Skip to main content

Advertisement

SpringerLink
Log in

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

  • Review Article
  • Published:
Sports Medicine Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Lin X, Zhang X, Guo J, et al. Effects of exercise training on cardiorespiratory fitness and biomarkers of cardiometabolic health: a systematic review and meta-analysis of randomized controlled trials. J Am Heart Assoc. 2015;4:e002014.

    PubMed  PubMed Central  Google Scholar 

  2. Murtagh EM, Nichols L, Mohammed MA, et al. The effect of walking on risk factors for cardiovascular disease: an updated systematic review and meta-analysis of randomised control trials. Prev Med. 2015;72:34–43.

    Article  PubMed  Google Scholar 

  3. Pattyn N, Cornelissen VA, Eshghi SR, et al. The effect of exercise on the cardiovascular risk factors constituting the metabolic syndrome: a meta-analysis of controlled trials. Sports Med. 2013;43:121–33.

    Article  PubMed  Google Scholar 

  4. Lavie CJ, Arena R, Swift DL, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015;117:207–19.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  5. Kachur S, Chongthammakun V, Lavie CJ, et al. Impact of cardiac rehabilitation and exercise training programs in coronary heart disease. Prog Cardiovasc Dis. 2017;60:103–14.

    Article  PubMed  Google Scholar 

  6. Kondamudi N, Haykowsky M, Forman DE, et al. Exercise training for prevention and treatment of heart failure. Prog Cardiovasc Dis. 2017;60:115–20.

    Article  PubMed  Google Scholar 

  7. Piepoli MF, Hoes AW, Agewall S, et al. 2016 European guidelines on cardiovascular disease prevention in clinical practice. Eur J Prev Cardiol. 2016;23:NP1–96.

  8. Eckel RH, Jakicic JM, Ard JD, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2960–84.

  9. Karlsen T, Aamot IL, Haykowsky M, et al. High intensity interval training for maximizing health outcomes. Prog Cardiovasc Dis. 2017;60:67–77.

    Article  PubMed  Google Scholar 

  10. Vanhees L, Geladas N, Hansen D, et al. Importance of characteristics and modalities of physical activity and exercise in the management of cardiovascular health in individuals with cardiovascular risk factors. Recommendations from the European Association for Cardiovascular Prevention and Rehabilitation (Part II). Eur. J Prev Cardiol. 2012;19:1005–33.

    Article  CAS  Google Scholar 

  11. Bjarnasons-Wherens B, McGee H, Zwisler AD, et al. Cardiac rehabilitation in Europe: results from the European cardiac rehabilitation inventory survey. Eur J Cardiovasc Prev Rehabil. 2010;17:410–8.

    Article  Google Scholar 

  12. Hansen D, Rovelo Ruiz G, Doherty P, et al. Do clinicians prescribe exercise similarly in patients with different cardiovascular diseases? Findings from the EAPC EXPERT working group survey. Eur J Prev Cardiol. 2018; (accepted for publication).

  13. Hansen D, Dendale P, Coninx K, et al. The EAPC EXercise Prescription in Everyday practice & Rehabilitative Training (EXPERT) tool: a digital training and decision support system for optimized exercise prescription in cardiovascular disease. Concept, definitions and construction methodology. Eur. J Prev Cardiol. 2017;24:1017–31.

    Article  Google Scholar 

  14. Harbour R, Miller J. A new system for grading recommendations in evidence based guidelines. BMJ. 2001;323:334–6.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  15. Myers J, Arena R, Franklin B, et al. American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention of the Council on Clinical Cardiology, the Council on Nutrition, Physical Activity, and Metabolism, and the Council on Cardiovascular Nursing. Recommendations for clinical exercise laboratories: a scientific statement from the American Heart Association. Circulation. 2009;119:3144–61.

    Article  PubMed  Google Scholar 

  16. British Association for Cardiovascular Prevention and Rehabilitation Exercise Professionals Group. Core Competences for the Physical Activity and Exercise Component for Cardiovascular Disease Prevention and Rehabilitation Services. British Cardiovascular Society, 2012: http://www.bacpr.com/resources/BACPR_Core_Comp_PA_Exercise_web_FINAL_NOV_12_2.pdf. Accessed 1 Mar 2018.

  17. Rydén L, Grant PJ, Anker SD, et al. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2013;34:3035–87.

    Article  PubMed  Google Scholar 

  18. Yumuk V, Tsigos C, Fried M, et al. Obesity Management Task Force of the European Association for the Study of Obesity. European guidelines for obesity management in adults. Obes Facts. 2015;8:402–24.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Donnelly JE, Blair SN, Jakicic JM, American College of Sports Medicine. American College of Sports Medicine Position Stand, et al. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc. 2009;41:459–71.

