Please select the eligibility criteria that correspond to the clinical trial below.
Title: Pre-operative Rehabilitation for Reduction of Hospitalization After Coronary Bypass and Valvular Surgery.
Brief Summary: The PREHAB study is a clinical trial where frail patients waiting for heart surgery are randomly chosen to either receive the current standard of care or to participate in an 8-week exercise/education program at a community-based cardiac rehabilitation facility. Patients can wait for elective heart surgery for as long as 3-4 months. During this time, individuals are often fearful of making things worse, causing them to stop being active and further deteriorate their physical condition. This wait period presents a potential opportunity for health care providers to engage the patient to take control of their self-managed care prior to surgery with the intent of improving post-surgical outcomes. Patients randomized to the PREHAB intervention group will participate in supervised exercise twice per week in a program designed to improve physical functioning and exercise capacity. The investigators hypothesize that the PREHAB program for frail elderly patients awaiting an elective cardiac surgery will reduce frailty, improve exercise capacity, improve physical activity behaviour, improve in-hospital outcomes, improve clinical outcomes 3 months and 1 year postoperatively, and improve overall quality of life.


Options:
A: Inclusion Criteria:

* Patients aged 60 years and older, undergoing elective isolated coronary artery bypass grafting (CABG), aortic valve repair/replacement for moderate aortic stenosis or severe regurgitation, mitral valve repair/replacement for moderate stenosis or severe regurgitation or combined CABG/valve procedures
* Patients with Clinical Frailty Score (CFS) ≥3 (vulnerable) and \< 7 (8 = very severely frail, approaching end-of-life or 9 = terminally ill) at time of acceptance for cardiac surgery
* Patients with an estimated ≥ 6 week wait time

Exclusion Criteria:

* Patients who have unstable or recent unstable cardiac syndrome as defined by:

  1. Severe heart failure (NYHA IV) or angina (CCS class IV) symptoms
  2. Critical left main (LM) coronary disease
  3. Hospitalization for arrhythmias, congestive heart failure or acute coronary syndrome prior to randomization
* Patients who have severe left ventricular obstructive disease as defined by:

  1. Severe aortic or mitral stenosis (aortic or mitral valve area \<1.0cm2 or mean gradient \> 40 mmHg or \> 10 mmHg respectively)
  2. Dynamic left ventricular (LV) outflow obstruction
* Patients who have demonstrated exercise induced ventricular arrhythmias or have experienced a recent hospitalization for arrhythmias
* Patients who have cognitive deficits that would preclude rehabilitation
* Patients who have physical limitations that would preclude rehabilitation
* Patients who are unable to attend the Prehab program
B: Inclusion Criteria:

* Stable Ischemic Heart Disease
* BMI 28 - 40 kg/m2

Exclusion criteria:

* Known Diabetes Mellitus
* Repeated Fasting plasma glucose ≥ 7 mmol/L or Hba1c \> 7 %
* Severe or moderate valve disease
* Main stem stenosis
* Severe heart failure, Ejection Fraction \< 35 %
* Physical or mental disability which are expected to prevent completion of intervention
* Severe Chronic obstructive Pulmonary Disease (COPD) (FEV1 \< 50 % of expected) or asthma
* Active cancer
* Severe kidney (GFR \< 40 ml/hour) or severe liver disease
* Severe ischemia or arrhythmias during exercise test
* 2. or 3. degree atrio-ventricular (AV) block, not protected by pacemaker
* Organised training more than 2 times a week prior to inclusion
* Significant weight loss or weight gain (\> 5 %)3 month prior to inclusion
* Not able to comprehend written and oral informed consent
* Hormone treatment
C: Inclusion Criteria:

* stable CAD
* min.1 coronary artery stenosis \>50%
* patient is symptomatic ( CCS 1-3)or has documented myocardial ischemia during stress test
* angina threshold \>75 Watt
* informed consent

Exclusion Criteria:

* Age \<18 oder \>75
* akut coronary syndrome within 2 weeks
* LV-EF \< 40 %
* significant valve diseases
* reduced patient compliance
* muscular disorder
* bronchial asthma or COLD stadium III and IV
D: Inclusion Criteria:

* Recent myocardial infarction (within 3 months after the index event)
* Standard rehabilitation program of 3-6 weeks performed
* Informed consent (obtained before any study specific procedure)

Exclusion Criteria:

* Age \> 75 years
* Any condition that in the opinion of the investigator would jeopardize the evaluation of efficacy or be associated with poor adherence to the protocol;
* Presence of any non-cardiac disease (e.g. cancer) that is likely to significantly shorten life expectancy

Answer: A