Cardiac rehabilitation in German speaking countries of Europe—evidence-based guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2
Creators: name: Schwaab, Bernhard
name: Bjarnason-Wehrens, Birna
name: Meng, Karin
name: Albus, Christian
name: Salzwedel, Annett
name: Schmid, Jean-Paul
name: Benzer, Werner
name: Metz, Matthes
name: Jensen, Katrin
name: Rauch, Bernhard
name: Bönner, Gerd
name: Brzoska, Patrick
name: Buhr-Schinner, Heike
name: Charrier, Albrecht
name: Cordes, Carsten
name: Dörr, Gesine
name: Eichler, Sarah
name: Exner, Anne-Kathrin
name: Fromm, Bernd
name: Gielen, Stephan
name: Glatz, Johannes
name: Gohlke, Helmut
name: Grilli, Maurizio
name: Gysan, Detlef
name: Härtel, Ursula
name: Hahmann, Harry
name: Herrmann-Lingen, Christoph
name: Karger, Gabriele
name: Karoff, Marthin
name: Kiwus, Ulrich
name: Knoglinger, Ernst
name: Krusch, Christian-Wolfgang
name: Langheim, Eike
name: Mann, Johannes
name: Max, Regina
name: Metzendorf, Maria-Inti
name: Nebel, Roland
name: Niebauer, Josef
name: Predel, Hans-Georg
name: Preßler, Axel
name: Razum, Oliver
name: Reiss, Nils
name: Saure, Daniel
name: Von Schacky, Clemens
name: Schütt, Morten
name: Schultz, Konrad
name: Skoda, Eva-Maria
name: Steube, Diethard
name: Streibelt, Marco
name: Stüttgen, Martin
name: Stüttgen, Michaela
name: Teufel, Martin
name: Tschanz, Hansueli
name: Völler, Heinz
name: Vogel, Heiner
name: Westphal, Ronja
Publisher: name: Universität Ulm
Year: 2021
Subjects: subject: Scientific guidelines
subject: Secondary prevention
subject: Physical activity
subject: Exercise training
subject: Psychological interventions
subject: Education
subject: Gender
subject: Frailty
subject: Migration
subject: Old patients
subject: Young patients
subject: Tele-medicine
subject: Home-based-rehabilitation
subject: DDC 610 / Medicine &amp; health
subject: Heart defects, Congenital
subject: Coronary artery disease
subject: Myocarditis
subject: Cardiac rehabilitation; Standards
subject: Herzkrankheit
subject: Koronare
subject: Myokarditis
subject: Rehabilitation

description: 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.