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Open Access 01-01-2015 | Review Article

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

Authors: R. J. Achttien, J. B. Staal, S. van der Voort, H. M. Kemps, H. Koers, M. W. A. Jongert, E. J. M. Hendriks, on behalf of the Practice Recommendations Development Group

Published in: Netherlands Heart Journal | Issue 1/2015

Abstract

Rationale

To 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 development

A 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 recommendations

Recommendations 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 issues

This 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.

Conclusion

This 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.

Commission Cardiovascular Prevention and Cardiac Rehabilitation of the Dutch Society for Cardiology. Multidisciplinary guideline heart failure 2011. CBO/NHG/NVVC/NIV and others; 2010.

Rutten FH, Poos MJJC, Engelfriet PM. Prevalence of heart failure and mortality rate. [In Dutch] In: Volksgezondheid Toekomst Verkenning, Nationaal Kompas Volksgezondheid; 2014.

AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease; 2006.

Davies EJ, Moxham T, Rees K, et al. Exercise training for systolic heart failure: Cochrane systematic review and meta-analysis. Eur J Heart Fail. 2010;12:706–15.PubMedCentralPubMedCrossRef

Bartlo P. Evidence-based application of aerobic and resistance training in patients with congestive heart failure. J Cardpulm Rehabil Prev. 2007;27:368–75.CrossRef

Piepoli MF, Davos C, Francis DP, et al. Exercise training meta-analysis of trials in patients with chronic heart failure (ExTraMATCH). BMJ. 2004;328:189.PubMedCrossRef

Vromen T, Spee RF, Kraal JJ, et al. Exercise training programs in Dutch cardiac rehabilitation centres. Neth Heart J. 2013;21:138–43.PubMedCentralPubMedCrossRef

Balady GJ, Williams MA, Ades PA, et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the american heart association exercise, cardiac rehabilitation, and prevention committee, the council on clinical cardiology; the councils on cardiovascular nursing, epidemiology and prevention, and nutrition, physical activity, and metabolism; and the american association of cardiovascular and pulmonary rehabilitation. J Cardpulm Rehabil Prev. 2007;115:2675–82.

Commission for Cardiovascular Prevention and Cardiac Rehabilitation of the Dutch Society for Cardiology. Multidisciplinary Guideline for Cardiac Rehabilitation 2011. Utrecht: Dutch Society for Cardiology (NVVC): Rehabilitation commission NVVC and project group PAAHR; 2011.

10.

Corra U, Giannuzzi P, Adamopoulos S, et al. Executive summary of the position paper of the working group on cardiac rehabilitation and exercise physiology of the european society of cardiology (ESC): core components of cardiac rehabilitation in chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2005;12:321–5.PubMedCrossRef

11.

Giannuzzi P, Saner H, Bjornstad H, et al. Secondary prevention through cardiac rehabilitation: position paper of the working group on cardiac rehabilitation and exercise physiology of the european society of cardiology. Eur Heart J. 2003;24:1273–8.PubMedCrossRef

12.

Piepoli MF, Corra U, Benzer W, et al. 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. Eur J Cardiovasc Prev Rehabil. 2010;17:1–17.PubMedCrossRef

13.

Smith Jr SC, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the national heart, lung, and blood institute. Circulation. 2006;113:2363–72.PubMedCrossRef

14.

Thomas RJ, King M, Lui K, et al. AACVPR/ACC/AHA 2007 performance measures on cardiac rehabilitation for referral to and delivery of cardiac rehabilitation/secondary prevention services endorsed by the american college of chest physicians, american college of sports medicine, american physical therapy association, Canadian association of cardiac rehabilitation, european association for cardiovascular prevention and rehabilitation, inter-american heart foundation, national association of clinical nurse specialists, preventive cardiovascular nurses association, and the society of thoracic surgeons. J Am Coll Cardiol. 2007;50:1400–33.PubMedCrossRef

15.

Achttien RJ, Staal JB, van der Voort S, et al. Exercise-based cardiac rehabilitation in patients with coronary heart disease: a practice guideline. Neth Heart J. 2013;21:429–38.PubMedCentralPubMedCrossRef

16.

van der Wees J, Hendriks H, Heldoorn J et al. Method for development, implementation and revision of guidelines for physiotherapists. Amersfoort/ Maastricht; 2007.

17.

Qaseem A, Forland F, Macbeth F, et al. Guidelines international network: toward international standards for clinical practice guidelines. Ann Intern Med. 2012;156:525–31.PubMedCrossRef

18.

