Integration of the patients’ perspective and tailoring of the programmes based on patients’ preference may help to increase uptake and incentives to cardiologists for prescribing structured cardiac rehabilitation programmes. Patient management (pharmacological therapy, vaccinations, oxygen therapy) should be performed in close cooperation with a pulmonologist146 (Table 13 147). Results of the ICAROS Survey, Exercise training is safe after coronary stenting: A prospective multicentre study, A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling, Does the timing of cardiac rehabilitation impact fitness outcomes? When prescribing exercise therapy in CHF patients undergoing CRT, it is also important to consider that certain patients may even show worsening symptoms after implantation, as far as device malfunction or infections in up to 5% of cases may occur : in these situations appropriate diagnosis and modulation or interruption of the exercise training programme is mandatory. Exploring life cycles, molecular mechanisms and regulatory systems, Institute of Macromolecular Chemistry Prague (IMC ASCR), Portuguese Oncology Institute of Porto (IPO Porto). Haemodynamically stable HTX recipients should perform a cardiopulmonary exercise test with ventilatory thresholds,82 to aid in physical activity prescription. Cardiovascular diseases remain the most common cause of morbidity and mortality in patients with chronic kidney disease (CKD).148 Contemporary cardiac rehabilitation programmes in Europe report a prevalence of CKD of 7% in elderly (>65 years) cardiac patients.105 Depending on the duration and classification of renal failure a moderate to severe reduction of physical capacity can be assumed, generated by renal anaemia, uraemic myopathy and polyneuropathy, disturbances in volume status, electrolyte balance and/or acid-base metabolism, physical inactivity as well as immunosuppressive therapy in patients after kidney transplantation.149 Exercise recommendations for patients with CKD do not differ from those for cardiac patients149 and integration into a cardiac rehabilitation programme is usually feasible (Table 14 150). The [email protected] study – a randomized, controlled clinical trial comparing home-based and centre-based cardiac rehabilitation in ischaemic heart disease patients168 – indicated that the former was non-inferior to the latter in terms of VO2peak improvement. Frailty has been defined as increased vulnerability to stress characterized by declines in multiple physiologic systems predisposing to a higher risk of negative outcomes, disability and death.111 Several instruments, encompassing the physical, nutritional, cognitive and psychosocial domains of health, have been used to evaluate frailty in community living elderly populations or in hospital settings.112–114, Frailty has been described in 10–50% of elderly patients admitted after an acute cardiac event, and it has proved to be an independent prognostic indicator even in these patients.115 However, due to selection bias and to several barriers, frail patients, potential candidates to cardiac rehabilitation, are poorly represented in cardiac rehabilitation studies.116 Therefore, the real frequency and impact of frailty on cardiac rehabilitation outcome is still unknown. As a result, cardiac telemedicine has been described as one of the ways to tackle current gaps in secondary prevention.170 There remain, however, some challenges/barriers for large-scale digital health deployment in cardiology.171 These include patient-related barriers for digital health deployment, physician-related barriers for digital health deployment, legal and ethical issues, interoperability and technical issues and lack of reimbursement. The main goals of cardiac rehabilitation in the aging patient are preservation of mobility, independence and mental function, prevention of sarcopenia and frailty, prevention/treatment of anxiety and depression, improvement of QoL, encouragement of social adaptation and reintegration, and return of patient to the same lifestyle as before the acute event (Table 9). patient assessment, physical activity counselling, exercise training, diet/nutritional counselling, weight control management, lipid management, blood pressure management, smoking cessation, and psychosocial management) to be considered among seven major clinical conditions (i.e. Istituti Santa Maria, Tecnologico Aeronautico “Costruzione del Mezzo”. Corsi finalizzati all'inserimento nel mondo del lavoro., con l'apprendimento pratico e teorico delle lingue straniere e dell'utilizzo dei computer. Similarly, the Telerehab III randomized, controlled trial compared the efficacy and cost-efficiency telerehabilitation in addition to classical cardiac rehabilitation versus classical cardiac rehabilitation alone,169 and patients receiving also telerehabilitation did better in terms of physical fitness improvement. The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. ISMA - Istituti di Santa Maria in Aquiro - Roma Description Istituzione Pubblica di Assistenza e Beneficienza per la fornitura di servizi socio-sanitari di qualità ai … A significant contribution to the improvement of human health, Biomedical Primate Research Centre (BPRC), Committed to health research and alternatives, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Technological and clinical