    Article  PubMed  Google Scholar 

  20. Franz MJ, VanWormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107:1755–67.

    Article  PubMed  Google Scholar 

  21. Shaw K, Gennat H, O’Rourke P, et al. Exercise for overweight or obesity. Cochrane Database Syst Rev. 2006;4:CD003817.

  22. Thorogood A, Mottillo S, Shimony A, et al. Isolated aerobic exercise and weight loss: a systematic review and meta-analysis of randomized controlled trials. Am J Med. 2011;124:747–55.

    Article  PubMed  Google Scholar 

  23. Ismail I, Keating SE, Baker MK, et al. A systematic review and meta-analysis of the effect of aerobic vs. resistance exercise training on visceral fat. Obes Rev. 2012;13:68–91.

    Article  PubMed  CAS  Google Scholar 

  24. Baillot A, Romain AJ, Boisvert-Vigneault K, et al. Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis. PLoS One. 2015;10:e0119017.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Clark JE. Diet, exercise or diet with exercise: comparing the effectiveness of treatment options for weight-loss and changes in fitness for adults (18–65 years old) who are overfat, or obese; systematic review and meta-analysis. J Diabetes Metab Disord. 2015;14:31.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Kuo CH, Harris MB. Abdominal fat reducing outcome of exercise training: fat burning or hydrocarbon source redistribution? Can J Physiol Pharmacol. 2016;94:695–8.

    Article  PubMed  CAS  Google Scholar 

  27. Mancia G, Fagard R, Narkiewicz K, et al. 2013 ESH/ESC guidelines for the management of arterial hypertension. Eur Heart J. 2013;34:2159–219.

    Article  PubMed  Google Scholar 

  28. Cornelissen VA, Buys R, Smart NA. Endurance exercise beneficially affects ambulatory blood pressure: a systematic review and meta-analysis. J Hypertens. 2013;31:639–48.

    Article  PubMed  CAS  Google Scholar 

  29. Cornelissen VA, Smart NA. Exercise training for blood pressure: a systematic review and meta-analysis. J Am Heart Assoc. 2013;2:e004473.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kelley GA, Kelley KS. Efficacy of aerobic exercise on coronary heart disease risk factors. Prev Cardiol. 2008;11:71–5.

    Article  PubMed  CAS  Google Scholar 

  31. Cornelissen VA, Fagard RH. Effects of endurance training on blood pressure, blood pressure regulating mechanisms and cardiovascular risk factors. Hypertension. 2005;46:667–75.

    Article  PubMed  CAS  Google Scholar 

  32. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized controlled trials. Ann Intern Med. 2002;136:493–503.

    Article  PubMed  Google Scholar 

  33. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33:S484–92.

    Article  PubMed  CAS  Google Scholar 

  34. Kelley GA, Kelley KS, Tran ZV. Walking and resting BP in adults: a meta-analysis. Prev Med. 2001;33:120–7.

    PubMed  CAS  Google Scholar 

  35. Tjonna AE, Lee SJ, Stolen TO, et al. Aerobic interval training versus continuous moderate exercise as a treatment for the metabolic syndrome: a pilot study. Circulation. 2008;118:346–54.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Molmen-Hansen HE, Stolen T, Tjonna AE, et al. Aerobic interval training reduces blood pressure and improves myocardial function in hypertensive patients. Eur J Prev Cardiol. 2012;19:151–60.

    Article  PubMed  Google Scholar 

  37. Guimaraes GV. Effect of continuous vs interval exercise training on blood pressure and arterial stiffness in treated hypertension. Hypertension Res. 2010;33:627–32.

    Article  CAS  Google Scholar 

  38. Ciolac EG, Bocchi EA, Bortolotto LA, et al. Effects of high-intensity aerobic interval training vs moderate exercise on hemodynamic, metabolic and neuro-humoral abnormalities of young normotensive women at high familial risk for hypertension. Hypertension Res. 2010;33:836–43.

    Article  CAS  Google Scholar 

  39. Cornelissen VA, Arnout J, Holvoet P, et al. Influence of exercise at lower and higher intensity on blood pressure and cardiovascular risk factors at older age. J Hypertens. 2009;27:753–62.

