Standardised Exercise Prescription for Patients with Chronic Coronary Syndrome and/or Heart Failure: A Consensus Statement from the EXPERT Working Group.

Whereas exercise training, as part of multidisciplinary rehabilitation, is a key component in the management of patients with chronic coronary syndrome (CCS) and/or congestive heart failure (CHF), physicians and exercise professionals disagree among themselves on the type and characteristics of the exercise to be prescribed to these patients, and the exercise prescriptions are not consistent with the international guidelines. This impacts the efficacy and quality of the intervention of rehabilitation. To overcome these barriers, a digital training and decision support system [i.e. EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool], i.e. a stepwise aid to exercise prescription in patients with CCS and/or CHF, affected by concomitant risk factors and comorbidities, in the setting of multidisciplinary rehabilitation, was developed. The EXPERT working group members reviewed the literature and formulated exercise recommendations (exercise training intensity, frequency, volume, type, session and programme duration) and safety precautions for CCS and/or CHF (including heart transplantation). Also, highly prevalent comorbidities (e.g. peripheral arterial disease) or cardiac devices (e.g. pacemaker, implanted cardioverter defibrillator, left-ventricular assist device) were considered, as well as indications for the in-hospital phase (e.g. after coronary revascularisation or hospitalisation for CHF). The contributions of physical fitness, medications and adverse events during exercise testing were also considered. The EXPERT tool was developed on the basis of this evidence. In this paper, the exercise prescriptions for patients with CCS and/or CHF formulated for the EXPERT tool are presented. Finally, to demonstrate how the EXPERT tool proposes exercise prescriptions in patients with CCS and/or CHF with different combinations of CVD risk factors, three patient cases with solutions are presented.

The clinical management of cardiac rehabilitation.

Cardiac rehabilitation (CR) has pioneered using multidisciplinary teams to attend all aspects of a patient's illness with high levels of professionalism and quality, providing individualized treatment, and negotiating any changes in lifestyle and treatment course. Clinical management transfers the management capacity to professionals, thus avoiding any increase in costs and healthcare spending, which can result in quality losses and less social legitimacy. Modern CR has been configured as the most effective comprehensive cardiovascular prevention strategy and given its preventive nature it must be a part of all cardiovascular health-related processes as a sub-process. Quality of care is the fundamental pillar of healthcare and CR, together with the sustainability of the system. Its improvement allows for better rationalization of resources, reduces costs, and offers safer care focused on the needs of the patient. The definition of the technical competencies of the different professionals (functions of the members of the CR unit) is a necessity both from the point of view of its teaching utility, and from planning and management of health services. For a CR team able to carry out clinical management by the quality and safety processes, it needs members who possess professionalism, leadership, adequate communication, adequate training and knowledge management.

Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group.

Whereas exercise training is key in the management of patients with cardiovascular disease (CVD) risk (obesity, diabetes, dyslipidaemia, hypertension), clinicians experience difficulties in how to optimally prescribe exercise in patients with different CVD risk factors. Therefore, a consensus statement for state-of-the-art exercise prescription in patients with combinations of CVD risk factors as integrated into a digital training and decision support system (the EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool) needed to be established. EXPERT working group members systematically reviewed the literature for meta-analyses, systematic reviews and/or clinical studies addressing exercise prescriptions in specific CVD risk factors and formulated exercise recommendations (exercise training intensity, frequency, volume and type, session and programme duration) and exercise safety precautions, for obesity, arterial hypertension, type 1 and 2 diabetes, and dyslipidaemia. The impact of physical fitness, CVD risk altering medications and adverse events during exercise testing was further taken into account to fine-tune this exercise prescription. An algorithm, supported by the interactive EXPERT tool, was developed by Hasselt University based on these data. Specific exercise recommendations were formulated with the aim to decrease adipose tissue mass, improve glycaemic control and blood lipid profile, and lower blood pressure. The impact of medications to improve CVD risk, adverse events during exercise testing and physical fitness was also taken into account. Simulations were made of how the EXPERT tool provides exercise prescriptions according to the variables provided. In this paper, state-of-the-art exercise prescription to patients with combinations of CVD risk factors is formulated, and it is shown how the EXPERT tool may assist clinicians. This contributes to an appropriately tailored exercise regimen for every CVD risk patient.

Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey.

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 (HRpeak)), 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 HRpeak), 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.

The European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool: A digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology.

Background Exercise rehabilitation is highly recommended by current guidelines on prevention of cardiovascular disease, but its implementation is still poor. Many clinicians experience difficulties in prescribing exercise in the presence of different concomitant cardiovascular diseases and risk factors within the same patient. It was aimed to develop a digital training and decision support system for exercise prescription in cardiovascular disease patients in clinical practice: the European Association of Preventive Cardiology Exercise Prescription in Everyday Practice and Rehabilitative Training (EXPERT) tool. Methods EXPERT working group members were requested to define (a) diagnostic criteria for specific cardiovascular diseases, cardiovascular disease risk factors, and other chronic non-cardiovascular conditions, (b) primary goals of exercise intervention, (c) disease-specific prescription of exercise training (intensity, frequency, volume, type, session and programme duration), and (d) exercise training safety advices. The impact of exercise tolerance, common cardiovascular medications and adverse events during exercise testing were further taken into account for optimized exercise prescription. Results Exercise training recommendations and safety advices were formulated for 10 cardiovascular diseases, five cardiovascular disease risk factors (type 1 and 2 diabetes, obesity, hypertension, hypercholesterolaemia), and three common chronic non-cardiovascular conditions (lung and renal failure and sarcopaenia), but also accounted for baseline exercise tolerance, common cardiovascular medications and occurrence of adverse events during exercise testing. An algorithm, supported by an interactive tool, was constructed based on these data. This training and decision support system automatically provides an exercise prescription according to the variables provided. Conclusion This digital training and decision support system may contribute in overcoming barriers in exercise implementation in common cardiovascular diseases.

Novedades en cardiología: riesgo vascular y rehabilitación cardiaca / Update in cardiology: vascular risk and cardiac rehabilitation

El conocimiento en las aéreas de riesgo vascular y rehabilitación, como en otras, se enriquece constantemente. Esta revisión aborda las novedades en los campos de la epidemiología, terreno que muestra lo lejos que se está´ de alcanzar un buen control de los factores de riesgo: en alimentación y nutrición, donde se hace patente la creciente obesidad de una sociedad que consume mal y en exceso; en ejercicio, donde tan difícil es lograr el equilibrio entre beneficio y riesgo, aunque se están haciendo esfuerzos de sistematización; en tabaquismo, donde lo nuevo se centra en programas y políticas, a´ rea en que el cigarrillo electrónico aparece más como problema que como solución; en lípidos, donde el debate transatlántico entre guías se erige como paradigma de divergencia de criterio en un aspecto profundamente estudiado; en hipertensión, donde la alternativa no farmacológica (la denervación renal) ha visto surgir el contratiempo del SYMPLICITY HTN-3, lo que obliga a un replanteamiento en profundidad; en diabetes mellitus, donde los nuevos fármacos inhibidores de la dipeptidil peptidasa-4 y del cotransportador sodio-glucosa tipo 2 y análogos del péptido similar al glucagon tipo 1 aportan mucha información nueva y anticipan la que está por llegar, y en rehabilitación cardiaca, que las nuevas tecnologías de información y comunicación siguen enriqueciendo y con la cual la enfermedad más avanzada, como insuficiencia cardiaca, no es óbice para obtener beneficio. Se finaliza con las novedades en el paciente anciano, al que se aplican los mismos criterios que se extrapolan de los más jóvenes, cuando la presente revisión establece que no debe ser asý (AU)

As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case (AU)

Update in cardiology: vascular risk and cardiac rehabilitation.