development of orthopaedics, Fondazione IRCCS Istituto Nazionale dei Tumori (INT-Milan), Centre for Regenerative Medicine “Stefano Ferrari”, University of Modena and Reggio Emilia, Istituto Nazionale Tumori IRCCS ‘Fondazione G. Pascale’, Hospital del Mar Medical Research Institute (IMIM), Institute of Biomedical Research of Málaga (IBIMA), Fondazione IRCCS SDN per la Ricerca e l’Alta Formazione in Diagnostica Nucleare, National Institute for Infectious Diseases Lazzaro Spallanzani, Vall d’Hebron Institute of Research (VHIR), Finding solutions to the health problems of society, Fondazione IRCCS Ospedale Pediatrico Bambino Gesù, IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Istituti Fisioterapici Ospitalieri – Istituto Dermatologico “San Gallicano”, Institute for Molecular Medicine Finland (FIMM). The independent role of balance training, nutritional supplementation and risk factor management, as the role of home-based cardiac rehabilitation or the new technologies, remains still undefined in this complex population. Above all, exercise is able to reduce some negative effects of cancer therapies – such as fatigue, pulmonary and immune system dysfunction, lymphoedema and cardio-toxicity152 – as far as to limit the growth of neoplastic cells.153 Moreover, cancer survivors have an increased risk of relapses, second cancers, cardiovascular diseases, fatigue, bone loss and psychosocial distress, all conditions in which structured exercise training has documented beneficial effects.154 For these reasons, active cancer patients and cancer survivors referred to cardiac rehabilitation programmes (independently from the cardiovascular diagnosis for referral) should receive appropriate exercise programmes in a multidisciplinary approach (see Gilchrist et al.25 for detailed prescription, which is outside the scope of the present position paper). Exercise interventions in patients with implantable cardioverter-defibrillators and cardiac resynchronization therapy: A systematic review and meta-analysis. This position paper supports a modern appreciation of the concept of core component, defined as a ‘specific area of intervention in the context of multifaceted and multidisciplinary structured cardiac rehabilitation activities, aimed (per se or in association to other areas) at obtaining clinical stabilization, cardiovascular risk reduction, disability reduction, psychosocial and vocational support, and lifestyle behaviour change including patients’ adherence and self-management’. Following the evolution of guidelines, this updated position paper has replaced the previous chapter on stable coronary artery disease and elective coronary angioplasty, now referring to CCS.7 For cardiac rehabilitation purposes (Table 3), this referral group mainly includes patients with ‘stable’ anginal symptoms (or atypical symptoms such as dyspnoea), symptomatic patients >1 year after initial diagnosis or revascularization, and patients with angina and suspected vasospastic or microvascular disease. Caution is required when prescribing exercise intensity based on estimated heart rate approaches, because of the risk of targeting the exercise heart rate above the detection threshold of the ICD; thus it is recommended that maximal heart rate be measured rather than estimated in this patient population. Exercise prescription should utilize one of the standard best-practice approaches of functional evaluation and monitoring, for example VO2, measured heart rate or rating of perceived exertion. Il report aggiornato è stato emesso il 29/04/2019. Patients need to accept the rationale of walking in spite of pain in a supervised exercise programme, as far as to include exercise in their daily battle with walking impairment and loss of independence.103. In cardiac patients referred to cardiac rehabilitation presenting diabetes mellitus as a comorbidity, next to the evaluation of the cardiovascular risk profile and glycaemic control in the intake screening, it is recommended to execute a cardiopulmonary exercise test ahead of exercise intervention, regardless of the planned exercise type or intensity, to rule out, or allow treatment of, exercise-induced arterial hypertension and/or silent myocardial ischaemia.130–132 Moreover, clinicians should be aware of the intake/administration of medications that are associated with elevated risk for hypoglycaemia during or after exercise (e.g. Gli Istituto Scolastici Santa Maria da sempre assicurano un ambiente appassionante e dinamico capace di motivare e interessare i propri studenti. Telefono: 081 / 48 26 79 Finally, given the specific experiences of people living with intermittent claudication, an intensive psychosocial intervention is often crucial to ensure favourable outcomes of the cardiac rehabilitation programme. Conversely, for monitoring purposes of exercise intensity, RPE may be the preferred method because the chronotropic response may be impaired in people with CRT.88 Other limiting factors associated with pacing therapy to be considered during exercise prescription and monitoring are: i) in the case of paced atrial rate (or set at a fixed rate) a blunted or delayed heart rate response to exercise may occur; and ii) electrocardiogram (ECG) changes (ST-segment depression) associated with myocardial ischaemia may not be visible, for which close clinical monitoring is