    Article  PubMed  CAS  Google Scholar 

  40. Dalleck LC, Allen BA, Hanson BA, et al. Dose-response relationship between moderate-intensity exercise duration and coronary heart disease risk factors in postmenopausal women. J Womens Health. 2009;18:105–13.

    Article  Google Scholar 

  41. Murphy MH, Blair SN, Murtagh EM. Accumulated versus continuous exercise for health benefits. Sports Med. 2009;39:29–43.

    Article  PubMed  Google Scholar 

  42. Pescatello LS, Kulikowich JM. The aftereffects of dynamic exercise on ambulatory blood pressure. Med Sci Sports Exerc. 2001;33:1855–61.

    Article  PubMed  CAS  Google Scholar 

  43. Anunciacao PG, Polito MD. A review on post-exercise hypotension in hypertensive individuals. Arq Bras Cardiol. 2011;96:e100–9.

    Article  Google Scholar 

  44. Kelley GA, Kelley KS. Progressive resistance exercise and resting blood pressure: a meta-analysis of randomized controlled trials. Hypertension. 2000;35:838–43.

    Article  PubMed  CAS  Google Scholar 

  45. Cornelissen VA, Fagard RH. Effect of resistance training on resting blood pressure: a meta-analysis of randomized controlled trials. J Hypertens. 2005;23:251–9.

    Article  PubMed  CAS  Google Scholar 

  46. Kelley GA, Kelley KS. Isometric handgrip exercise and resting blood pressur: a meta-analysis of randomized controlled trials. J Hypertens. 2010;28:411–8.

    Article  PubMed  CAS  Google Scholar 

  47. Owen A, Wiles J, Swaine I. Effect of isometric exercise on resting blood pressure: a meta-analysis. J Hum Hypertens. 2010;24:796–800.

    Article  PubMed  CAS  Google Scholar 

  48. The Task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC). ESH/ESC guidelines for the management of arterial hypertension. J Hypertens. 2013;2013(31):1281–357.

    Google Scholar 

  49. Fagard RH, Björnstad HH, Borjesson M, et al. ESC study group of sports cardiology recommendations for participation in leisure-time physical activities and competitive sports for patients with hypertension. Eur J Prev Cardiol. 2005;12:326–31.

    Article  Google Scholar 

  50. Sharman JE, Stowasser M. Australian association for exercise and sports science position statement on exercise and hypertension. J Sci Med Sport. 2009;12:252–7.

    Article  PubMed  Google Scholar 

  51. Pescatello LS, Franklin BA, Fagard R, American College of Sports Medicine, et al. Exercise and hypertension. Position stand. Med Sci Sports Exerc. 2004;36:533–53.

    Article  PubMed  Google Scholar 

  52. Badrov MB, Bartol CL, DiBartolomeo MA, et al. Effect of isometric handgrip training dose on resting blood pressure and resistance vessel endothelial function in normotensive women. Eur J Appl Physiol. 2013;113:2091–100.

    Article  PubMed  Google Scholar 

  53. Millar PJ, Levy AS, McGowan CL, et al. Isometric handgrip training lowers blood pressure and increases heart rate complexity in medicated hypertensive patients. Scand J Med Sci Sports. 2013;23:620–6.

    PubMed  CAS  Google Scholar 

  54. Wen H, Wang L. Reducing effect of aerobic exercise on blood pressure of essential hypertensive patients: a meta-analysis. Medicine. 2017;96:e6150.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Niewiadomski W, Pilis W, Laskowska D, et al. Effects of a brief Valsalva manoeuvre on hemodynamic response to strength exercises. Clin Physiol Funct Imaging. 2012;32:145–57.

    Article  PubMed  Google Scholar 

  56. Fihn SD, Gardin JM, Abrams J, et al; American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; American College of Physicians; American Association for Thoracic Surgery; Preventive Cardiovascular Nurses Association; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. J Am Coll Cardiol. 2012;60:e44–e164.

  57. Poli A, Marangoni F, Paoletti R, et al. Non-pharmacological control of plasma cholesterol levels. Nutr Metab Cardiovasc Dis. 2008;18:S1–16.

    Article  PubMed  CAS  Google Scholar 

  58. Hayashino Y, Jackson JL, Fukumori N, et al. Effects of supervised exercise on lipid profiles and blood pressure control in people with type 2 diabetes mellitus: a meta-analysis of randomized controlled trials. Diabetes Res Clin Pract. 2012;98:349–60.

    Article  PubMed  CAS  Google Scholar 

  59. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058.

