Introduction La maladie coronarienne reste une des premières causes de morbi-mortalité, et est responsable d'un coût social important. La reprise du travail est un objectif essentiel quand cette pathologie concerne les patients en activité professionnelle. Les données françaises restent parcellaires et relativement anciennes. Le GERSP (Groupe Exercice Réadaptation Sport et Prévention) de la Société Française de Cardiologie a proposé une étude multicentrique afin d'actualiser ces données. Méthodes Au décours d'un syndrome coronarien aigu, l’équipe cardiologique proposait au patient qui était en activité professionnelle de répondre à un questionnaire portant sur la pathologie, la profession et le projet de reprise. Un entretien au-delà de 6 mois permettait d'analyser la situation clinique et professionnelle du patient, afin d’étudier les facteurs associés à la reprise du travail. Résultats Entre 2018 et 2019, 364 patients ont été inclus dans 6 centres interventionnels et 17 centres de réadaptation cardiaque. Le taux de reprise était de 81 % (n = 295), dont 93 % dans le même poste, dans un délai moyen de 106 ± 56 jours. Les facteurs indépendants de non-reprise étaient sur le plan cardiologique la fraction d’éjection ventriculaire gauche, la présence d'un anticoagulant, un angor ou une insuffisance cardiaque, et sur le plan professionnel un travail posté, l'exposition au froid et les cadences imposées. Les facteurs d'allongement du délai de reprise étaient le retard d'accès à la réadaptation, le port de charges lourdes, les positions difficiles, les cadences imposées, mais également l'absence de projet du patient, l'absence d'avis du cardiologue et la demande d'aménagement du poste de travail. Conclusion Le taux de reprise du travail reste assez stable malgré l’évolution de la prise en charge de la maladie, et le délai de reprise relativement élevé. Une piste pour améliorer la situation consiste à améliorer l'accès aux programmes de réadaptation cardiaque, en proposant par exemple des alternatives comme la télé-réadaptation pour une partie des patients. Cela permettra de consacrer plus de temps aux patients plus sévères afin de mieux les préparer physiquement et psychologiquement à la reprise du travail, ce qui aura également un effet bénéfique économique.

INTRODUCTION:Coronary heart disease remains one of the leading causes of morbidity and mortality, and is responsible for significant social costs. Resumption of work is an essential objective when this pathology concerns working patients. French data remain patchy and relatively old. The French Society of Cardiology's Exercise, Rehabilitation, Sport and Prevention Group has proposed a multicentre study to update these data. METHODS:Following an acute coronary syndrome (ACS), the cardiology team asked the patient, who was currently working, to complete a questionnaire on his or her pathology, occupation and plans to return to work. An interview after 6 months enabled the clinical and professional situation of the patient to be analyzed, in order to study the factors predictive of a return to work. RESULTS:364 patients were included in 6 interventional and 17 cardiac rehabilitation centres between 2018 and 2019. The resumption rate was 81% (n = 295), 93% of them in the same position, with a mean delay of 106 ± 56 days. The cardiologic independent factors for non-return were left ventricular ejection fraction, the presence of an anticoagulant, angina or heart failure, and occupational factors, shift work, exposure to cold, and imposed work rates. Factors that lengthened the time taken to return to work included delayed access to rehabilitation, the carrying of heavy loads, difficult postures and imposed work rates, as well as the patient's lack of a project, the absence of a cardiologist's opinion and the request for a modified workstation. CONCLUSION:The rate of return to work remains fairly stable despite the evolution of disease management, and the time to return to work relatively high. One way of improving the situation is to enhance access to cardiac rehabilitation programs, for example by offering alternatives such as tele-rehabilitation for a proportion of patients. This will free up more time for more severe patients, to better prepare them physically and psychologically for a return to work, which will also have a beneficial economic effect.

A pre-participation medical assessment before cardiac rehabilitation (CR) is mandatory in order to deliver a safe programme tailored to the individual patient. This initial evaluation also aims to increase patient adherence and the efficiency of the programme. The entry assessment includes the following components: history, global patient evaluation including clinical questionnaires, physical examination, laboratory analysis, and non-invasive cardiovascular testing. Following this assessment, a risk stratification should be performed to determine the appropriate CR modalities.

