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

4. But do we need an EXPERT tool?

5. Impact of CV rehabilitation

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

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

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

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

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

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

12. 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

13. Impact of CR on CVD risk
Limited impact

14. Impact of CR on CVD risk
Limited impact

15. 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

16. Importance of optimal CV risk management

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

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

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

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

22. Hansen D, et al. Eur J Prev Cardiol 2018

23. Hansen D, et al. Eur J Prev Cardiol 2018

24. Hansen D, et al. Eur J Prev Cardiol 2018

25. Absence of logic relations

26. Relations with clinician’s features?

27. 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

28. 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