Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2

Bernhard Schwaab^{1

2}, Birna Bjarnason-Wehrens³, Karin Meng⁴, Christian Albus⁵, Annett Salzwedel⁶, Jean-Paul Schmid⁷, Werner Benzer⁸, Matthes Metz⁹, Katrin Jensen⁹, Bernhard Rauch^{10

11}, Gerd Bönner¹², Patrick Brzoska¹³, Heike Buhr-Schinner¹⁴, Albrecht Charrier¹⁵, Carsten Cordes¹⁶, Gesine Dörr¹⁷, Sarah Eichler⁶, Anne-Kathrin Exner¹⁸, Bernd Fromm¹⁹, Stephan Gielen¹⁸, Johannes Glatz²⁰, Helmut Gohlke²¹, Maurizio Grilli²², Detlef Gysan²³, Ursula Härtel²⁴, Harry Hahmann²⁵, Christoph Herrmann-Lingen²⁶, Gabriele Karger²⁷, Marthin Karoff²⁸, Ulrich Kiwus²⁹, Ernst Knoglinger³⁰, Christian-Wolfgang Krusch³¹, Eike Langheim²⁰, Johannes Mann³², Regina Max³³, Maria-Inti Metzendorf³⁴, Roland Nebel³⁵, Josef Niebauer³⁶, Hans-Georg Predel³, Axel Preßler³⁷, Oliver Razum³⁸, Nils Reiss³⁹, Daniel Saure⁹, Clemens von Schacky⁴⁰, Morten Schütt⁴¹, Konrad Schultz⁴², Eva-Maria Skoda⁴³, Diethard Steube⁴⁴, Marco Streibelt⁴⁵, Martin Stüttgen⁴⁶, Michaela Stüttgen⁴⁷, Martin Teufel⁴³, Hansueli Tschanz⁴⁸, Heinz Völler^{6

49}, Heiner Vogel⁵⁰, Ronja Westphal⁵¹

Affiliations

¹ Curschmann Klinik, D-23669 Timmendorfer Strand, Germany.
² Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany.
³ Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany.
⁴ Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany.
⁵ Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany.
⁶ Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany.
⁷ Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland.
⁸ Reha-Klinik Montafon, A-6780 Schruns, Austria.
⁹ Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany.
¹⁰ Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany.
¹¹ Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany.
¹² Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany.
¹³ Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany.
¹⁴ Ostseeklinik Schönberg-Holm, D-24217 Schönberg-Holm, Germany.
¹⁵ Private Practice, D-01328 Dresden, Germany.
¹⁶ Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany.
¹⁷ Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany.
¹⁸ Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany.
¹⁹ REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany.
²⁰ Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany.
²¹ Private Practice, D-79282 Ballrechten-Dottingen, Germany.
²² Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany.
²³ Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany.
²⁴ LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany.
²⁵ Private Practice, D-88316 Isny im Allgäu, Germany.
²⁶ Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany.
²⁷ Private Practice, D-69121 Heidelberg, Germany.
²⁸ Private Practice, D-58332 Schwelm, Germany.
²⁹ Private Practice, D-14169 Berlin, Germany.
³⁰ Kirchberg-Klinik, D-37431 Bad Lauterberg, Germany.
³¹ Private Practice, D-67059 Ludwigshafen, Germany.
³² KfH Nierenzentrum, D-80804 München, Germany.
³³ Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany.
³⁴ Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany.
³⁵ Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany.
³⁶ Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria.
³⁷ Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany.
³⁸ Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany.
³⁹ Schüchtermann-Schiller'sche Kliniken, D-49214 Bad Rothenfelde, Germany.
⁴⁰ Omegametrix, D-82152 Martinsried, Germany.
⁴¹ Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany.
⁴² Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany.
⁴³ Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany.
⁴⁴ Private Practice, D-14055 Berlin, Germany.
⁴⁵ Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany.
⁴⁶ Praxis Martin Stüttgen, D-67157 Wachenheim, Germany.
⁴⁷ ZAR Ludwigshafen Klinikum, D-67063 Ludwigshafen am Rhein, Germany.
⁴⁸ Berner Reha Zentrum, CH-3625 Heiligenschwendi, Switzerland.
⁴⁹ Klinik am See, D-15562 Rüdersdorf, Germany.
⁵⁰ Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany.
⁵¹ Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany.

