Effect of comprehensive cardiac rehabilitation after heart valve surgery (CopenHeartVR): study protocol for a randomised clinical trial

Trials

Ann-Dorthe Zwisler²  Barbara Christina Brocki⁶  Viviane Conraads⁵  Jean Paul Schmid⁷  Jane Lindschou Hansen⁹  Lau Caspar Thygesen²  Per Winkel⁹  Christian Gluud⁹  Daniel Steinbrüchel⁸  Lars Køber⁴  Christian Hassager⁴  Trine Bernholdt Rasmussen¹  Signe Stelling Risom⁴  Tina Birgitte Hansen³  Selina Kikkenborg Berg¹  Kirstine Laerum Sibilitz⁴ 

[1] Department of Cardiology, Gentofte Hospital, Gentofte, Denmark;National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark;Department of Cardiology, Roskilde Hospital, Roskilde, Denmark;The Heart Centre, Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark;Cardiac Rehabilitation Centre, Heart Failure Clinic and Medical Heart Transplant Follow-up, Department of Cardiology, Antwerp University Hospital, Antwerp, Belgium;Department of Ergo-and physiotherapy, Aalborg University Hospital, Aalborg, Denmark;Swiss Cardiovascular Centre Bern, Cardiovascular Prevention and Rehabilitation Unit, University Hospital, Bern, Switzerland;The Heart Centre, Heart and Lung Surgical Clinic, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark;Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark

关键词: Psycho-education;    Physical exercise;    Rehabilitation;    Heart valve surgery;   

Others  :  1094289
DOI  :  10.1186/1745-6215-14-104

 received in 2012-11-19, accepted in 2013-03-25,  发布年份 2013

【 摘 要 】

Background

Heart valve diseases are common with an estimated prevalence of 2.5% in the Western world. The number is rising due to an ageing population. Once symptomatic, heart valve diseases are potentially lethal, and heavily influence daily living and quality of life. Surgical treatment, either valve replacement or repair, remains the treatment of choice. However, post surgery, the transition to daily living may become a physical, mental and social challenge. We hypothesise that a comprehensive cardiac rehabilitation programme can improve physical capacity and self-assessed mental health and reduce hospitalisation and healthcare costs after heart valve surgery.

Methods

A randomised clinical trial, CopenHeart_VR, aims to investigate whether cardiac rehabilitation in addition to usual care is superior to treatment as usual after heart valve surgery. The trial will randomly allocate 210 patients, 1:1 intervention to control group, using central randomisation, and blinded outcome assessment and statistical analyses. The intervention consists of 12 weeks of physical exercise, and a psycho-educational intervention comprising five consultations. Primary outcome is peak oxygen uptake (VO₂ peak) measured by cardiopulmonary exercise testing with ventilatory gas analysis. Secondary outcome is self-assessed mental health measured by the standardised questionnaire Short Form 36. Also, long-term healthcare utilisation and mortality as well as biochemistry, echocardiography and cost-benefit will be assessed. A mixed-method design is used to evaluate qualitative and quantitative findings encompassing a survey-based study before the trial and a qualitative pre- and post-intervention study.

Discussion

The study is approved by the local regional Research Ethics Committee (H-1-2011-157), and the Danish Data Protection Agency (j.nr. 2007-58-0015).

Trial registration

ClinicalTrials.gov (http://NCT01558765 webcite).