    Article  PubMed  Google Scholar 

  60. Kelley GA, Kelley KS, Roberts S, et al. Comparison of aerobic exercise, diet or both on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Clin Nutr. 2012;31:156–67.

    Article  PubMed  CAS  Google Scholar 

  61. Kelley GA, Kelley KS. Impact of progressive resistance training on lipids and lipoproteins in adults: a meta-analysis of randomized controlled trials. Prev Med. 2009;48:9–19.

    Article  PubMed  CAS  Google Scholar 

  62. Kelley GA, Kelley KS, Franklin B. Aerobic exercise and lipids and lipoproteins in patients with cardiovascular disease: a meta-analysis of randomized controlled trials. J Cardiopulm Rehabil. 2006;26:131–9.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Kelley GA, Kelley KS, Vu Tran Z. Aerobic exercise, lipids and lipoproteins in overweight and obese adults: a meta-analysis of randomized controlled trials. Int J Obes. 2005;29:881–93.

    Article  CAS  Google Scholar 

  64. Kodama S, Tanaka S, Saito K, et al. Effect of aerobic exercise training on serum levels of high-density lipoprotein cholesterol: a meta-analysis. Arch Intern Med. 2007;167:999–1008.

    Article  PubMed  CAS  Google Scholar 

  65. Chudyk A, Petrella RJ. Effects of exercise on cardiovascular risk factors in type 2 diabetes: a meta-analysis. Diabetes Care. 2011;34:1228–37.

    Article  PubMed  PubMed Central  Google Scholar 

  66. American Diabetes Association. Standards of medical care in diabetes, 2017. Diabetes Care. 2017;40:S1–135.

    Article  Google Scholar 

  67. International Diabetes Federation. Recommendations for managing type 2 diabetes in primary care, 2017. http://www.idf.org/managing-type2-diabetes. Accessed 1 Mar 2018.

  68. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycaemia in type 2 diabetes, 2015: a patient-centred approach. Update to a position statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetologia. 2015;58:429–42.

    Article  PubMed  Google Scholar 

  69. Colberg SR, Sigal RJ, Fernhall B, et al. American College of Sports Medicine; American Diabetes Association. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care. 2010;33:2692–6.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Egger A, Niederseer D, Diem G, et al. Different types of resistance training in patients with type 2 diabetes mellitus: effects on glycemic control, muscle mass and strength. Eur J Prev Cardiol. 2013;20:1051–60.

    Article  PubMed  Google Scholar 

  71. Marwick TH, Hordern MD, Miller T, et al. Exercise training for type 2 diabetes mellitus: impact on cardiovascular risk: a scientific statement from the American Heart Association. Circulation. 2009;119:3244–62.

    Article  PubMed  Google Scholar 

  72. Niebauer J, Mayr K, Harpf H, et al. Long-term effects of outpatient cardiac rehabilitation in Austria: A nationwide registry. Wien Klin Wochenschr. 2014;126:148–55.

    Article  PubMed  Google Scholar 

  73. Niebauer J, Mayr K, Tschentscher M, et al. Outpatient cardiac rehabilitation—the Austrian model. Eur J Prev Cardiol. 2013;20:468–79.

    Article  PubMed  Google Scholar 

  74. Umpierre D, Ribeiro PAB, Schaan BD, et al. Volume of supervised exercise training impacts glycaemic control in patients with type 2 diabetes: a systematic review with meta-regression analysis. Diabetologia. 2013;56:242–51.

    Article  PubMed  CAS  Google Scholar 

  75. Umpierre D, Ribeiro PA, Kramer CK, et al. Physical activity advice only or structured exercise training and association with HbA1c levels in type 2 diabetes: a systematic review and meta-analysis. JAMA. 2011;305:1790–9.

    Article  PubMed  CAS  Google Scholar 

  76. van Buuren F, Mellwig KP, Horstkotte D, et al. Electrical myostimulation improves glucose metabolism and oxygen uptake in type 2 diabetes mellitus patients—results from the exEMS study. Diabetes Technol Ther. 2015;17:413–9.

    Article  PubMed  CAS  Google Scholar 

  77. Hansen D, Peeters S, Zwaenepoel B, et al. Exercise assessment and prescription in patients with type 2 diabetes in the private and home care setting: clinical recommendations from AXXON (Physical Therapy Association Belgium). Phys Ther. 2013;93:597–610.

    Article  PubMed  Google Scholar 

  78. Sixt S, Peschel T, Halfwassen U, et al. 6 months multifactorial intervention with focus on exercise training in patients with diabetes mellitus type 2 and coronary artery disease improves cardiovascular risk factor profile and endothelial dysfunction. Eur Heart J. 2010;31:112–9.

