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
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.
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