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

Autor: Schwaab B; Curschmann Klinik, D-23669 Timmendorfer Strand, Germany.; Medizinische Fakultät, Universität zu Lübeck, D-23562 Lübeck, Germany., Bjarnason-Wehrens B; Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany., Meng K; Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany., Albus C; Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany., Salzwedel A; Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany., Schmid JP; Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland., Benzer W; Reha-Klinik Montafon, A-6780 Schruns, Austria., Metz M; Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany., Jensen K; Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany., Rauch B; Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany.; Zentrum für ambulante Rehabilitation, ZAR Trier GmbH, D-54292 Trier, Germany., Bönner G; Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany., Brzoska P; Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany., Buhr-Schinner H; Ostseeklinik Schönberg-Holm, D-24217 Schönberg-Holm, Germany., Charrier A; Private Practice, D-01328 Dresden, Germany., Cordes C; Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany., Dörr G; Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany., Eichler S; Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany., Exner AK; Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany., Fromm B; REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany., Gielen S; Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany., Glatz J; Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany., Gohlke H; Private Practice, D-79282 Ballrechten-Dottingen, Germany., Grilli M; Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany., Gysan D; Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany., Härtel U; LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany., Hahmann H; Private Practice, D-88316 Isny im Allgäu, Germany., Herrmann-Lingen C; 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., Karger G; Private Practice, D-69121 Heidelberg, Germany., Karoff M; Private Practice, D-58332 Schwelm, Germany., Kiwus U; Private Practice, D-14169 Berlin, Germany., Knoglinger E; Kirchberg-Klinik, D-37431 Bad Lauterberg, Germany., Krusch CW; Private Practice, D-67059 Ludwigshafen, Germany., Langheim E; Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany., Mann J; KfH Nierenzentrum, D-80804 München, Germany., Max R; Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany., Metzendorf MI; Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany., Nebel R; Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany., Niebauer J; Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria., Predel HG; Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany., Preßler A; Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany., Razum O; Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany., Reiss N; Schüchtermann-Schiller'sche Kliniken, D-49214 Bad Rothenfelde, Germany., Saure D; Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany., von Schacky C; Omegametrix, D-82152 Martinsried, Germany., Schütt M; Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany., Schultz K; Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany., Skoda EM; Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany., Steube D; Private Practice, D-14055 Berlin, Germany., Streibelt M; Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany., Stüttgen M; Praxis Martin Stüttgen, D-67157 Wachenheim, Germany., Stüttgen M; ZAR Ludwigshafen Klinikum, D-67063 Ludwigshafen am Rhein, Germany., Teufel M; Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany., Tschanz H; Berner Reha Zentrum, CH-3625 Heiligenschwendi, Switzerland., Völler H; Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany.; Klinik am See, D-15562 Rüdersdorf, Germany., Vogel H; Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany., Westphal R; Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany.
Jazyk: angličtina
Zdroj: Journal of clinical medicine [J Clin Med] 2021 Jul 12; Vol. 10 (14). Date of Electronic Publication: 2021 Jul 12.
DOI: 10.3390/jcm10143071
Abstrakt: 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.
Databáze: MEDLINE
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