    Article  PubMed  CAS  Google Scholar 

  79. Desch S, Sonnabend M, Niebauer J, et al. Effects of physical exercise versus rosiglitazone on endothelial function in coronary artery disease patients with prediabetes. Diabetes Obes Metab. 2010;12:825–8.

    Article  PubMed  CAS  Google Scholar 

  80. Sixt S, Rastan A, Desch S, et al. Exercise training but not rosiglitazone improves endothelial function in pre-diabetic patients with coronary disease. Eur J Cardiovasc Prev Rehabil. 2008;15:473–8.

    Article  PubMed  Google Scholar 

  81. Colberg SR, Sigal RJ, Yardley JE, et al. Physical activity/exercise and diabetes: a position statement of the American Diabetes Association. Diabetes Care. 2016;39:2065–79.

    Article  PubMed  Google Scholar 

  82. Mendes R, Sousa N, Reis VM, et al. Prevention of exercise-related injuries and adverse events in patients with type 2 diabetes. Postgrad Med J. 2013;89:715–21.

    Article  PubMed  Google Scholar 

  83. Wallberg-Henriksson H, Gunnarsson R, Rossner S, et al. Long-term physical training in female type 1 (insulin-dependent) diabetic patients: absence of significant effect on glycaemic control and lipoprotein levels. Diabetologia. 1986;29:53–7.

    Article  PubMed  CAS  Google Scholar 

  84. Ebeling P, Tuominen JA, Bourey R, et al. Athletes with IDDM exhibit impaired metabolic control and increased lipid utilization with no increase in insulin sensitivity. Diabetes. 1995;44:471–7.

    Article  PubMed  CAS  Google Scholar 

  85. Galassetti P, Mann S, Tate D, et al. Effects of antecedent prolonged exercise on subsequent counterregulatory responses to hypoglycemia. Am J Physiol Endocrinol Metab. 2001;280:E908–17.

    Article  PubMed  CAS  Google Scholar 

  86. Lehmann R, Kaplan V, Bingisser R, et al. Impact of physical activity on cardiovascular risk factors in iddm. Diabetes Care. 1997;20:1603–11.

    Article  PubMed  CAS  Google Scholar 

  87. Moy CS, Songer TJ, LaPorte RE, et al. Insulin-dependent diabetes mellitus, physical activity, and death. Am J Epidemiol. 1993;137:74–81.

    Article  PubMed  CAS  Google Scholar 

  88. Zinman B, Ruderman N, Campaigne BN, et al. Physical activity/exercise and diabetes. Diabetes Care. 2004;27:S58–62.

    Article  Google Scholar 

  89. Horton ES. Role and management of exercise in diabetes mellitus. Diabetes Care. 1988;11:201–11.

    Article  PubMed  CAS  Google Scholar 

  90. Henriksson J. Effects of physical training on the metabolism of skeletal muscle. Diabetes Care. 1992;15:1701–11.

    Article  PubMed  CAS  Google Scholar 

  91. Jenni S, Oetliker C, Allemann S, et al. Fuel metabolism during exercise in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus-a prospective single-blinded randomised crossover trial. Diabetologia. 2008;51:1457–65.

    Article  PubMed  CAS  Google Scholar 

  92. Jenni S, Christ ER, Stettler C. Exercise-induced growth hormone response in euglycaemia and hyperglycaemia in patients with type 1 diabetes mellitus. Diabet Med. 2010;27:230–3.

    Article  PubMed  CAS  Google Scholar 

  93. Jenni S, Wueest S, Konrad D, et al. Response of interleukin-6 during euglycaemic and hyperglycaemic exercise in patients with type 1 diabetes mellitus. Diabetes Res Clin Pract. 2010;89:e27–9.

    Article  PubMed  CAS  Google Scholar 

  94. Stettler C, Jenni S, Allemann S, et al. Exercise capacity in subjects with type 1 diabetes mellitus in eu- and hyperglycaemia. Diabetes Metab Res Rev. 2006;22:300–6.

    Article  PubMed  Google Scholar 

  95. American Diabetes Association. Physical activity/exercise and diabetes. Diabetes Care. 2004;27(Suppl 1):S58–62.

    Google Scholar 

  96. Durak EP, Jovanovic-Peterson L, Peterson CM. Randomized crossover study of effect of resistance training on glycemic control, muscular strength, and cholesterol in type I diabetic men. Diabetes Care. 1990;13:1039–43.

