Physical activity in patients with CHD

a collaborative partnership to identify and share good practices among European countries

BACKGROUND

Erasmus+ Programme

 

In the field of sport, the Erasmus+ Programme aims to support actions that result in the development, transfer, and implementation of innovative ideas and practices at European, national, regional, and local level.

 

It is also expected that Sport Actions will contribute to the development of a European dimension to sport, increasing cooperation and

harmonisation between sport organisations.

 

The Erasmus+ programme provides support for several opportunities in the field of sport, including funding for:

• Collaborative partnerships

• Non-profit European sports events

• Actions that strengthen the evidence base for policy-making

 

The programme is open to a variety of organisations, including, among others:

• Public sporting bodies,

• Sporting organisations, leagues, and clubs at any level,

• Sporting unions or representations,

• Organisations active in promoting physical activity, including social inclusion in sports,

• Event organisers in the sport sector

Cardiovascular rehabilitation (CR)

 

In Europe CHD accounts for an estimated 1.95 million deaths each year, CHD is estimated to cost the EU economy €60 billion a year: of the total cost of CHD in the EU, around 33% is due to direct health care costs, 29% to productivity losses and 38% to the informal care of people with CHD.

 

The importance of physical activity in maintaining an high level of health in the population is a well known concept. The concept of “sport as medicine” to be prescribed exactly as a therapy, with indications, contraindications, dosage and administration, warning and precautions, risk of over dosage, and monitoring of compliance is more recent and difficult to be implemented. Eventually the role of Cardiac Rehabilitation (CR) after myocardial infarction, percutaneous coronary intervention or coronary bypass surgery has been fully demonstrated, but has not yet been accepted both by physicians and patients.

 

In meta-analyses of randomized clinical trials, exercise training after myocardial infarction improves quality of life and reduces the risk of recurrent myocardial infarction and death. Improvement in cardiovascular fitness appears to be a significant factor in the mortality reduction seen in CR.  As demonstrated by an international recent study the level of implementation of CR is very low in respect to the expected and factors associated fell into two broad groups: individual factors (general health, comorbidities, symptoms) and external factors (country, therefore level of assistance and culture, and level of education). The last can be considered as modifiable factors, and in the same country the decrease of physical activity after diagnosis of CHD correlates with cultural and/or health system-related factors in influencing physical activity in CHD patients.

 

Nevertheless while guidelines recommend 30 min of moderate or vigorous exercise each day many patients and their health advisors may be cautious. However for most CHD patients, the benefits of increasing physical activity are likely to outweigh the small risk of exercise triggering myocardial infarction or sudden death.  This explains the large international differences worldwide and also within the European Community in rates of attendance at cardiac rehabilitation and in the proportion of subjects reporting a decrease in exercise since CHD diagnosis.

 

CR programs are frequently unavailable and underutilized resources. Not only CR is generally under-resourced, despite the well known positive effects and the long term cost-effectiveness, but physician training in exercise physiology, nutrition and behavioural management is limited. Medical culture about physical activity promotion is low. Physicians often ignore the data about the prescription of physical activity and the healthcare system is currently focused with procedures and pharmaceuticals, with a widespread underestimation of the impact of exercise as “medicine” as in CR.

 

Many countries now recognise the importance of CR programs but struggle to raise the requisite funding. Even when funding is available, there remains a lack of applicable resources and acceptance among physicians, patients, and their families. In countries where resource and training assistance has been provided, CR programs have been successful. Successful programs have significant community development implications because patients will come back to working activities and to a full life.

 

In the field of CR a possible solution suggested is to make a strong change in mentality among general population (patients and their families), healthcare professionals, public health authorities and decision makers.

 

OBJECTIVES

According to the ERASMUS+ SPORT programme, TAKE HEART project general objective is to promote social inclusion, equal opportunities and awareness of the importance of health-enhancing physical activity, through increased participation in, and equal access to sport for all.

 

In particular, the project, by means of its activities will support the implementation of the EU Physical Activity Guidelines, to encourage participation in sport and physical activity.