Commission for Cardiovascular Prevention and Cardiac Rehabilitation of the Dutch Cardiologic Society. Guideline for Cardiac Rehabilitation (DUTCH NVVC);2011.

19.

Maher CG, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–21.PubMed

20.

Hischhorn AD, Richards D, Mungovan SF, et al. Supervise moderate intensity exercise improves distance walked at hospital discharge following coronary bypass graft surgery—a randomised controlled trial. Heart Lung Circ. 2008;17:129–38.CrossRef

21.

Mendes RG, Simoes RP, De Souza Melo CF, et al. Short-term supervised inpatient physiotherapy exercise protocol improves cardiac autonomic function after coronary artery bypass graft surgery—a randomised controlled trial. Disabil Rehabil. 2010;32:1320–7.PubMedCrossRef

22.

Dutch Society for Cardiac Rehabilitation (in Dutch NVVC). Dutch Algorithm for patient needs in Cardiac Rehabilitation (in Dutch “Beslisboom Poliklinische Indicatiestelling Hartrevalidatie”) 2012. Utrecht: Hartrevalidatie N-CCCPe, Hartrevalidatie LMDO-H.; 2012.

23.

Salén BA, Spangfort EV. Disability rating index. In: Koke AJA, Heuts PHTG, Vlaeyen JS, Weber WEJ. University Hospital Maastricht; 1999.

24.

Borg GAV. Psychophysical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–91.PubMed

25.

Keell SD, Chambers JS, Francis DP, et al. Shuttle-walk test to assess chronic heart failure. Lancet. 1998;352:705.PubMedCrossRef

26.

Morales FJ, Martinez A, Mendez M, et al. A shuttle walk test for assessment of functional capacity in chronic heart failure. Am Heart J. 1999;138:291–8.PubMedCrossRef

27.

Morales FJ, Montemayor T, Martinez A. Shuttle versus 6-min walk test in the prediction of outcome in chronic heart failure. Int J Cardiol. 2000;76:101–5.PubMedCrossRef

28.

Goldman L, Hashimoto B, Cook EF, et al. Comparative reproducibility and validity of systems assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981;64:1227–34.PubMedCrossRef

29.

Kemps HM, Schep G, de Vries WR, et al. Predicting effects of exercise training in patients with heart failure secondary to ischemic or idiopathic dilated cardiomyopathy. Am J Cardiol. 2008;102:1073–8.PubMedCrossRef

30.

Wilson JR, Groves J, Rayos G. Circulatory status and response to cardiac rehabilitation in patients with heart failure. Circulation. 1996;94:1567–72.PubMedCrossRef

31.

Haykowsky MJ, Liang Y, Pechter D, et al. A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. J Am Coll Cardiol. 2007;49:2329–36.PubMedCrossRef

32.

Wisloff U, Stoylen A, Loennechen JP, et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study. Circulation. 2007;115:3086–94.PubMedCrossRef

33.

Karvonen MJ, Kentala E, Mustala O. The effects of training on heart rate. Ann Med Exp Biol Fenn. 1957;35:377–81.

34.

Spruit MA, Eterman RM, Hellwig V, et al. A systematic review on the effects of moderate-to-high intensity resistance training in patients with chronic heart failure. Heart. 2009;95:1399–408.PubMedCrossRef

35.

Dall’Ago P, Chiappa GR, Guths H, et al. Inspiratory muscle training in patients with heart failure and inspiratory muscle weakness: a randomized trial. J Am Coll Cardiol. 2006;47:757–63.PubMedCrossRef

36.

Johnson PH, Cowley AJ, Kinnear WJ. A randomized controlled trial of inspiratory muscle training in stable chronic heart failure. Eur Heart J. 1998;19:1249–53.PubMedCrossRef

37.

Laoutaris I, Dritsas A, Brown MD, et al. Inspiratory muscle training using an incremental endurance test alleviates dyspnea and improves functional status in patients with chronic heart failure. Eur J Cardiovasc Prev Rehabil. 2004;11:489–96.PubMed

38.

Chang BH, Hendricks A, Zhao Y, et al. A relaxation response randomized trial on patients with chronic heart failure. J Cardpulm Rehabil. 2005;25:149–57.CrossRef

39.

Curiati JA, Bocchi E, Freire JO, et al. Meditation reduces sympathetic activation and improves the quality of life in elderly patients with optimally treated heart failure: a prospective randomized study. J Altern Complement Med. 2005;11:465–72.PubMedCrossRef

40.

Van Dixhoorn J. Relaxation program for patients with heart failure in the Kennemer Gasthuis. Haarlem: Kennemer Gasthuis; 2009.

41.