    Article  PubMed  CAS  Google Scholar 

  97. Ramalho AC, de Lourdes Lima M, Nunes F, et al. The effect of resistance versus aerobic training on metabolic control in patients with type-1 diabetes mellitus. Diabetes Res Clin Pract. 2006;72:271–6.

    Article  PubMed  CAS  Google Scholar 

  98. Gibala MJ. High-intensity interval training: a time-efficient strategy for health promotion? Curr Sports Med Rep. 2007;6:211–3.

    PubMed  Google Scholar 

  99. Bussau VA, Ferreira LD, Jones TW, et al. The 10-s maximal sprint: a novel approach to counter an exercise-mediated fall in glycemia in individuals with type 1 diabetes. Diabetes Care. 2006;29:601–6.

    Article  PubMed  Google Scholar 

  100. Guelfi KJ, Jones TW, Fournier PA. The decline in blood glucose levels is less with intermittent high-intensity compared with moderate exercise in individuals with type 1 diabetes. Diabetes Care. 2005;28:1289–94.

    Article  PubMed  CAS  Google Scholar 

  101. Bussau VA, Ferreira LD, Jones TW, et al. A 10-s sprint performed prior to moderate-intensity exercise prevents early post-exercise fall in glycaemia in individuals with type 1 diabetes. Diabetologia. 2007;50:1815–8.

    Article  PubMed  CAS  Google Scholar 

  102. Guelfi KJ, Ratnam N, Smythe GA, et al. Effect of intermittent high-intensity compared with continuous moderate exercise on glucose production and utilization in individuals with type 1 diabetes. Am J Physiol Endocrinol Metab. 2007;292:E865–70.

    Article  PubMed  CAS  Google Scholar 

  103. Maran A, Pavan P, Bonsembiante B, et al. Continuous glucose monitoring reveals delayed nocturnal hypoglycemia after intermittent high-intensity exercise in nontrained patients with type 1 diabetes. Diabetes Technol Ther. 2010;12:763–8.

    Article  PubMed  Google Scholar 

  104. West DJ, Stephens JW, Bain SC, et al. A combined insulin reduction and carbohydrate feeding strategy 30 min before running best preserves blood glucose concentration after exercise through improved fuel oxidation in type 1 diabetes mellitus. J Sports Sci. 2011;29:279–89.

    Article  PubMed  Google Scholar 

  105. Riddell MC, Gallen IW, Smart CE, et al. Exercise management in type 1 diabetes: a consensus statement. Lancet Diabetes Endocrinol. 2017;5:377–90.

    Article  PubMed  Google Scholar 

  106. Yardley JE, Sigal RJ, Perkins BA, et al. Resistance exercise in type 1 diabetes. Can J Diabetes. 2013;37:420–6.

    Article  PubMed  Google Scholar 

  107. Yardley JE, Hay J, Abou-Setta AM, et al. A systematic review and meta-analysis of exercise interventions in adults with type 1 diabetes. Diabetes Res Clin Pract. 2014;106:393–400.

    Article  PubMed  Google Scholar 

  108. Tonoli C, Heyman E, Roelands B, et al. Effects of different types of acute and chronic (training) exercise on glycaemic control in type 1 diabetes mellitus: a meta-analysis. Sports Med. 2012;42:1059–80.

    Article  PubMed  Google Scholar 

  109. Hansen D, Stevens A, Eijnde BO, et al. Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: a critical re-appraisal of current evidence. Sports Med. 2012;42:11–30.

    Article  PubMed  Google Scholar 

  110. Murlasits Z, Radák Z. The effects of statin medications on aerobic exercise capacity and training adaptations. Sports Med. 2014;44:1519–30.

    Article  PubMed  Google Scholar 

  111. Kawano Y, Takemoto M, Mito T, et al. Silent myocardial ischemia in asymptomatic patients with type 2 diabetes mellitus without previous histories of cardiovascular disease. Int J Cardiol. 2016;216:151–5.

