1. 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

2. Disclosure statement
None to be declared

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

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

5. 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:
Pattyn N, et al. Sports Med. 2013; 43:

6. Importance of optimal CV risk management

7. for exercise prescription

8. 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

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

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

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

12. Comparing different clinicians

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

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

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

16. A gap is present between…
Clinical practice
Guidelines

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

18. EXPERT Tool
Digital, interactive decision support tool for exercise prescription
Endorsed by the European Association of Preventive Cardiology
Access:
License:

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

20. EXPERT tool
Hansen D, et al. Sports Med 2018; e-pub ahead of print, doi: /s

21. 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.

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

23. EXPERT tool

24. EXPERT tool

25. EXPERT tool

26. EXPERT tool

27. 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

28. 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 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

29. EXPERT output EXPERT simulation Exercise prescription:
Intensity: HR 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

30. 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

31. 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

32. EXPERT output EXPERT simulation Exercise prescription:
Intensity: HR 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

33. 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

34. 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