Dominique Hansen, PhD, FESC The EXPERT-Tool: a digital decision support system for integrated state-of-the-art exercise prescription in CVD Dominique Hansen, PhD, FESC

Disclosure statement None to be declared

Exercise in cardiovascular disease: guidelines Piepoli MF, et al. Eur J Prev Cardiol 2016;23:NP1-96

But how good are we in lowering cardiovascular disease risk by exercise intervention?

Impact of exercise intervention on CVD risk Risk factor Primary prevention Secondary prevention Fat mass SBP DBP HDL LDL TC HbA1c (in diabetes) VO2peak Chen YC, et al. Eur J Cardiovasc Nurs. 2017: 16: 397-408 Pattyn N, et al. Sports Med. 2013; 43: 121-33.

Importance of optimal CV risk management

for exercise prescription

Tailor your intervention We should aim for maximum improvement of the CVD risk, but with optimal medical safety, to prevent cardiovascular disease Tailor your intervention

Approach in tailoring exercise Patient phenotype Prevalent CV disease CVD risk profile Blood lipid profile Glycemic control Fat mass

But what about different combinations of CVD risk factors? How good are we in prescribing exercise in these patients?

Compare exercise prescriptions from different clinicians to the same (complex) patient and observe …whether they agree between themselves …whether they agree with guidelines

Comparing different clinicians

Comparing different clinicians Hansen D, et al. Eur J Prev Cardiol 2018; 25: 682-91

Comparing different clinicians Hansen D, et al. Eur J Prev Cardiol 2018; 25: 682-91

Comparing different clinicians Hansen D, et al. Eur J Prev Cardiol 2018; 25: 682-91

A gap is present between… Clinical practice Guidelines

Hansen D, et al. Eur J Prev Cardiol 2017; 24: 1017-31 Hansen D, et al. Eur Heart J 2017; 38: 2318-20

EXPERT Tool Digital, interactive decision support tool for exercise prescription Endorsed by the European Association of Preventive Cardiology Access: https://expert-tool.edm.uhasselt.be License: www.escardio.org/Education/Practice-Tools/CVD-prevention-toolbox/expert-tool

EXPERT tool Hansen D, et al. Eur J Prev Cardiol 2017; 24: 1017-31

EXPERT tool Hansen D, et al. Sports Med 2018; e-pub ahead of print, doi: 10.1007/s40279-018-0930-4

as a recommendation tool for the professional EXPERT tool as a recommendation tool for the professional as an educational tool in university as a training tool in a hospital / rehab center integrated with a mobile patient app (e.g. HeartHab app UHasselt) -> S. Sankaran, et al.

EXPERT tool Hansen D, et al. Eur J Prev Cardiol 2017; 24: 1017-31

EXPERT tool

EXPERT tool

EXPERT tool

EXPERT tool

Simulations of exercise prescription Age: Body height: Body weight: BMI: Sex: VO2max: Resting HR: Peak exercise HR: Total cholesterol: LDL: Fasting glycaemia: Blood pressure: Medication intake: Co-morbidities: 61 years 170 cm 97 kg 33.56 kg/m² Male 2283 ml/min (100% of normal value) 69 bpm 141 bpm ? 125/80 mmHg Beta blocker, ACE inhibitor, Antiplatelet none

Tool starts with regular exercise prescription EXPERT simulation Tool starts with regular exercise prescription 150 min low-to-moderate intense endurance exercise training per week (spread over 3-5 days, achieving 1000-2000 kcal) for at least 12 weeks But further adjusts: Intake of diuretics, betablockers, ACE inhibitor Patient is thus hypertensive Elevate exercise frequency, consider hand grip strength exercises Obesity Maximize caloric expenditure Prolong intervention

EXPERT output EXPERT simulation Exercise prescription: Intensity: HR 98-111 bts/min Frequency: build up to at least 5 days/week Exercise session duration: from 30 up to 60 min/session Minimal program duration: >24 weeks Strength training: yes Consider hand grip strength exercises

EXPERT simulation Age: Body height: Body weight: BMI: Sex: VO2max: Resting HR: Peak exercise HR: Total cholesterol: LDL: Fasting glycaemia: Blood pressure: Medication intake: Co-morbidities: 61 years 170 cm 97 kg 33.56 kg/m² Male 1283 ml/min (65% of normal value) 69 bpm 141 bpm ? 125 mg/dl 125/80 mmHg Beta blocker, ACE inhibitor, Antiplatelet, Metformin none

Intake of diuretics, betablockers, ACE inhibitor EXPERT simulation Intake of diuretics, betablockers, ACE inhibitor Patient is thus hypertensive Elevate exercise frequency, consider hand grip strength exercises Obesity Maximize caloric expenditure Prolong intervention But further adjusts: Low VO2peak Start at lower intensity Type 2 diabetes Elevate exercise frequency, add strength training, prolong intervention

EXPERT output EXPERT simulation Exercise prescription: Intensity: HR 90-98 bts/min Frequency: build up to at least 5 days/week Exercise session duration: from 30 up to 60 min/session Minimal program duration: >24 weeks Strength training: yes Consider hand grip strength exercises Strength training for large muscle groups

Exercise intervention is potent to improve CVD risk Conclusions Exercise intervention is potent to improve CVD risk However, there is room for further improvement The variance in exercise perscriptions between clinicians is too large The EXPERT tool may be of clinical assistance

Members of EXPERT working group Colleagues of EDM from Hasselt university Prof. dr. Karin Coninx & dr. Gustavo Rovelo Ruiz Members of EXPERT survey working group