    Article  PubMed  Google Scholar 

  112. Hansen D, Coninx K, Dendale P. The EAPC EXPERT tool. Eur Heart J. 2017;38:2318–20.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium

    Dominique Hansen & Paul Dendale

  2. UHasselt, Faculty of Medicine and Life Sciences, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Agoralaan, Building A, 3590, Diepenbeek, Belgium

    Dominique Hansen, Martijn A. Spruit & Paul Dendale

  3. Institute of Sports Medicine, Prevention and Rehabilitation, Research Institute of Molecular Sports Medicine and Rehabilitation, Paracelsus Medical University Salzburg, Sports Medicine of the Olympic Center Salzburg-Rif, Salzburg, Austria

    Josef Niebauer

  4. Research group of Cardiovascular Rehabilitation, Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, KU Leuven, Louvain, Belgium

    Veronique Cornelissen & Luc Vanhees

  5. Family Medicine Department, National O.O. Bogomolets Medical University, Kiev, Ukraine

    Olga Barna

  6. Sport and Exercise Medicine Division, Department of Medicine, University of Padova, Padua, Italy

    Daniel Neunhäuserer

  7. University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University of Salzburg, Salzburg, Austria

    Daniel Neunhäuserer

  8. Division of Endocrinology, Diabetes and Clinical Nutrition, University Hospital/Inselspital, Bern, Switzerland

    Christoph Stettler

  9. Department of Rehabilitation Science and Physiotherapy, Ghent University, Ghent, Belgium

    Cajsa Tonoli

  10. Fuscaldo, CS, Italy

    Eugenio Greco

  11. Hypertension and Cardiovascular Rehabilitation Unit, KU Leuven University, Louvain, Belgium

    Robert Fagard

  12. UHasselt, Faculty of Sciences, Expertise Centre for Digital Media, Hasselt University, Hasselt, Belgium

    Karin Coninx & Gustavo Rovelo Ruiz

  13. Heart Failure Unit, Cardiac Department, Guglielmo da Saliceto Hospital, AUSL Piacenza, Piacenza, Italy

    Massimo F. Piepoli

  14. Department of Medicine and Cardiorespiratory Rehabilitation, Istituti Clinici Scientifici Maugeri, IRCCS Tradate, Tradate, Varese, Italy

    Roberto Pedretti & Simona Sarzi Braga

  15. Cardiologic Rehabilitation Department, Istituti Clinici Scientifici Salvatore Maugeri, SPA, SB, Scientific Institute of di Veruno, IRCCS, Veruno, NO, Italy

    Ugo Corrà

  16. Department of Cardiology, Clinic Barmelweid, Barmelweid, Switzerland

    Jean-Paul Schmid

  17. Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece

    Constantinos H. Davos

  18. Department of Internal Medicine with Cardiology, Charité-Universitaetsmedizin Berlin, Campus Virchow Klinikum, Berlin, Germany

    Frank Edelmann

  19. Department of Cardiology and Pneumology, University of Göttingen, Göttingen, Germany

    Frank Edelmann

  20. German Center for Cardiovascular Research, Partner Site Berlin, Göttingen, Germany

    Frank Edelmann

  21. Cardiology Department, Hospital Santa Marta, Lisbon, Portugal

    Ana Abreu

  22. Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen Am Rhein, Germany

    Bernhard Rauch

  23. Cardiovascular Rehabilitation Unit, Le Terrazze Clinic, Cunardo, Italy

    Marco Ambrosetti

  24. Department of Cardiology, Antwerp University Hospital, Edegem, Belgium

    Paul Beckers

  25. Translational Pathophysiological Research, Antwerp University, Antwerp, Belgium

    Paul Beckers

  26. Unit of Cardiorespiratory Rehabilitation, Instituti Clinici Maugeri, Institute of Milan, IRCCS, Milan, Italy

    Maurizio Bussotti

  27. Cardiology Department, Spedali Civili, Brescia, Italy

    Pompilio Faggiano

  28. Cardiology Service of Complejo Hospitalario Universitario de León, Léon, Spain

    Esteban Garcia-Porrero

  29. Laboratory of Sports Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Evangelia Kouidi

  30. CUB Erasme Hospital, Brussels, Belgium

    Michel Lamotte

  31. Cardiological Outpatient Clinics at the Park Sanssouci, Potsdam, Germany

    Rona Reibis

  32. Department of Research and Education, CIRO + , Centre of Expertise for Chronic Organ Failure, Horn, The Netherlands

    Martijn A. Spruit

  33. Department of Respiratory Medicine, Maastricht University Medical Centre, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands

    Martijn A. Spruit

  34. Division of Pediatrics, Child Development and Exercise Center, Wilhelmina Children’s Hospital, UMC Utrecht, Utrecht, The Netherlands