Background Exercise training as part of a comprehensive cardiac rehabilitation is recommended for patients with cardiac heart failure. It is a valuable method for the improvement of exercise tolerance. Some studies reported a similar improvement with quadricipital electrical myostimulation, but the effect of combined exercise training and electrical myostimulation in cardiac heart failure has not been yet evaluated in a large prospective multicentre study. Purpose The aim of this study was to determine whether the addition of low frequency electrical myostimulation to exercise training may improve exercise capacity and/or muscular strength in cardiac heart failure patients. Methods Ninety-one patients were included (mean age: 58 ± 9 years; New York Heart Association II/III: 52/48%, left ventricular ejection fraction: 30 ± 7%) in a prospective French study. The patients were randomised into two groups: 41 patients in exercise training and 50 in exercise training + electrical myostimulation. All patients underwent 20 exercise training sessions. In addition, in the exercise training + electrical myostimulation group, patients underwent 20 low frequency (10 Hz) quadricipital electrical myostimulation sessions. Each patient underwent a cardiopulmonary exercise test, a six-minute walk test, a muscular function evaluation and a quality of life questionnaire, before and at the end of the study. Results A significant improvement of exercise capacity (Δ peak oxygen uptake+15% in exercise training group and +14% in exercise training + electrical myostimulation group) and of quality of life was observed in both groups without statistically significant differences between the two groups. Mean creatine kinase level increased in the exercise training group whereas it remained stable in the combined group. Conclusions This prospective multicentre study shows that electrical myostimulation on top of exercise training does not demonstrate any significant additional improvement in exercise capacity in cardiac heart failure patients.

Cardiovascular mortality has decreased over the past 25 years, largely because of acute coronary syndrome care and preventive actions. Nevertheless, the rate of coronary heart disease remains high, with an annual risk of 4.7% (cardiac mortality, myocardial infarction, stroke). Cardiovascular risk factor management must be a priority in primary and secondary prevention, to improve the prognosis of this severe disease, in which absence of symptoms does not mean benignity. The current goals of therapeutic patient education are smoking cessation, regular physical activity, a cardioprotective (Mediterranean) diet, management of stress, good treatment adherence (which improves compliance), judicious use of the care system and help with occupational reintegration. Current and future programmes must be in accordance with the Haute Autorité de Santé recommendations published in 2007.

text isan extract from thereference ‘‘Good Practice for Cardiac Rehabilitation inAdults 2011’’, which available onwebsite of GERS (Groupe Exercice Readaptation Sport of the French Society of Cardiology [Societe franc¸aise de cardiologie];http://www.sfcardio.fr/groupes/groupes/exercice-readaptation-sport) and contains the complete bibliography, replacing the FrenchSociety of Cardiology text of 2002, version 2, establishing recommendations for cardiac rehabilitation in adults.

Cardiac rehabilitation has been shown to improve exercise tolerance and symptomatology in patients experiencing angina or heart failure and reduce long term mortality after myocardial infarction, with a good cost-effectiveness ratio. In addition to these ‘hard’ endpoints, cardiac rehabilitation improves the patient’s quality of life and risk factor profile through a multifactorial intervention. Indeed, cardiac rehabilitation is no longer restricted to physical reconditioning, but should now be understood as the long term care of cardiac patients through a personalised and periodically updated programme. The components of a comprehensive cardiac rehabilitation programme should comprise risk stratification of the patient, physical reconditioning programmes, secondary prevention and vocational counselling. This article is a synthesis of the principal guidelines and recently published recommendations on cardiac rehabilitation. It focuses on the practical modalities of a cardiac rehabilitation programme, the setting up of the multidisciplinary team, the different facilities according to local possibilities and the patient’s clinical status, the prescription of a personalised programme, safety measures and emergency procedures. Together with these general considerations, special populations which constitute new but growing indications for cardiac rehabilitation are addressed: patients with heart failure, elderly patients and women, who need specific management. In the future, cardiac rehabilitation should be characterised by a likely increase in its indications because of: (i) a predicted high prevalence of coronary artery disease (due to an aging population and an improvement in survival after a cardiac event) despite a lower mortality rate; and (ii) an expansion of the indications in both low and high risk patients. In low risk patients, the goals of cardiac rehabilitation will be to prevent further progression of coronary atheroma and preserve ventricular function by preventive measures such as lifestyle and medical treatment. The needs of high risk patients (who are essentially heart failure patients) are the restoration of autonomy, when lost, and a better quality of life through the improvement of exercise capacity: those patients who were formerly excluded from cardiac rehabilitation programmes are in fact those who are now deriving the greatest benefit from exercise training. Owing to the proven benefits of this new concept of the multifactorial approach, cardiac rehabilitation has, nowadays, become an integral part of the treatment of cardiac patients.

