1 Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium.
2 UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Belgium.
Eur J Prev Cardiol. 2018 May;25(7):682-691. doi: 10.1177/2047487318760888. Epub 2018 Feb 28.
Background Although disease-specific exercise guidelines for cardiovascular disease (CVD) are widely available, it remains uncertain whether these different exercise guidelines are integrated properly for patients with different CVDs. The aim of this study was to assess the inter-clinician variance in exercise prescription for patients with various CVDs and to compare these prescriptions with recommendations from the EXercise Prescription in Everyday practice and Rehabilitative Training (EXPERT) tool, a digital decision support system for integrated state-of-the-art exercise prescription in CVD. Design The study was a prospective observational survey. Methods Fifty-three CV rehabilitation clinicians from nine European countries were asked to prescribe exercise intensity (based on percentage of peak heart rate (HR)), frequency, session duration, programme duration and exercise type (endurance or strength training) for the same five patients. Exercise prescriptions were compared between clinicians, and relationships with clinician characteristics were studied. In addition, these exercise prescriptions were compared with recommendations from the EXPERT tool. Results A large inter-clinician variance was found for prescribed exercise intensity (median (interquartile range (IQR)): 83 (13) % of HR), frequency (median (IQR): 4 (2) days/week), session duration (median (IQR): 45 (18) min/session), programme duration (median (IQR): 12 (18) weeks), total exercise volume (median (IQR): 1215 (1961) peak-effort training hours) and prescription of strength training exercises (prescribed in 78% of all cases). Moreover, clinicians' exercise prescriptions were significantly different from those of the EXPERT tool ( p < 0.001). Conclusions This study reveals significant inter-clinician variance in exercise prescription for patients with different CVDs and disagreement with an integrated state-of-the-art system for exercise prescription, justifying the need for standardization efforts regarding integrated exercise prescription in CV rehabilitation.
背景 虽然针对心血管疾病 (CVD) 的特定疾病运动指南已经广泛应用，但对于不同 CVD 患者是否适当整合这些不同的运动指南仍然存在不确定性。本研究旨在评估不同临床医生在为各种 CVD 患者开具运动处方时的差异，并将这些处方与数字决策支持系统 EXercise Prescription in Everyday practice and Rehabilitative Training (EXPERT) 中推荐的处方进行比较，该系统为 CVD 综合最新运动处方提供了决策支持。 方法 该研究为前瞻性观察性调查。从欧洲九个国家的 53 名心血管康复临床医生中，邀请他们为 5 名相同的患者开具运动强度（以峰值心率的百分比表示）、频率、单次疗程持续时间、疗程持续时间和运动类型（耐力或力量训练）。比较了临床医生之间的运动处方差异，并研究了与临床医生特征的关系。此外，还将这些运动处方与 EXPERT 工具的建议进行了比较。 结果 为患者开具的运动强度（中位数（四分位距 (IQR)）：83（13）%的 HR）、频率（中位数 (IQR)）：4（2）天/周）、单次疗程持续时间（中位数 (IQR)）：45（18）分钟/次）、疗程持续时间（中位数 (IQR)）：12（18）周）、总运动量（中位数 (IQR)）：1215（1961）个峰值努力训练小时）和力量训练运动处方的开具（在所有病例中开具的处方占 78%）方面，临床医生之间存在较大差异。此外，临床医生的运动处方与 EXPERT 工具明显不同（p<0.001）。 结论 本研究揭示了不同 CVD 患者运动处方的显著临床医生间差异，以及与综合最新运动处方系统的不一致，这证明需要努力实现心血管康复中综合运动处方的标准化。
