Relaxation program | Week 0–4 FT 2–3/week | |||
Education | Week 0–12 RP 2–8 sessions | |||
Work resumption | Aerobic training (CT, HIT or LIT) | Week 0–12 CT, HIT or LIT: 3–5/week | CT: 50–80 % pVO2/HRR, 20–60 min | Symptom-limited exercise test at baseline and final evaluation |
Resistance training | Week 0–12 RT: 2–3/week | HIT: 80–90 % pVO2/HRR, active recovery 40–50 % of pVO2/ HRR, interval 4 × 4 min, active recovery 3 × 3 mina
| 6MWT(26) or SWT(25) for interim evaluation | |
Functional training | Week 0–4 FT: 2–3/week | LIT: 50 % maximal workload, 10–12 intervals 30 s, recovery 60 s | 1-RM-testing(27) at baseline, after 2 weeks and from there on every 4 weeks | |
Relaxation program | Week 0–12 IMT: 3–4/week | RT: work specific | ||
Education | Week 0–12 RP: 2–8 sessions | IMT: 3–4/week (if PiMax < 70 % of predicted) |