 

At systemic level, TAKE HEART project will expect to contribute to the development of the European dimension in physical activity for all, in line with the general objective of the Programme in the sport field.

 

From an individual's perspective, TAKE HEART project will engage patients and will motivate them to perform CR and to maintain an high adherence to physical activity programs and therefore to increased levels of participation in sport and physical activity.

 

PROJECT SUMMARY

An innovative approach to be used is that of partnership working, ie working across and within sectors pertaining to health in its broadest sense and to find and evaluate original approaches to guarantee an equal access to physical activity to all citizens with CHD across Europe.

 

The collaborative efforts and cooperation among the European Community Member States involved in this project will enable an exchange of information on strengths and weaknesses of the previous experiences of the countries involved and in relation to best practices for improving the CR. This exchange will help to avoid duplication of effort as well as improving the cost effectiveness of the activities.

 

The media coverage at national level in all the participating countries will increase in Europe the awareness about CR and its benefits.

Cultural, societal and health system-related factors need to be considered when planning strategies to increase physical activity in CHD patients. Hence is crucial to create a positive and powerful culture through articles, conferences, education activityies and mainly sharing of good  practices with the aim to encourages vigorous PA and other healthy behaviours, and otherwise to reassure frightened or hesitant subjects.

The good practices on cardiac rehabilitation will be based on the ESC guidelines and the EU Physical Activity Guidelines, but they will take in consideration the local situations, in order to implement activities feasible in local contexts characterized by different cultural, societal and health system-related profiles. Finally the activity of development of good practice will be announced to the health system responsibles, the scientific community and to the general population.

WORKPACKAGES

WP1 - PROJECT MANAGEMENT

 

The coordination of the project coherent structured Project Management Scheme is required in light of the number of participants, the ambitious objectives and the tight time frame of the project.

 

Overall Project Management will be under the responsibility of the applicant; the most effective method to keep the Project manageable is to allocate responsibility for self-contained work-subsets. The role of each partner is clearly defined and in line with the partner's expertise and experience in a specialised field. The Consortium will establish a shared workspace, accessible through the Internet, where draft reports and deliverables will be available for internal review and comment. The preferred method of communication is e-mail and skype, with regular TCs. After the kick-off meeting at M1, a two days meeting will be organized in M10 for the  identification of the good practices and a third meeting will be represented by the Train the Trainers event in M18.

WP2 – DISSEMINATION

 

The project objectives will be achieved, on the one hand by improving the knowledge of physicians, coaches and all the stakeholders involved and on the other by increasing awareness and acceptance by patients and their families. The dissemination of project materials across Europe, mainly through major networks will amplify the effects. Furthermore in each country, a conference for the general population and media activities will be organized to increase the awareness.

WP3 - EVALUATION OF THE PROJECT

 

A process of continuous and final evaluation will be developed. It will consist in a follow-up every six months, with record-filing systems, to analyse the execution of the project comparing the plan to the practice. Operative Report will be issued using this information including critical issues and suggestions aimed at project optimisation.

 

At the end of the project, a final evaluation report will be performed by a selected and specialised company, based on the documentation analysis, assessment of the project collaborators (feedback evaluation questionnaire), as well as beneficiaries of the project.

WP4 - ANALYSIS OF THE LOCAL CONTEXT

 

Development of a deep analysis of local context in the participating countries (CHD epidemiology, CR structures, CR protocols, identification of the project target groups and assessment of their needs) to verify the development of cardiac rehabilitation and the local unmet needs.

WP5 - IDENTIFICATION OF GOOD PRACTICES

 

Each country will explore promoting and inhibiting factors of CR through an analysis of successful and unsuccessful local experiences. Obviously, the needs have different weights and characteristics in each participating country; in the course of work the modalities to ensure that actions are balanced according to the actual needs of the participating countries will be defined.

 

The evaluation of the good practices will allow to imagine for the different European local contexts cost-effective and applicable solutions.

 

Moving from international guidelines and based on a wide literature review the participants will identify good practices in the field of CR and will share a final document.

