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In Deutschland werden jahrlich ca. 95 000 Operationen mittels Sternotomie und minimalinvasiv durchgefuhrt. Dennoch gibt es fur Inhalte, Trainingsplanung und Durchfuhrung der Bewegungstherapie keine einheitlichen Empfehlungen. Die vorliegende Studie soll eine Moglichkeit aufzeigen, das sporttherapeutische Spektrum von herzoperierten Patienten zu erweitern und die Machbarkeit eines gerategestutzten Krafttrainings bereits ab der 3. Woche postoperativ aufzeigen. Dafur wurden 42 Patienten nach kardiochirurgischen Eingriffen einem dosierten, schmerzadaptierten Krafttraining an Sequenztrainingsgeraten wahrend einer Anschlussheilbehandlung unterzogen. Die Effekte wurden mittels eines Maximalkrafttests und subjektivem Belastungsempfinden (BORG-Skala) uberpruft. Die Patienten trainierten bei 65% der Maximalkraft nach dem Modus 2–3 Serien a 10 Wiederholungen. Bei allen Patienten kam es zu einer signifikanten Steigerung der Maximalkraft, ohne dass Wundheilungsstorungen oder Sternuminstabilitaten auftraten. Kein Patient musste das Training schmerzbedingt abbrechen. Die Gewichtsbelastung lag uber den allgemeinen Empfehlungen aus den chirurgischen Zentren. Somit ware eine Uberarbeitung der Empfehlungen wunschenswert. In 85% of all cardiac surgery interventions in Germany, sternotomy is chosen as access to the heart, the median sternotomy is performed annually in around 90 000 operations. Minimally invasive methods have meanwhile been introduced at almost all cardiac surgery centres and partially form the standard technique for surgical interventions on the heart: „The most common sternotomy-free heart operation in Germany is performed on the mitral valve with almost 50% of all mitral valve operations“. Nevertheless, there are no standardized recommendations for the content, training planning and implementation of exercise therapy, either in early mobilization or in procedures related to follow-up care. Therefore, due to lack of training guidelines in Germany, therapy is given with large discrepancies in the rehabilitation structure.

Zusammenfassung Hintergrund Durch Reha-Nachsorgeprogramme konnen Patienten mit kardiovaskularen Erkrankungen die im Rahmen einer Rehabilitation erzielten Erfolge nachhaltig verstetigen und weiter verbessern. Allerdings ist es nicht allen Patienten moglich, an ambulanten Nachsorgeprogrammen teilzunehmen, z.B. wenn diese unvereinbar mit beruflichen oder familiaren Verpflichtungen sind. Daher bieten sich telemedizinische Verfahren an, um langere Phasen der Nachbetreuung, die raumlich und zeitlich flexible Nutzung von Nachsorgeangeboten oder variable Intensitaten der Nachsorge umzusetzen. Die Studie untersuchte die Fragestellung, welche Erwartungen Rehabilitanden mit kardiovaskularen Erkrankungen an eine telemedizinische Nachsorge haben. Methoden Es wurden halbstrukturierte, leitfadengestutzte Einzelinterviews mit kardiologischen Rehabilitanden durchgefuhrt, in denen die Erwartungen an eine telemedizinische Nachsorge erfasst wurden. Es erfolgte eine inhaltsanalytische Auswertung der protokollierten Ergebnisse mit Bildung von Themenkomplexen. Ergebnisse Es nahmen neun Rehabilitanden (8 Manner, 1 Frau) mit kardiovaskularen Erkrankungen an den Interviews teil. Keiner der Rehabilitanden hatte im Vorfeld ein telemedizinisches Angebot genutzt, aber acht der neun Rehabilitanden konnten es sich vorstellen, ein solches Angebot in Anspruch zu nehmen. Hierbei praferierten die befragten Personen eine telefonische Nachsorge, teilweise wunschten sie sich erganzende Angebote im Internet oder per SMS. Den Rehabilitanden war es wichtig, dass sie im Rahmen der Nachsorge telefonischen Kontakt mit einem Mitarbeiter haben, der ihre Ziele und Problemstellungen kennt. Schlussfolgerungen Die Rehabilitanden bewerteten die Option einer telemedizinischen Nachsorge insgesamt positiv, legten jedoch gleichzeitig grosen Wert auf personliche Kontakte zum betreuenden Behandler und bevorzugten bereits vertraute Medien (insbesondere Telefon). Niedrigschwellige praktische Erfahrungen mit neuen Technologien konnten dazu beitragen, dass Rehabilitanden Vorbehalte abbauen und mehr Aufgeschlossenheit gegenuber innovativen telemedizinischen Angeboten entwickeln. Im Rahmen solcher Angebote sollte (zumindest gelegentlich oder zu Beginn) auch eine personliche Interaktion mit dem Behandler stattfinden.

