Journal of Clinical Medicine (Jul 2021)
Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2
- Bernhard Schwaab,
- Birna Bjarnason-Wehrens,
- Karin Meng,
- Christian Albus,
- Annett Salzwedel,
- Jean-Paul Schmid,
- Werner Benzer,
- Matthes Metz,
- Katrin Jensen,
- Bernhard Rauch,
- Gerd Bönner,
- Patrick Brzoska,
- Heike Buhr-Schinner,
- Albrecht Charrier,
- Carsten Cordes,
- Gesine Dörr,
- Sarah Eichler,
- Anne-Kathrin Exner,
- Bernd Fromm,
- Stephan Gielen,
- Johannes Glatz,
- Helmut Gohlke,
- Maurizio Grilli,
- Detlef Gysan,
- Ursula Härtel,
- Harry Hahmann,
- Christoph Herrmann-Lingen,
- Gabriele Karger,
- Marthin Karoff,
- Ulrich Kiwus,
- Ernst Knoglinger,
- Christian-Wolfgang Krusch,
- Eike Langheim,
- Johannes Mann,
- Regina Max,
- Maria-Inti Metzendorf,
- Roland Nebel,
- Josef Niebauer,
- Hans-Georg Predel,
- Axel Preßler,
- Oliver Razum,
- Nils Reiss,
- Daniel Saure,
- Clemens von Schacky,
- Morten Schütt,
- Konrad Schultz,
- Eva-Maria Skoda,
- Diethard Steube,
- Marco Streibelt,
- Martin Stüttgen,
- Michaela Stüttgen,
- Martin Teufel,
- Hansueli Tschanz,
- Heinz Völler,
- Heiner Vogel,
- Ronja Westphal
Affiliations
- Bernhard Schwaab
- Curschmann Klinik, D-23669 Timmendorfer Strand, Germany
- Birna Bjarnason-Wehrens
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany
- Karin Meng
- Institute for Clinical Epidemiology and Biometry (ICE-B), University of Würzburg, D-97080 Würzburg, Germany
- Christian Albus
- Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 Köln, Germany
- Annett Salzwedel
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany
- Jean-Paul Schmid
- Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland
- Werner Benzer
- Reha-Klinik Montafon, A-6780 Schruns, Austria
- Matthes Metz
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany
- Katrin Jensen
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany
- Bernhard Rauch
- Institut für Herzinfarktforschung Ludwigshafen, IHF, D-67063 Ludwigshafen am Rhein, Germany
- Gerd Bönner
- Medizinische Fakultät, Albert-Ludwigs-Universität zu Freiburg, D-79104 Freiburg, Germany
- Patrick Brzoska
- Fakultät für Gesundheit, Universität Witten/Herdecke, Lehrstuhl für Versorgungsforschung, D-58448 Witten, Germany
- Heike Buhr-Schinner
- Ostseeklinik Schönberg-Holm, D-24217 Schönberg-Holm, Germany
- Albrecht Charrier
- Private Practice, D-01328 Dresden, Germany
- Carsten Cordes
- Gollwitzer-Meier-Klinik, D-32545 Bad Oeynhausen, Germany
- Gesine Dörr
- Alexianer St. Josefs-Krankenhaus Potsdam, D-14472 Potsdam, Germany
- Sarah Eichler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany
- Anne-Kathrin Exner
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany
- Bernd Fromm
- REHA-Klinik Sigmund Weil, D-76669 Bad Schönborn, Germany
- Stephan Gielen
- Klinikum Lippe GmbH, Standort Detmold, D-32756 Detmold, Germany
- Johannes Glatz
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany
- Helmut Gohlke
- Private Practice, D-79282 Ballrechten-Dottingen, Germany
- Maurizio Grilli
- Library Department, University Medical Centre Mannheim, D-68167 Mannheim, Germany
- Detlef Gysan
- Department für Humanmedizin, Private Universität Witten/Herdecke GmbH, D-58455 Witten, Germany
- Ursula Härtel
- LMU München, Institut für Medizinische Psychologie, D-80336 München, Germany