required.89. Efficacy of different types of exercise-based cardiac rehabilitation on coronary heart disease: A network meta-analysis, Clinical and cost-effectiveness of home-based cardiac rehabilitation compared to conventional, centre-based cardiac rehabilitation: Results of the, Effect of comprehensive cardiac telerehabilitation on one-year cardiovascular rehospitalization rate, medical costs and quality of life: A cost-effectiveness analysis, Challenges in secondary prevention after acute myocardial infarction: A call for action, BMC Sports Science, Medicine and Rehabilitation, Core components and objectives common to all clinical conditions, Core components and objectives in specific clinical conditions, Core components and objectives in challenging populations, Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. Home-based individual cardiac rehabilitation (alone or in combination with centre-based cardiac rehabilitation)73 is also feasible using technology-based telemedicine programmes,74 in combination with home visits and telephone support when appropriate.75 Further research is required to investigate the impact of exercise-based cardiac rehabilitation on older and/or frail/cachectic patients and those with CHF with preserved ejection fraction76 or non-ischaemic CHF.77. Kraal, JJ, van den Akker-van Marle, ME, Abu-Hanna, A. If you have access to a journal via a society or association membership, please browse to your society journal, select an article to view, and follow the instructions in this box. If these are excluded, the exercise programme intensity should be tailored to the patient’s baseline functional state and based mainly on aerobic training associated with strength and balance training, flexibility exercises, secondary prevention interventions, dietary counselling, risk factor control and psychosocial management (Table 9). Attestati validi e riconosciuti in tutta Europa, completeranno il curriculum vitae per affrontare le future sfide dei nostri studenti, certificando la loro professionalità nel mondo. ISTITUTI SANTA MARIA Scuola paritaria - Istituto Tecnico Indirizzo: CORSO GARIBALDI, 197, 80055 PORTICI (NA) Codice: NATD3V500N Telefono: 081482679 : Pec: email@example.com: Mobile WebApp La scuola in numeri. A recent call to action by EAPC recommended that some of these tools be adopted by cardiac rehabilitation cardiologists in their routine assessment, particularly of patients >75 years old.116, Cardiac rehabilitation programmes should be tailored according to the results of frailty evaluation. Concept, definitions and construction methodology. In the year 2010, the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation – now European Association of Preventive Cardiology (EAPC) – released a position paper aimed at summarizing the key steps to deliver all cardiac rehabilitation components for cardiac conditions, while highlighting key differences and exceptions for specific cardiac manifestations.1 The greatest strengths of that document were: (a) the provision of commonly agreed cardiac rehabilitation activities applicable to all conditions as a standard reference, coupled with recommendations for specific clinical conditions, and (b) the organization of a series of tables suitable for routine practice, also presenting levels of evidence from the most robust class 1 and reference sources. Concerning exercise training, emphasis was put on the systematic adoption of the FITT (frequency, intensity, time – duration – and type of exercise) prescription model. Therefore, translation into clinical practice should be feasible, making exercise training a promising therapy option for LVAD patients. Table 6. When appropriately delivered and integrated with secondary prevention intervention, participation in cardiac rehabilitation programmes may provide better medication adherence, as confirmed by the EUROASPIRE IV survey163 in patients after ACS and/or revascularization procedures. ZRV SAN NICOLA PDF 191 KB 17. © 2016 Tutti i diritti sono riservati. cognitive function, sureness of movement) in this population. As a chronic condition, it is never too late to start a secondary prevention programme with a target of a longer sustainability (phase III). We also use third-party cookies that help us analyze and understand how you use this website. Dos Santos, TD, Pereira, SN, Portela, LOC. Core components of cardiac rehabilitation in peripheral artery disease. The additive role of exercise training superimposed onto CRT in increasing functional capacity and improving cardiovascular prognosis – since up to one-third of patients are initially non-responder to CRT and may gain from exercise – is still unclear, due to conflicting evidence.86,87 When prescribing exercise in CRT patients, wound evaluation in terms of both skin and heart muscle wire insertion has to be preliminary performed, and, in case, information regarding adverse events during device implantation should be collected. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Access to society journal content varies across our titles. View or download all the content the society has access to. In this patient population exercise-based cardiac rehabilitation is recommended as an effective means to achieve a healthy lifestyle and manage risk factors (class I A), as far as to reduce disease recurrence and the atherosclerotic process.