Physical activity for primary and secondary prevention. Position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology.

There is now clear scientific evidence linking regular aerobic physical activity to a significant cardiovascular risk reduction, and a sedentary lifestyle is currently considered one of the five major risk factors for cardiovascular disease. In the European Union, available data seem to indicate that less than 50% of the citizens are involved in regular aerobic leisure-time and/or occupational physical activity, and that the observed increasing prevalence of obesity is associated with a sedentary lifestyle. It seems reasonable therefore to provide institutions, health services, and individuals with information able to implement effective strategies for the adoption of a physically active lifestyle and for helping people to effectively incorporate physical activity into their daily life both in the primary and the secondary prevention settings. This paper summarizes the available scientific evidence dealing with the relationship between physical activity and cardiovascular health in primary and secondary prevention, and focuses on the preventive effects of aerobic physical activity, whose health benefits have been extensively documented.

Secondary prevention through cardiac rehabilitation: position paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology.

The purpose of this statement is to provide specific recommendations in regard to evaluation and intervention in each of the core components of cardiac rehabilitation (CR) to assist CR staff in the design and development of their programmes; the statement should also assist health care providers, insurers, policy makers and consumers in the recognition of the comprehensive nature of such programmes. Those charged with responsibility for secondary prevention of cardiovascular disease, whether at European, at national or at individual centre level, need to consider where and how structured programmes of CR can be delivered to the large constituency of patients now considered eligible for CR.

A representative study of cardiac rehabilitation activities in European Union Member States: the Carinex survey.

PURPOSE: Empirical data on the level and nature of service delivery in cardiac rehabilitation (CR) in Europe are unavailable. Such information would facilitate service development across European Union (EU) Member States. A first EU-wide postal survey to provide baseline data was conducted. METHODS: Organizations providing CR in 1995 were identified for 13 of 15 EU states (all except Luxembourg and Denmark). Using the World Health Organization definitions, 454 phase II (medium-term recovery after hospital release) and 383 phase III (long-term maintenance) centers were contacted in the relevant language. Staffing, content, duration, cost, and safety aspects of CR were queried. RESULTS: Response rates were 57% (phase II) and 56% (phase III). Replies illustrate consistency across the EU; for instance, in having exercise as a core component of phase II programs. They also exemplify the diversity of services, particularly in phase III. The multidisciplinary aspect of CR is less developed in phase III. From this survey it is possible to make general estimates of the level of CR service coverage across EU States. Fewer than 50% of patients eligible to participant do so in most countries, with services in particularly short supply in countries with the greatest cardiovascular burden. CONCLUSION: Many cardiac patients who could benefit from CR, an evidence-based treatment, do not participate in such programs. This survey provides important baseline and EU comparison data to monitor patterns of service development in the future.

Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme.

OBJECTIVE: To examine and evaluate improvements in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status in postmyocardial infarction patients during and after a comprehensive 12 month exercise rehabilitation programme. SUBJECTS: The sample population comprised 124 patients with a clinical diagnosis of myocardial infarction (122 men and two women). INTERVENTIONS: 62 patients were randomly allocated to a regular weekly aerobic training programme, three times a week for 12 months, and compared with 62 matched controls who did not receive any formal exercise training. A five year follow up questionnaire/interview was subsequently conducted on this population to determine selected vocational/lifestyle changes. RESULTS: Significant improvements in cardiorespiratory fitness (p < 0.01-0.001), psychological profiles (p < 0.05-0.001), and quality of life scores (p < 0.001) were recorded in the treatment population when compared with their matched controls. Although there were no significant differences in mortality, a larger percentage of the regular exercisers resumed full time employment and they returned to work earlier than the controls. Controls took lighter jobs, lost more time from work, and suffered more non-fatal reinfarctions (p < 0.05-0.01). CONCLUSIONS: Regularly supervised and prolonged aerobic exercise training improves cardiorespiratory fitness, psychological status, and quality of life. The trained population also had a reduction in morbidity following myocardial infarction, and significant improvement in vocational status over a five year follow up period.