Comparison of the organisation of exercise training in phase III cardiac rehabilitation in four European countries: a pilot study
Authors: Lion A , Feiereisen P , Delagardelle C 
Published: June 2024

Abstract

Introduction
The phase III cardiac rehabilitation is a lifetime maintenance program with the aim to decrease the risk of subsequent cardiac events and guarantee a good quality of life. This phase includes lifestyle modifications and exercise training. To our knowledge, there is no clear recommendation regarding the structured organisation of exercise training in phase III cardiac rehabilitation. We aimed to investigate how exercise training in phase III cardiac rehabilitation was administratively organized in the Greater Region (an international region composed by territories from Belgium, France, Germany, and Luxembourg).

Methods
Several organisations offering or coordinating the exercise training of the phase III cardiac rehabilitation in the Greater Region were contacted. We were interested to know the status of the contacted organisations, the profile of their participants, how these participants were recruited, and how exercise training classes were organised. In addition, the websites and the registration forms of the organisations offering the exercise training of the phase III cardiac rehabilitation were screened.

Results
Exercise training in phase III cardiac rehabilitation was offered by non-profit organisations in all territories. The profile of the participants in exercise training was different across the different territories: 1) participants with cardiac diseases, 2) the latter plus participants presenting risk factors for cardiovascular disease and exceptionally their relatives and friends, 3) everybody. A medical clearance/referral by a medical doctor was mandatory in each territory at the 1st registration. In some territories, a stress test was additionally required for participants with cardiac diseases and participants presenting risk factors for cardiovascular disease. The results of the stress test were reviewed by a medical doctor or an exercise therapist in charge of the classes. Annual medical clearance from medical doctor was, however, not mandatory in some territories. In two territories, participants may be referred into a starter programme at the beginning of phase III cardiac rehabilitation. After this starter programme, participants are invited to continue into the regular programme. Exercise therapists are either physiotherapists or sports therapists in most cases. A medical surveillance of the exercise training by a medical doctor or a nurse was often recommended but rarely and heterogeneously implemented.

Conclusions
The organisation of the outpatient phase III cardiac rehabilitation in the 4 territories of the Greater Region is rather heterogenous. A larger and more comprehensive study should be conducted in other regions/countries to better identify the risks, the barriers, and the good practices which could then be used to elaborate international guidelines. The non-profit organisations may need new guidelines to better organise and administrate exercise training of the phase III cardiac rehabilitation.