 

WP6 - TRAIN THE TRAINERS ACTIVITY

 

A Train the trainers (TtT) methodology will be used to implement medical educational activities through the organization of a training course for healthcare professionals working in the selected countries. For each participating country will be selected 2 healthcare professionals and they will be involved in the TAKE HEART training programme. At the end of the course, these professionals will be able to train other professionals. The training contents will be adapted to the local needs and will address the project target group.

WP7 - E-LEARNING ENVIRONMENT

 

A digital platform will be available for all the users of the participating countries interested in the training on the project issues. This tool will assure a a constant updating and support in the replication of the training courses in each local context and a high dissemination of the project contents in a cost-effectiveness way. The educational contents will be prepared for healthcare contents, but practical educational packages will be structured to involve also selected trainers.

 

PARTNERS

Institute of Sports Medicine and Science CONI Servizi

 

PIC number: 937739353

Rome - Italy

The Institute of Sports Medicine and Science is a national health care and scientific structure of Coni Servizi. Its role is to implement, in accordance with the guidelines issued by the Italian National Olympic Committee projects pertaining to sports medicine aimed both at practical application and scientific research.

The Institute of Sports Medicine and Science was established by CONI in 1965, with a view to ensuring evaluation, medical and physiological examinations and assistance to Olympic level and high level athletes.   The Institute of Sports Medicine and Science has recently changed its internal organization and its mission. The Institute of Sports Medicine and Science opens the doors to the amateurs and to the general population, offering its experience in the field of physical exercise to the public health, in primary, secondary and tertiary prevention.

 

DEKUT

PIC number: 950248085

Debrecen - Hungary

The « Hungarian Sport and Lifestyle Development Cluster » was established on the 12th of May 2011.

The cluster member’s common interests can be summarized as follows:

• more efficient spread of a healthier lifestyle among the population

• rise of the demand for sport related services, and for goods made by healthy-foodstuff producers

• increase in the quality of the services offered by sport service providers, by the usage of synergy coming from collaboration, from application of best practices and from the supply of complex customer demands

 

LHL-Klinikkene AS

PIC number: 937749829

Oslo - Norway

Department of Cardiac Rehabilitation at the Feiring Heart Clinic (LHL-klinikkene Feiring)

No profit organisation owned by LHL (patient organisation for heart and lung diseases).

The institution (department of cardiology and department of cardiac surgery) has all together 10 physicians with a Ph.D. The department of cardiac rehabilitation has participated and is participating in several scientific studies now and over the past years together with Oslo University Hospital.

 

 UNIVERSITY OF CRAIOVA

 Faculty of Physical Education and Sport-Sports Medicine and Kinesiology Department.

 

PIC number: 999632434

Craiova - Romania

Activity field: Sport research, Kinesiology, Sport medicine, Rehabilitation, Sport training, Sport performance, Biomechanics

The University of Craiova was founded pursuant to Law 138/25 April 1947. The University of Craiova ranks topmost among the Romanian higher education system. The University of Craiova is integrated to the academic European community, sharing its cultural, moral, scientific and educational values.

 

SALK

Gemeinnützige Salzburger Landeskliniken Betriebsgesellschaft mbH

 

PIC number: 938052081

Salzburg - Austria

University Institute of Sports Medicine, Prevention and Rehabilitation

Since 2008, the UIS is a fully equipped outpatient clinic for cardiac rehabilitation. About 30 patients can train simultaneously, endurance exercise or resistance exercise. The clinic is staffed with two physicians, two sports scientists, and a physiotherapist. The UIS is part of the Private Medical University, Salzburg and is completed by the department of sport medicine, and the Research Institute of Molecular Sport and Rehabilitation Medicine to fulfill scientific research.