【 授权许可】

   
2013 Sibilitz et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Nkomo VT, Gardin JM, Skelton TN, Gottdiener JS, Scott CG, Enriquez-Sarano M: Burden of valvular heart diseases: a population-based study. Lancet 2006, 368:1005-1011.
• [2]Supino PG, Borer JS, Preibisz J, Bornstein A: The epidemiology of valvular heart disease: a growing public health problem. Heart Fail Clin 2006, 2:379-393.
• [3]Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Baron-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schafers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Authors/Task Force Members: Guidelines on the management of valvular heart disease (version 2012): The Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2012, 33:2451-2496.
• [4]Stoll C, Schelling G, Goetz AE, Kilger E, Bayer A, Kapfhammer HP, Rothenhausler HB, Kreuzer E, Reichart B, Peter K: Health-related quality of life and post-traumatic stress disorder in patients after cardiac surgery and intensive care treatment. J Thorac Cardiovasc Surg 2000, 120:505-512.
• [5]Lunel C, Laurent M, Corbineau H, Boulmier D, Chaperon J, Guillo P, Dewitte JD, Leguerrier A: Return to work after cardiac valvular surgery. Retrospective study of a series of 105 patients. Arch Mal Coeur Vaiss 2003, 96:15-22.
• [6]Sire S: Physical training and occupational rehabilitation after aortic valve replacement. Eur Heart J 1987, 8:1215-1220.
• [7]Butchart EG, Gohlke-Barwolf C, Antunes MJ, Tornos P, De Caterina R, Cormier B, Prendergast B, Iung B, Bjornstad H, Leport C, Hall RJ, Vahanian A, Thrombosis , Working Groups on Valvular Heart Disease: Recommendations for the management of patients after heart valve surgery. Eur Heart J 2005, 26:2463-2471.
• [8]Heran BS, Chen JM, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson DR, Taylor RS: Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev 2011, 7:CD001800.
• [9]Davies EJ, Moxham T, Rees K, Singh S, Coats AJ, Ebrahim S, Lough F, Taylor RS: Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2010, 4:CD003331.
• [10]Newell JP, Kappagoda CT, Stoker JB, Deverall PB, Watson DA, Linden RJ: Physical training after heart valve replacement. Br Heart J 1980, 44:638-649.
• [11]Gohlke-Barwolf C, Gohlke H, Samek L, Peters K, Betz P, Eschenbruch E, Roskamm H: Exercise tolerance and working capacity after valve replacement. J Heart Valve Dis 1992, 1:189-195.
• [12]Ueshima K, Kamata J, Kobayashi N, Saito M, Sato S, Kawazoe K, Hiramori K: Effects of exercise training after open heart surgery on quality of life and exercise tolerance in patients with mitral regurgitation or aortic regurgitation. Jpn Heart J 2004, 45:789-797.
• [13]Meurin P, Iliou MC, Ben Driss A, Pierre B, Corone S, Cristofini P, Tabet JY, Working Group of Cardiac Rehabilitation of the French Society of Cardiology: Early exercise training after mitral valve repair: a multicentric prospective French study. Chest 2005, 128:1638-1644.
• [14]Landry F, Habel C, Desaulniers D, Dagenais GR, Moisan A, Cote L: Vigorous physical training after aortic valve replacement: analysis of 10 patients. Am J Cardiol 1984, 53:562-566.
• [15]Habel-Verge C, Landry F, Desaulniers D, Dagenais GR, Moisan A, Cote L, Robitaille NM: Physical fitness improves after mitral valve replacement. CMAJ 1987, 136:142-147.
• [16]Niemela K, Ikaheimo M, Takkunen J: Functional evaluation after aortic valve replacement. Scand J Thorac Cardiovasc Surg 1983, 17:221-225.
• [17]Lapum J, Angus JE, Peter E, Watt-Watson J: Patients’ discharge experiences: returning home after open-heart surgery. Heart Lung 2011, 40:226-235.
• [18]Maillet JM, Somme D, Hennel E, Lessana A, Saint-Jean O, Brodaty D: Frailty after aortic valve replacement (AVR) in octogenarians. Arch Gerontol Geriatr 2009, 48:391-396.