Jayadevappa R, Johnson JC, Bloom BS, et al. Effectiveness of transcendental meditation on functional capacity and quality of life of African Americans with congestive heart failure: a randomized control study. Ethn Dis. 2007;17:72–7.PubMedCentralPubMed

42.

Luskin F, Reitz M, Newell K, et al. A controlled pilot study of stress management training of elderly patients with congestive heart failure. Prev Cardiol. 2002;5:168–72.PubMedCrossRef

43.

Parati G, Malfatto G, Boarin S, et al. Device-guided paced breathing in the home setting: effects on exercise capacity, pulmonary and ventricular function in patients with chronic heart failure: a pilot study. Circ Heart Fail. 2008;1:178–83.PubMedCrossRef

44.

Pullen PR, Nagamia SH, Mehta PK, et al. Effects of yoga on inflammation and exercise capacity in patients with chronic heart failure. J Card Fail. 2008;14:407–13.PubMedCrossRef

45.

Pullen PR, Thompson WR, Benardot D, et al. Benefits of yoga for African American heart failure patients. Med Sci Sports Exerc. 2010;42:651–7.PubMedCrossRef

46.

Swanson KS, Gevirtz RN, Brown M, et al. The effect of biofeedback on function in patients with heart failure. Appl Psychophysiol Biofeedback. 2009;34:71–91.PubMedCrossRef

47.

Yu DS, Lee DT, Woo J, et al. Non-pharmacological interventions in older people with heart failure: effects of exercise training and relaxation therapy. Gerontology. 2007;53:74–81.PubMedCrossRef

48.

Yu DS, Lee DT, Woo J. Effects of relaxation therapy on psychologic distress and symptom status in older Chinese patients with heart failure. J Psychosom Res. 2007;62:427–37.PubMedCrossRef

49.

Giannuzzi P, Temporelli PL, Corra U, et al. Antiremodeling effect of long-term exercise training in patients with stable chronic heart failure: results of the exercise in left ventricular dysfunction and chronic heart failure (ELVD-CHF) trial. Circulation. 2003;108:554–9.PubMedCrossRef

50.

Nilsson BB, Westheim A, Risberg MA. Long-term effects of a group-based high-intensity aerobic interval-training program in patients with chronic heart failure. Am J Cardiol. 2008;102:1220–4.PubMedCrossRef

51.

Prescott E, Hjardem-Hansen R, Dela F, et al. Effects of a 14-month low-cost maintenance training program in patients with chronic systolic heart failure: a randomized study. Eur J Cardiovasc Prev Rehabil. 2009;16:430–7.PubMedCrossRef

52.

Trompers WH, Jongert MWA, Chorus AMJ et al. Web-based monitoring in heart patients (in Dutch). TNO quality of life. 2008.

53.

Kemps HM, van Engen-Verheul MM, Kraaijenhagen RA, et al. Improving guideline adherence for cardiac rehabilitation in the Netherlands. Neth Heart J. 2011;19:285–9.PubMedCentralPubMedCrossRef

54.

Snoek JA, Cramer MJ, Backx FJ. Cardiac rehabilitation: how much pain for the optimal gain? Neth Heart J. 2013;21:135–7.PubMedCentralPubMedCrossRef

55.

Boyne JJ, Vrijhoef HJ. Implementing telemonitoring in heart failure care: barriers from the perspectives of patients, healthcare professionals and healthcare organizations. Curr Heart Fail Rep. 2013;10:254–61.PubMedCrossRef

56.

Sunamura M, Ter Hoeve N, van den Berg-Emons HJG, et al. OPTImal CArdiac REhabilitation (OPTICARE) following acute coronary syndromes: rationale and design of a randomised, controlled trial to investigate the benefits of expanded educational and behavioural intervention programs. Neth Heart J. 2013;21:324–30.PubMedCentralPubMedCrossRef

Title: Exercise-based cardiac rehabilitation in patients with chronic heart failure: a Dutch practice guideline
Authors: R. J. Achttien
J. B. Staal
S. van der Voort
H. M. Kemps
H. Koers
M. W. A. Jongert
E. J. M. Hendriks
on behalf of the Practice Recommendations Development Group
Publication date: 01-01-2015
Publisher: Bohn Stafleu van Loghum
Published in: Netherlands Heart Journal / Issue 1/2015
Print ISSN: 1568-5888
Electronic ISSN: 1876-6250
DOI: https://doi.org/10.1007/s12471-014-0612-2

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

Abstract

Rationale

Guideline development

Clinical and research recommendations

Applicability and implementation issues

Conclusion

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Guideline development

Clinical and research recommendations

Applicability and implementation issues

Conclusion

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