    Tim Takken

  35. Internal Medicine and Cardiac Rehabilitation, Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy

    Carlo Vigorito

  36. Department of Cardiology, Klinik am See, Rüdersdorf, Germany

    Heinz Völler

  37. Center of Rehabilitation Research, University of Potsdam, Potsdam, Germany

    Heinz Völler

  38. Department of Health Sciences, University of York, York, UK

    Patrick Doherty

Authors
  1. Dominique Hansen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Josef Niebauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Veronique Cornelissen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olga Barna
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Daniel Neunhäuserer
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Christoph Stettler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Cajsa Tonoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eugenio Greco
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Robert Fagard
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Karin Coninx
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Luc Vanhees
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Massimo F. Piepoli
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Roberto Pedretti
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Gustavo Rovelo Ruiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Ugo Corrà
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Jean-Paul Schmid
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Constantinos H. Davos
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Frank Edelmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. Ana Abreu
    View author publications

    You can also search for this author in PubMed Google Scholar

  20. Bernhard Rauch
    View author publications

    You can also search for this author in PubMed Google Scholar

  21. Marco Ambrosetti
    View author publications

    You can also search for this author in PubMed Google Scholar

  22. Simona Sarzi Braga
    View author publications

    You can also search for this author in PubMed Google Scholar

  23. Paul Beckers
    View author publications

    You can also search for this author in PubMed Google Scholar

  24. Maurizio Bussotti
    View author publications

    You can also search for this author in PubMed Google Scholar

  25. Pompilio Faggiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  26. Esteban Garcia-Porrero
    View author publications

    You can also search for this author in PubMed Google Scholar

  27. Evangelia Kouidi
    View author publications

    You can also search for this author in PubMed Google Scholar

  28. Michel Lamotte
    View author publications

    You can also search for this author in PubMed Google Scholar

  29. Rona Reibis
    View author publications

    You can also search for this author in PubMed Google Scholar

  30. Martijn A. Spruit
    View author publications

    You can also search for this author in PubMed Google Scholar

  31. Tim Takken
    View author publications

    You can also search for this author in PubMed Google Scholar

  32. Carlo Vigorito
    View author publications

    You can also search for this author in PubMed Google Scholar

  33. Heinz Völler
    View author publications

    You can also search for this author in PubMed Google Scholar

  34. Patrick Doherty
    View author publications

    You can also search for this author in PubMed Google Scholar

  35. Paul Dendale
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

DH, JN, VC, OB, DN, CS, CT, EG, RF, KC, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, PD, and PD contributed to the conception or design of the work. DH, JN, VC, OB, DN, CS, CT, EG, RF, KC, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, PD, and PD contributed to the acquisition, analysis, or interpretation of data for the work. DH, PD and KC drafted the manuscript. JN, VC, OB, DN, CS, CT, EG, RF, LV, MP, RP, GRR, UC, J-PS, CD, FE, AA, BR, MA, SSB, PB, MB, PF, EG-P, EK, ML, RR, MS, TT, CV, HV, and PD critically revised the manuscript. All gave final approval and agreed to be accountable for all aspects of work ensuring integrity and accuracy.

Corresponding author

Correspondence to Dominique Hansen.

Ethics declarations

Funding

The realisation of the proof of concept of the EXPERT tool was supported by an UHasselt IOF PoC project.

Conflicts of interest

Dominique Hansen, Josef Niebauer, Veronique Cornelissen, Olga Barna, Daniel Neunhäuserer, Christoph Stettler, Cajsa Tonoli, Eugenio Greco, Robert Fagard, Karin Coninx, Luc Vanhees, Massimo Piepoli, Roberto Pedretti, Gustavo Rovelo Ruiz, Ugo Corrà, Jean-Paul Schmid, Constantinos Davos, Frank Edelmann, Ana Abreu, Bernhard Rauch, Marco Ambrosetti, Simona Sarzi Braga, Paul Beckers, Maurizio Bussotti, Pompilio Faggiano, Esteban Garcia-Porrero, Evangelia Kouidi, Michel Lamotte, Rona Reibis, Martijn Spruit, Tim Takken, Carlo Vigorito, Heinz Völler, Patrick Doherty and Paul Dendale declare that they have no conflicts of interest relevant to the content of this review.

Additional information

EXPERT stands for ‘EXercise Prescription in Everyday practice & Rehabilitative Training’, this working group is endorsed by the European Association of Preventive Cardiology (EAPC).

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 14 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hansen, D., Niebauer, J., Cornelissen, V. et al. Exercise Prescription in Patients with Different Combinations of Cardiovascular Disease Risk Factors: A Consensus Statement from the EXPERT Working Group. Sports Med 48, 1781–1797 (2018). https://doi.org/10.1007/s40279-018-0930-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-018-0930-4

Search

Navigation