- Harry Hahmann
- Private Practice, D-88316 Isny im Allgäu, Germany
- Christoph Herrmann-Lingen
- 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
- Gabriele Karger
- Private Practice, D-69121 Heidelberg, Germany
- Marthin Karoff
- Private Practice, D-58332 Schwelm, Germany
- Ulrich Kiwus
- Private Practice, D-14169 Berlin, Germany
- Ernst Knoglinger
- Kirchberg-Klinik, D-37431 Bad Lauterberg, Germany
- Christian-Wolfgang Krusch
- Private Practice, D-67059 Ludwigshafen, Germany
- Eike Langheim
- Reha-Zentrum Seehof der Deutschen Rentenversicherung Bund, D-14513 Teltow, Germany
- Johannes Mann
- KfH Nierenzentrum, D-80804 München, Germany
- Regina Max
- Zentrum für Rheumatologie, Drs. Dornacher/Schmitt/Max/Lutz, D-69115 Heidelberg, Germany
- Maria-Inti Metzendorf
- Cochrane Metabolic and Endocrine Disorders Group, Institute of General Practice, Medical Faculty of the Heinrich-Heine University, D-40225 Düsseldorf, Germany
- Roland Nebel
- Hermann-Albrecht-Klinik METTNAU, Reha-Einrichtungen der Stadt Radolfzell, D-7385 Radolfzell, Germany
- Josef Niebauer
- Universitätsinstitut für Präventive und Rehabilitative Sportmedizin, Uniklinikum Salzburg, Paracelsus Medizinische Privatuniversität, A-5020 Salzburg, Austria
- Hans-Georg Predel
- Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 Köln, Germany
- Axel Preßler
- Privatpraxis für Kardiologie, Sportmedizin, Prävention, Rehabilitation, D-81675 München, Germany
- Oliver Razum
- Epidemiologie und International Public Health, Fakultät für Gesundheitswissenschaften, Universität Bielefeld, D-33615 Bielefeld, Germany
- Nils Reiss
- Schüchtermann-Schiller’sche Kliniken, D-49214 Bad Rothenfelde, Germany
- Daniel Saure
- Institute of Medical Biometry and Informatics (IMBI), University of Heidelberg, D-69120 Heidelberg, Germany
- Clemens von Schacky
- Omegametrix, D-82152 Martinsried, Germany
- Morten Schütt
- Diabetologische Schwerpunktpraxis, D-23552 Lübeck, Germany
- Konrad Schultz
- Klinik Bad Reichenhall, Zentrum für Rehabilitation, Pneumologie und Orthopädie, D-83435 Bad Reichenhall, Germany
- Eva-Maria Skoda
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany
- Diethard Steube
- Private Practice, D-14055 Berlin, Germany
- Marco Streibelt
- Department for Rehabilitation Research, German Federal Pension Insurance, D-10704 Berlin, Germany
- Martin Stüttgen
- Praxis Martin Stüttgen, D-67157 Wachenheim, Germany
- Michaela Stüttgen
- ZAR Ludwigshafen Klinikum, D-67063 Ludwigshafen am Rhein, Germany
- Martin Teufel
- Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany
- Hansueli Tschanz
- Berner Reha Zentrum, CH-3625 Heiligenschwendi, Switzerland
- Heinz Völler
- Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany
- Heiner Vogel
- Abteilung für Medizinische Psychologie und Psychotherapie, Medizinische Soziologie und Rehabilitationswissenschaften, Universität Würzburg, D-97070 Würzburg, Germany
- Ronja Westphal
- Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany
- DOI
- https://doi.org/10.3390/jcm10143071
- Journal volume & issue
-
Vol. 10,
no. 14
p. 3071
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
- scientific guidelines
- secondary prevention
- physical activity
- exercise training
- psychological interventions