Aims This prospective, randomized, controlled, multicentre study aimed to evaluate efficacy and safety of exercise training in patients with pulmonary arterial (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH). Methods and results For the first time a specialized PAH/CTEPH rehabilitation programme was implemented in 11 centres across 10 European countries. Out of 129 enrolled patients, 116 patients (58 vs. 58 randomized into a training or usual care control group) on disease-targeted medication completed the study [85 female; mean age 53.6 ± 12.5 years; mean pulmonary arterial pressure 46.6 ± 15.1 mmHg; World Health Organization (WHO) functional class II 53%, III 46%; PAH n = 98; CTEPH n = 18]. Patients of the training group performed a standardized in-hospital rehabilitation with mean duration of 25 days [95% confidence interval (CI) 17–33 days], which was continued at home. The primary endpoint, change of 6-min walking distance, significantly improved by 34.1 ± 8.3 m in the training compared with the control group (95% CI, 18–51 m; P Conclusion This is the first multicentre and so far the largest randomized, controlled study on feasibility, safety, and efficacy of exercise training as add-on to medical therapy in PAH and CTEPH. Within this study, a standardized specialized training programme with in-hospital start was successfully established in 10 European countries.

Aims: This prospective randomized controlled study investigates the effects of exercise training on peak VO 2 /kg, hemodynamics and further clinically relevant parameters in pulmonary hypertension (PH) patients. Methods: Eighty-seven patients with pulmonary arterial hypertension and inoperable chronic thromboembolic PH (54% female, 56±15years, 84% WHO functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO 2 /kg. Secondary endpoints included changes in hemodynamics. For missing data, multiple imputation and responder analyses were performed. Results: Study results showed a significant improvement of peak VO 2 /kg in the training group (difference baseline to 15 weeks: training +3.1±2.7 equals +24.3% vs. control -0.2±2.3mL/min/kg equals +0.9%, p Conclusions: Low-dose exercise training at 4-7days/week significantly improved peak VO 2 /kg, hemodynamics and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicenter trials are necessary to confirm these results.

Aims The impact of exercise training on the right heart and pulmonary circulation has not yet been invasively assessed in patients with pulmonary hypertension (PH) and right heart failure. This prospective randomized controlled study investigates the effects of exercise training on peak VO2/kg, haemodynamics, and further clinically relevant parameters in PH patients. Methods and results Eighty-seven patients with pulmonary arterial hypertension and inoperable chronic thrombo-embolic PH (54% female, 56 ± 15 years, 84% World Health Organization functional class III/IV, 53% combination therapy) on stable disease-targeted medication were randomly assigned to a control and training group. Medication remained unchanged during the study period. Non-invasive assessments and right heart catheterization at rest and during exercise were performed at baseline and after 15 weeks. Primary endpoint was the change in peak VO2/kg. Secondary endpoints included changes in haemodynamics. For missing data, multiple imputation and responder analyses were performed. The study results showed a significant improvement of peak VO2/kg in the training group (difference from baseline to 15 weeks: training +3.1 ± 2.7 mL/min/kg equals +24.3% vs. control −0.2 ± 2.3 mL/min/kg equals +0.9%, P < 0.001). Cardiac index (CI) at rest and during exercise, mean pulmonary arterial pressure, pulmonary vascular resistance, 6 min walking distance, quality of life, and exercise capacity significantly improved by exercise training. Conclusion Low-dose exercise training at 4–7 days/week significantly improved peak VO2/kg, haemodynamics, and further clinically relevant parameters. The improvements of CI at rest and during exercise indicate that exercise training may improve the right ventricular function. Further, large multicentre trials are necessary to confirm these results.

Exercise training as an add-on to medical therapy has been shown to improve exercise capacity, quality of life, and possibly prognosis in patients with pulmonary hypertension (PH). The purpose of this study was to analyze the impact of exercise training on healthcare costs in PH. Estimated healthcare costs have been compared between patients with severe PH under optimized medical therapy only (control group) versus patients who received exercise training as an add-on to medical therapy (training group). Cost-analysis included a cost-estimation model of costs for baseline and follow-up visits and all PH-related healthcare events that occurred within the follow-up period. Time to clinical worsening and survival were assessed by clinical records, phone, and/or control visits. At baseline, the training (n = 58) and control group (n = 48) did not differ in age, gender, WHO-functional class, 6-min walking distance, hemodynamic parameters, or PH-targeted medication. During a follow-up of 24 ± 12 months, the training group had significantly better survival rates at 1 and 3 years and less worsening events (death, lung transplantation, hospitalization due to PH, new PAH-targeted medication) than the control group (15 vs. 25 events, p