Dominique Hansen, PhD, FESC Hasselt University

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Presentation transcript:

Exercise prescription in cardiovascular patients: do we need an EXPERT tool? Dominique Hansen, PhD, FESC Hasselt University Faculty of Medicine & Life Sciences Hasselt, Belgium

But do we need an EXPERT tool?

Impact of CV rehabilitation

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

How good are we in affecting the cardiovascular risk by exercise intervention in patients with heart disease?

Impact of CR on CVD risk -3.8 mmHg -1.4 mmHg

Impact of CR on CVD risk +3.8 mg/dl -5.5 mg/dl

Impact of CR on CVD risk -13.2 mg/dl -4.8 mg/dl

Impact of CR on CVD risk +3.5 ml/kg/min

67% of patients attending cardiac rehabilitation is insulin resistant! Impact of CR on CVD risk 67% of patients attending cardiac rehabilitation is insulin resistant! Khadanga S, et al. Insulin Resistance and Diabetes Mellitus in Contemporary Cardiac Rehabilitation. J Cardiopulm Rehabil Prev 2016;36:331-8. Limited impact AIT, aerobic interval training; LED, low-energy diet

Impact of CR on CVD risk Limited impact

Impact of CR on CVD risk Limited impact

Interim conclusion Are we good at lowering CVD risk by exercise intervention in heart disease? Yes, and larger effects Physical fitness Yes, but smaller effects (Systolic) blood pressure and lipid profile No Fat mass Insulin sensitivity

Importance of optimal CV risk management

Tailor your EXERCISE intervention We should aim for maximal reduction in the CVD risk to prevent cardiovascular disease Tailor your EXERCISE intervention as well!

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

How good are we at tailoring exercise intervention in patients with heart disease?

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

Hansen D, et al. Eur J Prev Cardiol 2018

Hansen D, et al. Eur J Prev Cardiol 2018

Hansen D, et al. Eur J Prev Cardiol 2018

Absence of logic relations

Relations with clinician’s features?

Conclusions Certain CVD risk factors are not affected sufficiently by exercise training There is a large variance in exercise prescription to the same patient by different clinicians The EXPERT tool may assist in overcoming these issues

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

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