• [19]Hoyer J, Eifert GH, Einsle F, Zimmermann K, Krauss S, Knaut M, Matschke K, Kollner V: Heart-focused anxiety before and after cardiac surgery. J Psychosom Res 2008, 64:291-297.
• [20]Lim HY, Lee CW, Park SW, Kim JJ, Song JK, Hong MK, Jin YS, Park SJ: Effects of percutaneous balloon mitral valvuloplasty and exercise training on the kinetics of recovery oxygen consumption after exercise in patients with mitral stenosis. Eur Heart J 1998, 19:1865-1871.
• [21]Jairath N, Salerno T, Chapman J, Dornan J, Weisel R: The effect of moderate exercise training on oxygen uptake post-aortic/mitral valve surgery. J Cardiopulm Rehabil 1995, 15:424-430.
• [22]Kassirskii GI, Semenovskii ML, Petrunina LV, Fomina NG: Evaluation of patient rehabilitation effectiveness after aortic valve prosthesis based on spiroergometric study data. Kardiologiia 1983, 23:82-86.
• [23]Rasmussen TB, Zwisler AD, Sibilitz KL, Risom SS, Bundgaard H, Gluud C, Moons P, Winkel P, Thygesen LC, Hansen JL, Norekval TM, Berg SK, the CopenHeartIE Group: A randomised clinical trial of comprehensive cardiac rehabilitation versus usual care for patients treated for infective endocarditis-the CopenHeartIE trial protocol. BMJ Open 2012., 2(6) Print 2012
• [24]Risom SS, Zwisler AD, Rasmussen TB, Sibilitz KL, Svendsen JH, Gluud C, Hansen JL, Winkel P, Thygesen LC, Perhonen M, Hansen J, Dunbar SB, Berg SK: The effect of integrated cardiac rehabilitation versus treatment as usual for atrial fibrillation patients treated with ablation: the randomised CopenHeartRFA trial protocol. BMJ Open 2013., 3(2) Print 2013
• [25]Stewart KJ, Badenhop D, Brubaker PH, Keteyian SJ, King M: Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. Chest 2003, 123:2104-2111.
• [26]Rasmussen S: Cardiac rehabilitation in Denmark. An overview of Danish experiences and costs. DSI 2011, project number 2770:1-40.
• [27]Scordo KA: Effects of aerobic exercise training on symptomatic women with mitral valve prolapse. Am J Cardiol 1991, 67:863-868.
• [28]Grady KL, Lee R, Subacius H, Malaisrie SC, McGee EC Jr, Kruse J, Goldberger JJ, McCarthy PM: Improvements in health-related quality of life before and after isolated cardiac operations. Ann Thorac Surg 2011, 91:777-783.
• [29]Nugteren LB, Sandau KE: Critical review of health-related quality of life studies of patients with aortic stenosis. J Cardiovasc Nurs 2010, 25:25-39.
• [30]Alehagen U, Dahlstrom U, Rehfeld JF, Goetze JP: Association of copeptin and N-terminal proBNP concentrations with risk of cardiovascular death in older patients with symptoms of heart failure. JAMA 2011, 305:2088-2095.
• [31]Haykowsky M, Scott J, Esch B, Schopflocher D, Myers J, Paterson I, Warburton D, Jones L, Clark AM: A meta-analysis of the effects of exercise training on left ventricular remodeling following myocardial infarction: start early and go longer for greatest exercise benefits on remodeling. Trials 2011, 12:92. BioMed Central Full Text
• [32]Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM: A meta-analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: the benefit depends on the type of training performed. J Am Coll Cardiol 2007, 49:2329-2336.
• [33]Papadakis S, Oldridge NB, Coyle D, Mayhew A, Reid RD, Beaton L, Dafoe WA, Angus D: Economic evaluation of cardiac rehabilitation: a systematic review. Eur J Cardiovasc Prev Rehabil 2005, 12:513-520.
• [34]Zigmond AS, Snaith RP: The hospital anxiety and depression scale. Acta Psychiatr Scand 1983, 67:361-370.
• [35]Schweikert B, Hahmann H, Leidl R: Validation of the EuroQol questionnaire in cardiac rehabilitation. Heart 2006, 92:62-67.
• [36]Oldridge N, Saner H, McGee HM, HeartQoL Study Investigators: The Euro Cardio-QoL Project. An international study to develop a core heart disease health-related quality of life questionnaire, the HeartQoL. Eur J Cardiovasc Prev Rehabil 2005, 12:87-94.