 

DELIVERABLES

BIBLIOGRAPHY

  • Sallis RE Exercise is medicine and physicians need to Br. J. Sports Med. 2009;43;3-4;
  • Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database SystRev 2011; CD001800.
  • Martin B-J, Arena R, Haykowsky M, Hauer T, Austford LD, Knudtson M, Aggarwal S, Stone JA for the APPROACH Investigators. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clin Proc 2013;88:455–463.
  • Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation 2007;116:1081–1093.
  • Perk J, de Backer G, Gohlke H, Graham I, Reiner Z, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Kaadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvanne M, Op Reimer WJ, Vrints C,Wood D, Zamorano JL, Zannad F. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur J Prev Cardiol 2012;19:585–667.
  • Dahabreh IJ, Paulus JK. Association of episodic physical and sexual activity with triggering of acute cardiac events: systematic review and meta-analysis. JAMA 2011;305: 1225–1233.
  • Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA III, Fulton JE, Gordon NF, Haskell WL, Link MS, Maron MA, Pelliccia A,Wenger NK, Willich SN, Costa F. American Heart Association Councilon Nutrition, Physical Activity and Metabolism; American Heart Association Council on Clinical Cardiology; American College of Sports Medicine. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation 2007;115:2358–2368.
  • Stewart R, Held C, Brown R Physical activity in patients with stable coronary heart disease: an international perspective Eur Heart J. 2013 Nov;34(42):3286-93. doi: 10.1093/eurheartj/eht258. Epub 2013 Sep 6
  • Allison TG Changing medical culture to promote physical activity in secondary prevention of coronary
  • artery disease European Heart Journal (2013) 34, 3245–3247 doi:10.1093/eurheartj/eht363
  • Peterson S, Peto V, Rayner M. European cardiovascular disease statistics - 2005 edition, British Heart Foundation Health Promotion Research Group, Department of Public Health, University of Oxford.
  • http://www.escardio.org/about/documents/eu-cardiovascular-disease-statistics-2012.pd

AUSTRIA

http://www.agakar.at/rehabinstitutionen/ambulante.html

http://www.agakar.at/rehabinstitutionen/stationaere.html

https://rehakompass.goeg.at/Rehazentren/Listenansicht

 

HUNGARY

http://gyogyaszat.aquaticum.hu/hu/kardiologiai-rehabilitacio/

Local public outpatient facility with 3 weeks post-event programme (lifestyle education, sports, physical follow-up)

 

http://www.szivegyesulet.hu/

III phase local CR initiative (regular exercise, social events, sporadic lectures)

 

http://www.mkrt.hu/?p=beteginfo

Hungarian CR association (online education, guidelines and facility directory)

 

http://www.bfkor.hu/

Countries most important public in- and outpatient facility

 

https://ir.kardio.hu/ir/fooldal

National Infarction Registry

 

ITALY

www.gicr.it

 

NORWAY

http://www.helse-bergen.no/no/Sider/default.aspx

https://hnt.no/

http://www.siv.no/

 http://www.vestreviken.no/

 https://stolav.no/

 

ROMANIA

https://www.spitalulmonza.ro/centre/specialitati-medicale/reabilitare-cardiovasculara/

S.C. Centrul Medical Policlinico di Monza S.R.L. –Spitalul Monza

 

http://www.cardiokinetic.ro/reabilitarea-cardio-vasculara.html

Cardio-kinetic

 

http://www.hipocrat2000.ro/hipocrat/centrul_de_preventie_si_recuperare_cardiovasculara_hipocrat

Centrul de Preventie si Recuperare Cardiovasculara Hipocrat

 

http://www.cardiorec.com/

Centrul De Preventie Si Recuperare Cardiovasculara CardioRec Corbeanca –

 

http://www.cardiologie.ro/organizare/sectii/recuperare-cardiovasculara

Institutul de boli cardiovasculare Timisoara- Sectia Recuperare Cardiovasculara

 

http://www.cardiom.ro/#/service-cardiomed

CardioMed Craiova

 

LINKS

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CONTACTS

This project has been funded with support from the European Commission (ERA-COPART - G.A. 2014-3140/002-001 – ERASMUS+ SPORT). This project product reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

take heart project - Piazza Lauro de Bosis, 15 00135 - Roma - Italia - P.I. 00993181007