Physical activity is important in heart failure to improve functional capacity, quality of life and prognosis, and is a class IA recommendation in the European Society of Cardiology guidelines (Ponikowski et al., 2016). The benefits of exercise training are widely recognized. Cardiac rehabilitation centres offer tailored exercise training to patients with heart failure, as part of specialized multidisciplinary care, alongside pharmacological treatment optimization and patient education. After cardiac rehabilitation, maintenance of regular physical activity long term is essential, as the benefits of exercise training vanish within a few weeks. Unfortunately, only 10% of patients benefit from a cardiac rehabilitation programme after hospitalization for acute heart failure, and the majority of patients do not pursue long-term physical activity. In this paper, two Working Groups of the French Society of Cardiology (the heart failure group [Groupe Insuffisance Cardiaque et Cardiomyopathies; GICC] and the cardiac rehabilitation group [Groupe Exercice Réadaptation Sport et Prévention; GERS-P]) discuss the obstacles to broader access to cardiac rehabilitation centres, and propose ways to improve the diffusion of cardiac rehabilitation programmes and encourage long-term adherence to physical activity.

Background. - Nutrition has a major influence after coronary events but long-term adherence to dietary advice is poorly evaluated.Aim. - To evaluate if a cardiovascular rehabilitation programme including dietary counselling has a positive impact on adherence to dietary recommendations.Methods. - Two groups of coronary patients were compared in an observational non-randomized study. Group I included 32 patients at the acute phase of a coronary syndrome and group 11 included 104 patients between six months and three years after completing a cardiovascular rehabilitation programme. The evaluation was performed with (1) a validated 14-item food frequency questionnaire (FFQ), which gives scores for the consumption of saturated fatty acids (SFA), monounsaturated fatty acids (MUFA), Omega-6 and Omega-3 polyunsaturated fatty acids (PUFA), fruits and vegetables, and a global cardiovascular protective dietary score; and (2) biological markers.Results. - SFA score was higher in group I vs II (7.4 +/- 2.8 vs 4.4 +/- 2.1, p < 0.001) whereas Omega-3 PUFA (2.2 +/- 2.0 vs 4.7 +/- 2.1, p < 0.001), fruit and vegetables score (3.3 +/- 1.4 vs 4.3 +/- 1.7, p = 0.001) and global dietary score (-1.1 +/- 4.5 to 7.0 +/- 4.9, p < 0.001) were higher in group II. The Omega-6:Omega-3 PUFA ratio was higher in group I (14.2 +/- 12.7 vs 6.3 +/- 5.4, p < 0.001). Biological markers showed higher plasma contents of Omega-3 PUFA (4.05 +/- 1.70% vs 2.80 +/- 1.07%, p < 0.001), fotate (19.7 +/- 12.2 nmol/L vs 13.0 +/- 5.0 nmol/L, p < 0.001) and vitamin C (7.60 +/- 3.99 mg/L vs 4.18 +/- 3.46 mg/L, p < 0.001), and a higher erythrocyte membrane Omega-3 PUFA content (6.60 +/- 2.19% vs 5.38 +/- 2.17%, p = 0.016) in group II vs I.Conclusion. - Using a short FFQ, this study showed sustained improvement in dietary habits in patients with coronary heart disease who receive nutritional education during a cardiovascular rehabilitation programme. (c) 2008 Elsevier Masson SAS. All rights reserved.

Background Dietary habits play a major role in cardiovascular disease risk but few simple nutrition assessment tools are available for clinical practice, We developed a 14-item food frequency questionnaire to evaluate dietary patterns in relation with coronary risk in a French population.Design and methods This food frequency questionnaire gave different scores of intake: saturated fatty acids (six questions), mono-unsaturated fatty acids, Omega-3 and Omega-6/Omega-3 polyunsaturated fatty acids (five questions), and fruits and vegetables (three questions). Validity was assessed against a 7-day dietary history (n=49 subjects) and against biomarkers (n=181). The food frequency questionnaire was also administered twice with an interval of 15 days to evaluate its reproducibility (n=20).Results Validity against dietary history was assessed with Spearman correlation coefficients which ranged from 0.47 (fruits and vegetables) to 0.63 (polyunsaturated fatty acids/saturated fatty acids) (all P<0.05), with a mean value of 0.54. On average, 39% of the subjects were classified in the same quartile with the food frequency questionnaire and the dietary history and 84% in the same or adjacent quartile. Biomarker-based validity using Spearman correlation coefficients varied from 0.21 (saturated fatty acids) to 0.53 (Omega-3 polyunsaturated fatty acids) (all P<0.05), with a mean value of 0.35. On average, 37% of the participants were classified in the same quartile with the food frequency questionnaire and the corresponding biomarkers and 73% in the same or adjacent quartile. Reproducibility assessed by the intraclass correlation coefficient ranged from 0.71 (mono-unsaturated fatty acids) to 0.93 (global score), with a mean value of 0.81.Conclusion We validated a short food frequency questionnaire for dietary pattern assessment in coronary prevention.