Exercise prescription by physiotherapists to patients with cardiovascular disease is in greater agreement with European recommendations after using the EXPERT training tool

ABSTRACT

Background

Exercise prescriptions by clinicians to patients with cardiovascular disease (CVD) often disagree with recommendations, thus requiring improvement.

Aim

To assess whether exercise prescriptions by physiotherapists to patients with CVD are better in agreement with European (ESC/EAPC) recommendations when the EXPERT (EXercise Prescription in Everyday practice & Rehabilitative Training) Training tool is used for digital educational training.

Design

In a prospective non-randomized intervention study.

Methods

Twenty-three belgian physiotherapists first prescribed exercise intensity, frequency, session duration, program duration and exercise type (endurance or strength training) for the same three patient cases, from which the agreement with ESC/EAPC recommendations (based on a maximal score of 60/per case: agreement score) was assessed. Next, they completed a one-month digital training by using the EXPERT Training tool and completed 31 ± 13 training cases. The EXPERT tool is a training and decision support system that automatically generates a (personalised) exercise prescription according to the patient’s characteristics, thus integrating the exercise prescriptions for different CVDs and risk factors, all based on ESC/EAPC recommendations. Thereafter, the same three patient cases as at entry of study were filled out again, with re-assessment of level of agreement with ESC/EAPC recommendations.

Results

After using the EXPERT Training tool, the physiotherapists prescribed significantly greater exercise frequencies, program durations and total exercise volumes in all three patient cases (p < 0.05). In cases 1, 2 and 3, the agreement score increased from 29 ± 9 (out of 60), 28 ± 9, and 34 ± 7 to 41 ± 9, 41 ± 10, and 45 ± 8, respectively (p < 0.001). Hence, the total agreement score increased from 91 ± 17 (out of 180) to 127 ± 19 (p < 0.001, +44 ± 32%). A lower starting agreement score and younger age correlated with a greater improvement in total agreement score (p < 0.05).

Conclusions

Exercise prescriptions to patients with CVD, generated by physiotherapists, are significantly better in agreement with European recommendations when the EXPERT Training tool is used, indicating its educational potential.

KEYWORDS:

• Exercise prescription
• cardiovascular disease
• rehabilitation
• clinical decision support system
• physiotherapy

Acknowledgments

We are very thankful to the participants in this study, as well as to the Board of AXXON for their cooperation. This work was supported by the Flemish Research Fund (FWO, FWO-ICA: G0F4220N).

We deeply appreciate the support and advice that was provided by the EXPERT Network group members, which include Luc Vanhees, PhD, FESC; Paul Beckers, PhD; Massimo F. Piepoli, MD, PhD; Bernhard Rauch, MD; Heinz Völler, MD, PhD; Ugo Corrà, MD; Jean-Paul Schmid, MD, FESC; Birna Bjarnason-Wehrens, MD; Patrick Doherty, PhD; Rona Reibis, MD; Frank Edelmann, MD; Michel Lamotte, PhD; Josef Niebauer, MD, MBA, PhD; Olga Barna, MD; Daniel Neunhäuserer, MD, PhD; Christoph Stettler, MD; Cajsa Tonoli, PhD; Eugenio Greco, MD, PhD, FESC; Karin Coninx, PhD; Roberto F.E. Pedretti, MD; Constantinos H. Davos, MD, PhD, FESC; Ana Abreu, MD; Marco Ambrosetti, MD; Simona Sarzi Braga, MD; Maurizio Bussotti, MD; Pompilio Faggiano, MD; Esteban Garcia-Porrero, MD; Evangelia Kouidi, MD, PhD; Martijn A. Spruit, PhD, FERS; Tim Takken, PhD; Carlo Vigorito, MD, PhD; Paul Dendale, MD, PhD, FESC; Schwaab Bernhard, MD.

Disclosure statement

No potential conflict of interest was reported by the authors.

Author contributions

D.H., K.C., and V.C contributed to the conception and design of the study. N.M. and W.R. contributed to data collection and/or analysis. All authors participated in writing of the study and substantively revised it. All authors approved the submitted version and have agreed both to be personally accountable for their own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated.

Data availability statement

The data underlying this article will be shared on reasonable request to the corresponding author.

Trials registration

This study was registered in ClinicalTrials.gov with the registration number NCT05449652

Additional information

Funding

This work was supported by the Flemish Research Fund (FWO, FWO-ICA: G0F4220N).