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      Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

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          Abstract

          Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and ‘modern’ cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.

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          Most cited references115

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          AGREE II: advancing guideline development, reporting and evaluation in health care.

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            Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis.

            Regular exercise improves glucose control in diabetes, but the association of different exercise training interventions on glucose control is unclear. To conduct a systematic review and meta-analysis of randomized controlled clinical trials (RCTs) assessing associations of structured exercise training regimens (aerobic, resistance, or both) and physical activity advice with or without dietary cointervention on change in hemoglobin A(1c) (HbA(1c)) in type 2 diabetes patients. MEDLINE, Cochrane-CENTRAL, EMBASE, ClinicalTrials.gov, LILACS, and SPORTDiscus databases were searched from January 1980 through February 2011. RCTs of at least 12 weeks' duration that evaluated the ability of structured exercise training or physical activity advice to lower HbA(1c) levels as compared with a control group in patients with type 2 diabetes. Two independent reviewers extracted data and assessed quality of the included studies. Of 4191 articles retrieved, 47 RCTs (8538 patients) were included. Pooled mean differences in HbA(1c) levels between intervention and control groups were calculated using a random-effects model. Overall, structured exercise training (23 studies) was associated with a decline in HbA(1c) level (-0.67%; 95% confidence interval [CI], -0.84% to -0.49%; I(2), 91.3%) compared with control participants. In addition, structured aerobic exercise (-0.73%; 95% CI, -1.06% to -0.40%; I(2), 92.8%), structured resistance training (-0.57%; 95% CI, -1.14% to -0.01%; I(2), 92.5%), and both combined (-0.51%; 95% CI, -0.79% to -0.23%; I(2), 67.5%) were each associated with declines in HbA(1C) levels compared with control participants. Structured exercise durations of more than 150 minutes per week were associated with HbA(1c) reductions of 0.89%, while structured exercise durations of 150 minutes or less per week were associated with HbA(1C) reductions of 0.36%. Overall, interventions of physical activity advice (24 studies) were associated with lower HbA(1c) levels (-0.43%; 95% CI, -0.59% to -0.28%; I(2), 62.9%) compared with control participants. Combined physical activity advice and dietary advice was associated with decreased HbA(1c) (-0.58%; 95% CI, -0.74% to -0.43%; I(2), 57.5%) as compared with control participants. Physical activity advice alone was not associated with HbA(1c) changes. Structured exercise training that consists of aerobic exercise, resistance training, or both combined is associated with HbA(1c) reduction in patients with type 2 diabetes. Structured exercise training of more than 150 minutes per week is associated with greater HbA(1c) declines than that of 150 minutes or less per week. Physical activity advice is associated with lower HbA(1c), but only when combined with dietary advice.
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              ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: the Task Force for the diagnosis and treatment of acute and chronic heart failure 2008 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care Medicine (ESICM).

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                Author and article information

                Journal
                European Journal of Preventive Cardiology
                Eur J Prev Cardiolog
                SAGE Publications
                2047-4873
                2047-4881
                March 30 2020
                : 204748732091337
                Affiliations
                [1 ]Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
                [2 ]Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
                [3 ]Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
                [4 ]REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
                [5 ]Department of Cardiology, Jessa Hospital, Belgium
                [6 ]Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
                [7 ]Cardiology Department, IRCCS Multimedica, Italy
                [8 ]Department of Cardiology, Clinic Barmelweid, Switzerland
                [9 ]University of Naples Federico II, Italy
                [10 ]Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
                [11 ]Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
                [12 ]Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
                [13 ]Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
                [14 ]St. John of God’s Hospital Linz, Austria
                [15 ]Cardiology Department, Hopital Lariboisiere, Paris University, France
                [16 ]Cardiovascular Exercise Physiology Group, KU Leuven, Belgium
                [17 ]Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
                [18 ]Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany
                [19 ]BCRT – Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
                [20 ]University of Medicine & Pharmacy ‘Victor Babes’ Cardiovascular Prevention & Rehabilitation Clinic, Romania
                [21 ]Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
                [22 ]Department of Cardiology, Maxima Medical Centre, The Netherlands
                [23 ]Charité – University Medicine Berlin, Germany
                [24 ]German Centre for Cardiovascular Research (DZHK), Germany
                [25 ]Central Finland Health Care District Hospital District, Finland
                [26 ]Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
                [27 ]University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
                [28 ]Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, ‘V.A. Almazov National Medical Research Centre’ of the Ministry of Health of the Russian Federation, Russian Federation
                [29 ]REHPA–Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
                Article
                10.1177/2047487320913379
                33611446
                18589319-8931-4a3e-a700-81d7301603c9
                © 2020

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