As in other fields, understanding of vascular risk and rehabilitation is constantly improving. The present review of recent epidemiological update shows how far we are from achieving good risk factor control: in diet and nutrition, where unhealthy and excessive societal consumption is clearly increasing the prevalence of obesity; in exercise, where it is difficult to find a balance between benefit and risk, despite systemization efforts; in smoking, where developments center on programs and policies, with the electronic cigarette seeming more like a problem than a solution; in lipids, where the transatlantic debate between guidelines is becoming a paradigm of the divergence of views in this extensively studied area; in hypertension, where a nonpharmacological alternative (renal denervation) has been undermined by the SYMPLICITY HTN-3 setback, forcing a deep reassessment; in diabetes mellitus, where the new dipeptidyl peptidase-4 and sodium-glucose cotransporter type 2 inhibitors and glucagon like peptide 1 analogues have contributed much new information and a glimpse of the future of diabetes treatment, and in cardiac rehabilitation, which continues to benefit from new information and communication technologies and where clinical benefit is not hindered by advanced diseases, such as heart failure. Our summary concludes with the update in elderly patients, whose treatment criteria are extrapolated from those of younger patients, with the present review clearly indicating that should not be the case.

Challenges in secondary prevention of cardiovascular diseases: a review of the current practice.

With the changing demography of populations and increasing prevalence of co-morbidity, frail patients and more complex cardiac conditions, the modern medicine is facing novel challenges leading to rapid innovation where evidence and experiences are lacking. This scenario is also evident in cardiovascular disease prevention, which continuously needs to accommodate its ever changing strategies, settings, and goals. The present paper summarises actual challenges of secondary prevention, and discusses how this intervention should not only be effective but also efficient. By this way the paper tries to bridge the gaps between research and real-world findings and thereby may find ways to improve standard care.

Secondary prevention in the clinical management of patients with cardiovascular diseases. Core components, standards and outcome measures for referral and delivery: a policy statement from the cardiac rehabilitation section of the European Association for Cardiovascular Prevention & Rehabilitation. Endorsed by the Committee for Practice Guidelines of the European Society of Cardiology.

Despite major improvements in diagnostics and interventional therapies, cardiovascular diseases remain a major health care and socio-economic burden both in western and developing countries, in which this burden is increasing in close correlation to economic growth. Health authorities and the general population have started to recognize that the fight against these diseases can only be won if their burden is faced by increasing our investment on interventions in lifestyle changes and prevention. There is an overwhelming evidence of the efficacy of secondary prevention initiatives including cardiac rehabilitation in terms of reduction in morbidity and mortality. However, secondary prevention is still too poorly implemented in clinical practice, often only on selected populations and over a limited period of time. The development of systematic and full comprehensive preventive programmes is warranted, integrated in the organization of national health systems. Furthermore, systematic monitoring of the process of delivery and outcomes is a necessity. Cardiology and secondary prevention, including cardiac rehabilitation, have evolved almost independently of each other and although each makes a unique contribution it is now time to join forces under the banner of preventive cardiology and create a comprehensive model that optimizes long term outcomes for patients and reduces the future burden on health care services. These are the aims that the Cardiac Rehabilitation Section of the European Association for Cardiovascular Prevention & Rehabilitation has foreseen to promote secondary preventive cardiology in clinical practice.

[Update on preventive cardiology and rehabilitation]. / Actualidades en cardiología preventiva y rehabilitación.

The aim of the Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology is to promote knowledge about and adoption of the lifestyle, therapy and rehabilitation program guidelines that are best able to improve cardiovascular health in the Spanish population. To achieve this aim, a number of working groups have carried out research into and provided education about the latest developments in cardiovascular prevention, and have provided information about these developments to all those affected, including physicians, healthcare workers, healthcare administrators and the general public. This year, the working group on smoking produced an key document that was presented to cardiologists in our Society; its intention was to provide a simple algorithm to help patients give up smoking that could be applied in only 3 minutes. The working group on cardiac rehabilitation gave a presentation on the true impact of rehabilitation on survival after percutaneous coronary intervention and heart failure. Also this year, the European Society of Cardiology published a major revision of guidelines on the treatment of dyslipidemia, which was welcomed by many but criticized by others. Our correspondent at the European Society reflects on the role and usefulness of these guidelines in practice.