BACKGROUND:Exercise training is included in cardiac rehabilitation programs to enhance physical capacity and cardiovascular function. Among the existing rehabilitation programs, exercises in water are increasingly prescribed. However, it has been questioned whether exercises in water are safe and relevant in patients with stable chronic heart failure (CHF), coronary artery disease (CAD) with normal systolic left ventricular function. The goal was to assess whether a rehabilitation program, including water-based gymnastic exercises, is safe and induces at least similar benefits as a traditional land-based training. METHODS AND RESULTS:Twenty-four male CAD patients and 24 male CHF patients with stable clinical status participated in a 3-week rehabilitation. They were randomized to either a group performing the training program totally on land (CADl, CHFl; endurance + callisthenic exercises) or partly in water (CADw, CHFw; land endurance + water callisthenic exercises). Before and after rehabilitation, left ventricular systolic and cardiorespiratory functions, hemodynamic variables and autonomic nervous activities were measured. No particular complications were associated with both of our programs. At rest, significant improvements were seen in CHF patients after both types of rehabilitation (increases in stroke volume and left ventricular ejection fraction [LVEF]) as well as a decrease in heart rate (HR) and in diastolic arterial pressure. Significant increases in peaks VO(2), HR, and power output were observed in all patients after rehabilitation in exercise test. The increase in LVEF at rest, in HR and power output at the exercise peak were slightly higher in CHFw than in CHFl. CONCLUSIONS:Altogether, both land and water-based programs were well tolerated and triggered improvements in cardiorespiratory function.

Background Rehabilitation programs involving immersed exercises are more and more frequently used, with severe cardiac patients as well. Design This study investigated whether a rehabilitation program including water-based exercises has additional effects on the cardiovascular system compared with a traditional land-based training in heart disease patients. Methods Twenty-four male stable chronic heart failure patients and 24 male coronary artery disease patients with preserved left ventricular function participated in the study. Patients took part in the rehabilitation program performing cycle endurance exercises on land. They also performed gymnastic exercises either on land (first half of the participants) or in water (second half). Resting plasma concentration of nitric oxide metabolites (nitrate and nitrite) and catecholamine were evaluated, and a symptom-limited exercise test on a cycle ergometer was performed before and after the rehabilitation program. Results In the groups performing water-based exercises, the plasma concentration of nitrates was significantly increased (P = 0.035 for chronic heart failure and P = 0.042 for coronary artery disease), whereas it did not significantly change in the groups performing gymnastic exercise on land. No changes in plasma catecholamine concentration occurred. Conclusion In every group, the cardiorespiratory capacity of patients was significantly increased after rehabilitation. The water-based exercises seemed to effectively increase the basal level of plasma nitrates. Such changes may be related to an enhancement of endothelial function and may be of importance for the health of the patients. Eur J Cardiovasc Prev Rehabil 16:215-221 © 2009 The European Society of Cardiology

Hippocrates’ famous aphorism “we are what we eat” is more than ever pertinent at the present time. Indeed, strong scientific evidence has demonstrated that dietary patterns are important determinants of health status, especially concerning the cardiovascular system. However, nutrition must be considered not only as an energetic source, but must be integrated with its other components: culture, beliefs, tradition, and pleasure. This complexity explains why behavioral modifications in nutrition are so difficult to promote and sustain in subjects, often needing deep changes in the ways of being and thinking. Moreover, as cardiovascular prevention is multifactorial, healthy food choices must often be associated with other behavioral modifications, such as smoking cessation or physical exercise, so our main task will be to help patients to cope with all these recommendations.

