Hubert Dereppe

Position paper of the Belgian Working Group on Cardiovascular Prevention and Rehabilitation: cardiovascular rehabilitation.

The Belgian Working Group on Cardiovascular Prevention and Rehabilitation has taken the initiative to write a position paper with the aim to optimize the quality of cardiovascular rehabilitation (CR) in Belgium. This position paper is based on existing guidelines from the European and American cardiological societies and published reviews, and reflects the optimal organisation of CR according to the scientific knowledge in this field, adapted to the Belgian situation. They are intended to be used as a basis for measures of quality control for rehabilitation centres and for the organisation of peer review. Cardiovascular rehabilitation has been defined by the former working group on Cardiac Rehabilitation of the European Society of Cardiology (ESC) as “the sum of interventions required to ensure the best possible physical, psychological and social conditions, so that the patients with subacute or chronic heart disease may, by their own efforts, preserve or resume a place as normal as possible in the life of the community”. Cardiac rehabilitation is conventionally divided into three phases1,2: • phase 1: acute/subacute rehabilitation: in-hospital mobilisation, education and psychosocial counselling/referral (first days or weeks after admission), • phase 2: convalescence: reconditioning/early lifestyle modification, • phase 3: long-term maintenance programme. Effectiveness and cost-effectiveness of CR for a wide range of indications have been documented by several meta-analyses3-7, but also by publications from Belgium8,9: mortality and morbidity are reduced by 25-30%. A recent publication10 showed that more than half of the mortality reduction caused by CR is due to an increased improvement in coronary risk profile.

Biofeedback on heart rate variability in cardiac rehabilitation: Practical feasibility and psycho-physiological effects

Objective Biofeedback is a self-regulation therapy by which the patient learns how to optimize the functioning of his autonomic nervous system. It has been applied to patients with various cardiovascular disorders. The purpose of this study was to investigate the practical feasibility and the psychophysiological effects of biofeedback applied to heart rate variability (HRV biofeedback) in order to increase cardiac coherence in coronary artery disease (CAD) patients participating in a cardiac rehabilitation programme. Methods and results In this randomised and controlled study, 31 CAD patients were randomly assigned to an experimental or to a control group. The experimental group participated in a programme of 10 sessions of cardiac coherence biofeedback training, in addition to the rehabilitation programme. The control group participated in the usual cardiac rehabilitation programme only. Physiological variables (systolic and diastolic blood pressure, SDNN) and psychosocial variables (anxiety, depression, type D personality) were measured at the start and at the end of the programme in both groups. Statistical comparisons assessed the inter and intra group differences. The small sample size precludes any fi rm conclusions concerning the effect of cardiac coherence biofeedback on physiological or psychological variables. However, we observed a significant increase of the percentage of cardiac coherence, in relation with an increased SDNN index. Conclusions Our study demonstrated the practical feasibility of cardiac coherence biofeedback training in CAD patients. Further research is desirable to investigate the potential benefit of cardiac coherence biofeedback as an adjunct to stress management in cardiac rehabilitation.