Can level of education, accreditation and use of databases in cardiac rehabilitation be improved? Results from the European Cardiac Rehabilitation Inventory Survey.

INTRODUCTION: Professional skills, education and accreditation, along with clinical outcome assessment, are considered important factors to achieve comprehensive delivery and quality of cardiac rehabilitation (CR). This study assessed professional educational programmes, accreditation and use of databases in CR across the European countries. MATERIALS AND METHODS: Questions on professional education, accreditation and clinical databases from the European Cardiac Rehabilitation Inventory Survey, which is a postal questionnaire survey, conducted from November 2007 to January 2009 among national CR-related organizations in Europe; 28 countries responded (72%) to this survey. RESULTS: Among the participating countries, 32% had guidelines on professional CR skills, 61% had formal educational programmes and 29% had accreditation systems for professional CR skills. One hundred and seventy-four ad-hoc educational and scientific activities were registered during 2005-2007. Forty-three percent of the countries had established CR programme accreditation systems, primarily aimed at phase 2. One in three (35%) countries had established clinical CR databases with a further 25% planning to do so. CONCLUSION: More than half of the European countries had developed formal CR educational programmes. Furthermore, many ad-hoc CR-related meetings and conference activities take place across Europe. Although only a quarter of countries had developed accreditation systems aimed at professionals, programme accreditation was somewhat more widespread with over a third having programme accreditation systems. Clinical databases were underdeveloped. A greater focus on education, accreditation and database implementation is needed to promote CR availability and the quality of CR services for the benefit of cardiac patients across Europe.

Actualidades en cardiología preventiva y rehabilitación / Update on preventive cardiology and rehabilitation

La Sección de Cardiología Preventiva y Rehabilitación de la Sociedad Española de Cardiología tiene como objetivos la promoción del conocimiento y la aplicación de las mejores pautas de estilos de vida y terapéuticas y programas de rehabilitación que consigan mejorar la salud cardiovascular en los españoles. Para ello, a través de distintos grupos de trabajo, se persigue la investigación y la formación en las últimas novedades sobre prevención cardiovascular y la transmisión de ellas a todos los colectivos implicados: médicos, personal sanitario, administración y población general. El Grupo de Trabajo de Tabaquismo elaboró este año un importante documento que presentó a los cardiólogos de nuestra sociedad, que intenta que un sencillo algoritmo de tan sólo 3 min consiga ayudar al paciente a dejar el tabaco. El Grupo de Trabajo de Rehabilitación Cardiaca hace una presentación del impacto real que la rehabilitación supone en la supervivencia tras el intervencionismo coronario y en la insuficiencia cardiaca. También este año, la Sociedad Europea de Cardiología ha publicado una importante revisión de las guías para el tratamiento de las dislipemias. Aplaudidas por muchos y criticadas por otros, el corresponsal de nuestra sección en la Sociedad Europea hace una reflexión sobre su papel y su utilidad real (AU)

The aim of the Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology is to promote knowledge about and adoption of the lifestyle, therapy and rehabilitation program guidelines that are best able to improve cardiovascular health in the Spanish population. To achieve this aim, a number of working groups have carried out research into and provided education about the latest developments in cardiovascular prevention, and have provided information about these developments to all those affected, including physicians, healthcare workers, healthcare administrators and the general public. This year, the working group on smoking produced an key document that was presented to cardiologists in our Society; its intention was to provide a simple algorithm to help patients give up smoking that could be applied in only 3 minutes. The working group on cardiac rehabilitation gave a presentation on the true impact of rehabilitation on survival after percutaneous coronary intervention and heart failure. Also this year, the European Society of Cardiology published a major revision of guidelines on the treatment of dyslipidemia ,which was welcomed by many but criticized by others. Our correspondent at the European Society reflects on the role and usefulness of these guidelines in practice (AU)

[Preventive cardiology and cardiac rehabilitation]. / Cardiología preventiva y rehabilitación cardiaca.

The Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology provides the principal national reference point for scientific knowledge about cardiovascular risk factors in the Spanish population, about the incidence and prevalence of cardiovascular disease in Spain, and about disease prevention and the use of cardiac rehabilitation to improve the quality of life and prolong the survival of individuals already affected by the disease. By necessity, research into cardiovascular prevention involves sponsoring the implementation of studies into cardiovascular risk factors and disease occurrence. The MESYAS study is a good example. It is the fruit of the combined efforts of members of the metabolic syndrome working group belonging to our Section of the Spanish Society of Cardiology and its aim was to answer a number of unresolved questions that had arisen about the incidence, prevalence and consequences of cardiovascular disease in the Spanish population. Today, after this cohort has been followed up for more than 5 years, the first analysis of the cardiovascular events that occurred in the cohort and their relationship with individual risk factors observed many years previously has become available. Here, the metabolic syndrome working group reports some interesting findings. With the aim of communicating up-to-date information that has undergone expert review, the coordinator of the cardiac rehabilitation working group has the responsibility of summarizing, evaluating and updating the scientific data available on the important subject of the secondary prevention of cardiovascular disease.

Cardiología preventiva y rehabilitación cardiaca / Preventive cardiology and cardiac rehabilitation

La Sección de Cardiología Preventiva y Rehabilitación de la Sociedad Española de Cardiología ha de ser una importante referencia científica nacional en el conocimiento de los factores de riesgo cardiovascular de los españoles, la incidencia y la prevalencia de la enfermedad cardiovascular en España y la forma de prevenir su aparición y, mediante la rehabilitación cardiaca, mejorar la calidad de vida y la supervivencia de todos los que ya la han padecido. La investigación en prevención cardiovascular debe potenciarse auspiciando la elaboración de registros sobre los factores de riesgo cardiovascular y la presencia de la enfermedad. El estudio MESYAS es un buen ejemplo de ello. Es el fruto del esfuerzo de los miembros del grupo de trabajo sobre síndrome metabólico de nuestra sección, que intenta responder a varias incógnitas que se planteaban sobre su incidencia, su prevalencia y sus consecuencias en nuestra población. Ahora, con más de 5 años de seguimiento de esa cohorte, disponemos ya de los primeros análisis sobre los episodios cardiovasculares que han acontecido en ella y su relación con los factores de riesgo individuales detectados años atrás. El grupo de trabajo de síndrome metabólico nos presenta esos interesantes resultados. En el interés de trasladar el conocimiento actualizado y asimilado por expertos, el coordinador del grupo de trabajo de rehabilitación cardiaca se encarga de sintetizar, ponderar y poner al día la información científica disponible en esa importante área de la prevención secundaria cardiovascular (AU)

The Preventive Cardiology and Rehabilitation Section of the Spanish Society of Cardiology provides the principal national reference point for scientific knowledge about cardiovascular risk factors in the Spanish population, about the incidence and prevalence of cardiovascular disease in Spain, and about disease prevention and the use of cardiac rehabilitation to improve the quality of life and prolong the survival of individuals already affected by the disease. By necessity, research into cardiovascular prevention involves sponsoring the implementation of studies into cardiovascular risk factors and disease occurrence. The MESYAS study is a good example. It is the fruit of the combined efforts of members of the metabolic syndrome working group belonging to our Section of the Spanish Society of Cardiology and its aim was to answer a number of unresolved questions that had arisen about the incidence, prevalence and consequences of cardiovascular disease in the Spanish population. Today, after this cohort has been followed up for more than 5 years, the first analysis of the cardiovascular events that occurred in the cohort and their relationship with individual risk factors observed many years previously has become available. Here, the metabolic syndrome working group reports some interesting findings. With the aim of communicating up-to-date information that has undergone expert review, the coordinator of the cardiac rehabilitation working group has the responsibility of summarizing, evaluating and updating the scientific data available on the important subject of the secondary prevention of cardiovascular disease (AU)

