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The EACPR EXPERT Flowchart Project

EXercise Prescription in Everyday practice & Rehabilitation Training - a project of the EACPR Cardiac Rehabilitation Section


In adult individuals with cardiovascular disease (CVD) and/or CVD risk factors, the implementation of exercise therapy is considered a cornerstone. This is endorsed by clinical guidelines from various international instances. However, it becomes difficult to properly select training modalities in presence of a combination of CVD risk factors and/or diseases since in previous guidelines specific training modalities are proposed for each individual CVD risk factor and cardiovascular pathology separately.


Project aims

Therefore, the aim of this European project is:

  1. To develop a flowchart that assists physicians and healthcare professionals to choose and adopt the optimal exercise intervention in patients with various CVDs and/or a combination of risk factors.
  2. To implement the flowchart as an e-learning tool/web application, which shall assists physicians and healthcare professionals to choose and implement effective exercise interventions in patients with CVDs and/or various risk factors.
  3. To provide the theoretical framework of the actual state of the art in exercise prescription and to promote its application by the ESC e-learning platform or educational activities.


In this project, 28 cardiopulmonary rehabilitation experts throughout Europe contribute to this flowchart. These experts will collect state-of the art evidence (mainly out of meta-analyses and clinical guidelines) for exercise prescription in certain CVD’s, CVD risk factors, and chronic disease that require modification of exercise prescription. In this prescription, the experts need to define exercise intensity, frequency and duration, type of exercise, minimal program duration and safety precautions for exercise.

The included CVD’s in this flowchart are:

• Angina pectoris
• Coronary artery disease (CAD) with recent coronary artery bypass graft (CABG)
• CAD with recent percutaneous coronary intervention (PCI)
• CAD with acute myocardial infarction
• Heart failure with lowered left-ventricular ejection fraction
• Heart failure with preserved left-ventricular ejection fraction
• Claudicating intermittens
• Pacemaker / implantable cardioverter defibrillator (ICD)
• Assist devices
• Cardiac transplantation
• Valve surgery without CABG
• Congenital heart disease

The included CVD risk factors in this flowchart are:
• Hypertension
• Dislipidemia
• Insulin resistance/type 2 diabetes
• Type 1 diabetes
• Obesity

The exercise modifiers
(factors/chronic diseases that significantly affect the content of rehabilitation intervention) are:

• Cardiac resynchronisation therapy (CRT) in heart failure
• Pulmonary hypertension
• Chronic lung disease
• Renal failure and sarcopenia/frailty

It thus follows that the EACPR EXPERT-flowchart will be constructed based on 22 different CVD’s, CVD risk factors and exercise modifiers. 


A first project group meeting has occurred at EuroPrevent 2013 in Rome. Currently, the EXPERT-flowchart contributors are collecting state-of-the-art evidence from the literature to define the specific training modalities. A next group meeting is planned at the ESC Congress in Amsterdam, where (hopefully) the first draft of this flowchart will be proposed. It is aimed to finalise this flowchart afterwards (based on observed difficulties, and suggestions/comments from the EXPERT-flowchart members), and propose the final EACPR EXPERT-flowchart at EuroPrevent 2014 in Amsterdam. It is foreseen to produce an EXPERT-flowchart i-pad/i-phone application once the scientific work is finalised.

Project Coordinator:
Dominique Hansen (BE)

Promoters: Paul Dendale (BE), Jean-Paul Schmid (CH)

Project contributors: Luc Vanhees (BE), Bernhard Rauch (DE), Patrick Doherty (UK), Massimo Piepoli (IT), Ugo Corra (IT), Paul Beckers (BE), Frank Edelmann (DE), Olga Barna (UKR),  Christoph Stettler (CH), Cajsa Tonoli (BE), Joseph Niebauer (AUT), Veronique Cornelissen (BE), Robert Fagard (BE),  Eugenio Greco (IT), Pompilio Faggiano (IT), Viviane Conraads (BE), Michel Lamotte (BE), Heinz Voller (DE), Carlo Vigorito (IT), Ana Abreu (POR), Martijn Spruit (NL), Evangelia Kouidi (GR), Tim Takken (NL), Constantinos Davos (GR), Esteban Garcia-Porrero (ESP)