Aims Little is known about which patients who have undergone coronary bypass surgery are at risk of future clinical cardiovascular events and may benefit from further medical treatment. We sought to determine if routine non-invasive cardiac investigations performed early after surgery were able to stratify the risk of cardiovascular events in this population.Methods Two thousand and sixty-five consecutive patients were enrolled in a prospective multicenter study (PERISCOP). Exercise testing, echocardiography, and 24-h ambulatory ECG monitoring were performed at day 20 10 after coronary bypass surgery. Follow-up was performed 1 year after coronary bypass surgery. Causes of all hospitalisation and death occurring within 1 year were documented and classified by an End-point Committee. The principal endpoint was the combination of all-cause deaths and cardiovascular events requiring hospitalisation (myocardial infarction, unstable or severe angina, stroke, congestive heart failure).Results The 1-year frequency of first events was 155 (8%). In multivariate analysis, exercise duration < 420 s (RR= 1.68; 95% Cl: 1.13-2.49), exercise induced ST segment depression >1 mm (RR = 1.90; 95% Cl: 1.18-3.05), and left ventricular (LV) dysfunction (watt motion index < 1.1 5) (RR = 1.97; 95% Cl: 1.10-3.51) were independent predictors of cardiovascular events and deaths. Ambulatory ECG monitoring had no predictive value.Conclusion Exercise testing and echocardiography performed early after coronary bypass surgery are able to identify high-risk patients who may benefit from intensive secondary prevention. (C) 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. AU rights reserved.

PURPOSE:The aim of this study was to evaluate the predictive factors of return to work after coronary bypass graft surgery, for the subgroup of professionally active patients aged less than 60 years included in the PERISCOP study.METHODS:In the principal, prospective, multicentre study, 2065 patients were evaluated 20+/-10 days after surgery by exercise testing, echocardiogram and 24-h ambulatory ECG monitoring. A questionnaire was completed one year after surgery. We studied a subgroup of this population, consisting of 530 patients previously defined (94.5% men; mean age: 50.5+/-5.8 years).RESULTS:One year after surgery, five of these patients had died and 21 were lost to follow-up. Among the remaining patients, 340 patients (67.5%) had returned to work. Forty patients (7.9%) had retired, 45 (8.9%) were on sick leave, 22 (4.4%) were unemployed, 49 (9.7%) returned to work after the deadline of 12 months, eight (1.6%) had given insufficient information on return to work. In multivariate analysis, the independent predictors of a failure to return to work were age >51 years [OR: 0.39 (95% CI: 0.25-0.59)], being a manual worker [OR: 0.49 (95% CI: 0.31-0.79)], being from South East France [(OR: 0.42 (95% CI: 0.23-0.74)], presence of angina [OR: 0.40 (95% CI: 0.20-0.82)], dyspnoea [(OR: 0.46 (95% CI: 0.28-0.77)] and a duration of exercise <420 s [(OR: 0.50 (95% CI: 0.33-0.76)].CONCLUSIONS:Return to work after coronary bypass graft surgery is observed in 67.5% of cases and depends essentially on socio-professional factors and residual symptoms. A regional effect was also observed, which requires further study.

Cardiac rehabilitation has been shown to improve exercise tolerance and symptomatology in patients experiencing angina or heart failure and reduce long term mortality after myocardial infarction, with a good cost-effectiveness ratio. In addition to these ‘hard’ endpoints, cardiac rehabilitation improves the patient’s quality of life and risk factor profile through a multifactorial intervention.