Rehabilitación de los pacientes después de la colocación de una endoprótesis coronaria / Patient rehabilitation after coronary stent placement

La incorporación precoz del enfermo al que se ha realizado una angioplastia con stent a su vida habitual, por ausencia de impedimentos propios de la técnica, ha permitido incluir más pronto a estos pacientes en la fase II de la rehabilitación cardiaca. Aunque la rehabilitación del paciente coronario sigue para todos los pacientes unas pautas generales que pretenden abordar desde un punto de vista de prevención secundaria la aterosclerosis coronaria, las circunstancias de cada enfermo, entre las que se incluye la técnica con que ha sido revascularizado, determinan aspectos individuales de la rehabilitación del enfermo con cardiopatía isquémica. El ejercicio físico continuado (entrenamiento físico) produce, por sí mismo, grandes beneficios cardiovasculares para la prevención cardiovascular primaria y secundaria. En pacientes con infarto disminuye la mortalidad y mejora la capacidad funcional, la función ventricular y el remodelado ventricular, y hay esperanzas de que pueda mejorar la circulación colateral. También mejora la función endotelial y estimula la circulación de células madre. Se ha demostrado que el entrenamiento físico tras revascularización percutánea disminuye el número de eventos y que en pacientes con angina estable el entrenamiento físico produce menos eventos que la revascularización percutánea (AU)

Patients who have undergone angioplasty with stenting can be reintegrated into normal life at an early stage, thanks to the absence of sequelae associated with the procedure itself. Consequently, these patients can be involved earlier in the second stage of cardiac rehabilitation. Although rehabilitation for coronary patients follows the general guidelines used for all patients, which were developed with the secondary prevention of coronary artery atherosclerosis in mind, the specific form of rehabilitation adopted for each individual with ischemic heart disease will depend on the patient’s circumstances, including the revascularization technique used. Regular physical exercise (i.e. physical training), in itself, has substantial cardiovascular benefits for both primary and secondary cardiovascular prevention. In patients who have had a myocardial infarction, training decreases mortality, increases functional capacity and improves ventricular function and remodeling. It is also thought to boost the collateral circulation. In addition, training improves endothelial function and stimulates the circulation of stem cells. It has been shown that physical training after percutaneous revascularization decreases the number of cardiac events. Moreover, in patients with stable angina, it results in fewer events than percutaneous revascularization (AU)

[Preventive cardiology and cardiac rehabilitation]. / Cardiología preventiva y rehabilitación.

Prevention is the most effective and efficient way of tackling cardiovascular disease and, similarly, cardiac rehabilitation programs are the most effective and efficient means of secondary prevention. The main objective of the metabolic syndrome working group is to increase understanding of cardiovascular risk in Spain by studying the occurrence of various risk factors, and the connections and associations between them, in economically active individuals. The group's first study and, subsequently, the MESYAS (Metabolic Syndrome in Active Subjects) study have led to significant and informative new findings, and continue to be produce data that can be used to improve disease prevention in everyday clinical practice. Furthermore, cardiac rehabilitation and secondary prevention programs for cardiovascular disease provide the most effective means of decreasing morbidity and mortality. However, it is worrying to observe that, in cardiological practice, there are significant gaps in compliance with scientific society recommendations on secondary prevention. On request, the coordinator of the cardiac rehabilitation working group has provided a report on the latest data and findings from across the full spectrum of activity in this vital area of disease prevention.