PMID: 34300237
PMCID: PMC8306118
DOI: 10.3390/jcm10143071

Review

Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2

Bernhard Schwaab et al. J Clin Med. 2021.

. 2021 Jul 12;10(14):3071.

doi: 10.3390/jcm10143071.

Authors

Affiliations

¹ Curschmann Klinik, D-23669 Timmendorfer Strand, Germany.
² Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany.
³ Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany.
⁴ Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany.
⁵ Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany.
⁶ Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany.
⁷ Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland.
⁸ Reha-Klinik Montafon, A-6780 Schruns, Austria.
⁹ Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany.
¹⁰ Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany.
¹¹ Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany.
¹² Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany.
¹³ Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany.
¹⁴ Ostseeklinik Schönberg-Holm, D-24217 Schönberg-Holm, Germany.
¹⁵ Private Practice, D-01328 Dresden, Germany.
¹⁶ Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany.
¹⁷ Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany.
¹⁸ Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany.
¹⁹ REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany.
²⁰ Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany.
²¹ Private Practice, D-79282 Ballrechten-Dottingen, Germany.
²² Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany.
²³ Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany.
²⁴ LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany.
²⁵ Private Practice, D-88316 Isny im Allgäu, Germany.
²⁶ Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center and German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, D-37075 Göttingen, Germany.
²⁷ Private Practice, D-69121 Heidelberg, Germany.
²⁸ Private Practice, D-58332 Schwelm, Germany.
²⁹ Private Practice, D-14169 Berlin, Germany.
³⁰ Kirchberg-Klinik, D-37431 Bad Lauterberg, Germany.
³¹ Private Practice, D-67059 Ludwigshafen, Germany.
³² KfH Nierenzentrum, D-80804 München, Germany.
³³ Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany.
³⁴ Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany.
³⁵ Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany.
³⁶ Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria.
³⁷ Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany.
³⁸ Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany.
³⁹ Schüchtermann-Schiller'sche Kliniken, D-49214 Bad Rothenfelde, Germany.
⁴⁰ Omegametrix, D-82152 Martinsried, Germany.
⁴¹ Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany.
⁴² Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany.
⁴³ Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany.
⁴⁴ Private Practice, D-14055 Berlin, Germany.
⁴⁵ Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany.
⁴⁶ Praxis Martin Stüttgen, D-67157 Wachenheim, Germany.
⁴⁷ ZAR Ludwigshafen Klinikum, D-67063 Ludwigshafen am Rhein, Germany.
⁴⁸ Berner Reha Zentrum, CH-3625 Heiligenschwendi, Switzerland.
⁴⁹ Klinik am See, D-15562 Rüdersdorf, Germany.
⁵⁰ Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany.
⁵¹ Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany.

PMID: 34300237
PMCID: PMC8306118
DOI: 10.3390/jcm10143071

Abstract

Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients' groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well.

Methods: Generation of evidence and search of literature have been described in part 1.

Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for "distress management" and "lifestyle changes". PE is able to increase patients' knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients' groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR.

Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.

Keywords: cardiac rehabilitation; education; exercise training; frailty; gender; home-based-rehabilitation; migration; old patients; physical activity; psychological interventions; scientific guidelines; secondary prevention; tele-medicine; young patients.

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Conflict of interest statement

All authors have officially declared and published their conflicts of interest (https://www.awmf.org/leitlinien/detail/ll/133-001.html) (date of declaration: 7 January 2020).

References

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Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2

Affiliations

Cardiac Rehabilitation in German Speaking Countries of Europe-Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH-Part 2

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

Grants and funding

LinkOut - more resources

Full Text Sources

Research Materials

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