Cardiología preventiva y rehabilitación / Preventive cardiology and cardiac rehabilitation

La prevención es la herramienta más eficaz y eficiente en la enfermedad cardiovascular y, de igual forma, los programas de rehabilitación cardiaca son los más eficaces y eficientes en la prevención secundaria. Conocer la situación de riesgo cardiovascular en nuestro país a través del estudio de la presentación de los distintos factores de riesgo y de su relación y asociación en trabajadores españoles es el objetivo principal del grupo de trabajo de nuestra sección sobre síndrome metabólico. A través de su primero registro y luego estudio denominado MESYAS (MEtabolic SYndrome Active Subjets), nos ha ofrecido importantes e interesantes resultados y sigue produciendo datos que nos ayudan en nuestra práctica preventiva diaria. Por otra parte, los programas de rehabilitación cardiaca y de prevención secundaria de las enfermedades cardiovasculares son el método más eficaz para disminuir su morbimortalidad. Sin embargo, es preocupante observar que en la asistencia cardiológica hay importantes lagunas en cuanto al seguimiento de las recomendaciones de las sociedades científicas sobre esa prevención secundaria. Le hemos pedido al coordinador del grupo de trabajo de rehabilitación cardiaca que nos informe con los últimos datos y evidencias del panorama de esta importante actividad preventiva (AU)

Prevention is the most effective and efficient way of tackling cardiovascular disease and, similarly, cardiac rehabilitation programs are the most effective and efficient means of secondary prevention. The main objective of the metabolic syndrome working group is to increase understanding of cardiovascular risk in Spain by studying the occurrence of various risk factors, and the connections and associations between them, in economically active individuals. The group’s first study and, subsequently, the MESYAS (Metabolic Syndrome in Active Subjects) study have led to significant and informative new findings, and continue to be produce data that can be used to improve disease prevention in everyday clinical practice. Furthermore, cardiac rehabilitation and secondary prevention programs for cardiovascular disease provide the most effective means of decreasing morbidity and mortality. However, it is worrying to observe that, in cardiological practice, there are significant gaps incompliance with scientific society recommendations on secondary prevention. On request, the coordinator of the cardiac rehabilitation working group has provided a report on the latest data and findings from across the full spectrum of activity in this vital area of disease prevention (AU)

[Update on cardiovascular prevention and cardiac rehabilitation]. / Temas de actualidad en prevención cardiovascular y rehabilitación cardiaca.

This article contains a review of the main developments in cardiovascular disease prevention reported during the last year and a discussion of recent consensus statements. As in previous years, a substantial part of the research effort has concentrated on cardiovascular risk scores, imaging techniques (particularly cardiac computed tomography), cardiometabolic risk factors, and exercise training.

Temas de actualidad en prevención cardiovascular y rehabilitación cardiaca / Update on cardiovascular prevention and cardiac rehabilitation

En este artículo se revisan los principales avances publicados en la prevención de las enfermedades cardiovasculares en el último año, así como los nuevos documentos de consenso. Como en años precedentes, buena parte del esfuerzo investigador está relacionado con las clasificaciones de riesgo cardiovascular, las técnicas de imagen (especialmente la tomografía computarizada cardiaca),los factores de riesgo cardiometabólico y el entrenamiento físico (AU)

This article contains a review of the main developments in cardiovascular disease prevention reported during the last year and a discussion of recent consensus statements. As in previous years, a substantial part of the research effort has concentrated on cardiovascular risk scores, imaging techniques (particularly cardiac computed tomography),cardio metabolic risk factors, and exercise training (AU)

[Cardiovascular prevention and cardiac rehabilitation]. / Prevención cardiovascular y rehabilitación cardiaca.

This article contains a review of the main developments in cardiovascular disease prevention reported during the last year. In addition, the most recent clinical practice guidelines are also discussed. The aims of cardiovascular prevention are to reduce mortality and morbidity in individuals at a high risk and to help those at a low risk to maintain their status. Lifestyle modification and the reduction of modifiable cardiovascular risk factors are key to cardiovascular disease prevention. The implementation of clinical practice guidelines provides the primary means of achieving these goals.