• [37]Hallal PC, Victora CG: Reliability and validity of the International Physical Activity Questionnaire (IPAQ). Med Sci Sports Exerc 2004, 36:556.
• [38]Bowman GS: Emotions and illness. J Adv Nurs 2001, 34:256-263.
• [39]Creswell JW, Plano Clark VL: Designing and conducting mixed methods research. Thousand Oaks, CA: SAGE Publications; 2007.
• [40]Lewin S, Glenton C, Oxman AD: Use of qualitative methods alongside randomised controlled trials of complex healthcare interventions: methodological study. BMJ 2009, 339:b3496.
• [41]Chan A, Tetzlaff J, Altman D, Gotzsche P, Hrobjartsson A, Krleza-Jeric K, Laupacis A, Moher D: The SPIRIT initiative: defining standard protocol items for randomised trials [conference abstract]. German J Evid Quality Health Care 2008, Suppl:S27.
• [42]Boutron I, Moher D, Altman DG, Schulz KF, Ravaud P, CONSORT Group: Extending the CONSORT statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008, 148:295-309.
• [43]Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, Skidmore B, Stone JA, Thompson DR, Oldridge N: Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 2004, 116:682-692.
• [44]ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories: ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med 2002, 166:111-117.
• [45]Vahanian A, Baumgartner H, Bax J, Butchart E, Dion R, Filippatos G, Flachskampf F, Hall R, Iung B, Kasprzak J, Nataf P, Tornos P, Torracca L, Wenink A, Task Force on the Management of Valvular Hearth Disease of the European Society of Cardiology: Guidelines on the management of valvular heart disease: The Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology. Eur Heart J 2007, 28:230-268.
• [46]Egeblad H, Gill S, Hassager C, Strange S, Thiis J: The national guideline for treatment of heart valve diseases. Danish Soc Cardiol 2011., chapter 6http://www.cardio.dk/ webcite
• [47]Berg SK, Svendsen JH, Zwisler AD, Pedersen BD, Preisler P, Siersbaek-Hansen L, Hansen MB, Nielsen RH, Pedersen PU: COPE-ICD: a randomised clinical trial studying the effects and meaning of a comprehensive rehabilitation programme for ICD recipients -design, intervention and population. BMC Cardiovasc Disord 2011, 11:33. BioMed Central Full Text
• [48]Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, McGee H, Mendes M, Niebauer J, Zwisler AD, Schmid JP, Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation: Secondary prevention through cardiac rehabilitation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European Association of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010, 17:1-17.
• [49]Rasmusen H, Prescott E, Zwisler A, Andersen U, Refsgaard O: Statement paper: Minimum competences for cardiac rehabilitation in Denmark. Danish Soc Cardiol 2008, 4:47-49.
• [50]The Danish National Board of Health: Recommendations for physical activity. Copenhagen: Danish National Board of Health; 2011.
• [51]Ekholm O, Hesse U, Davidsen M, Kjoller M: The study design and characteristics of the Danish national health interview surveys. Scand J Public Health 2009, 37:758-765.
• [52]Ashworth NL, Chad KE, Harrison EL, Reeder BA, Marshall SC: Home versus center based physical activity programs in older adults. Cochrane Database Syst Rev 2005, 1:CD004017.
• [53]Oerkild B, Frederiksen M, Hansen JF, Simonsen L, Skovgaard LT, Prescott E: Home-based cardiac rehabilitation is as effective as centre-based cardiac rehabilitation among elderly with coronary heart disease: results from a randomised clinical trial. Age Ageing 2011, 40:78-85.
• [54]Sumide T, Shimada K, Ohmura H, Onishi T, Kawakami K, Masaki Y, Fukao K, Nishitani M, Kume A, Sato H, Sunayama S, Kawai S, Shimada A, Yamamoto T, Kikuchi K, Amano A, Daida H: Relationship between exercise tolerance and muscle strength following cardiac rehabilitation: comparison of patients after cardiac surgery and patients with myocardial infarction. J Cardiol 2009, 54:273-281.
• [55]Borg GA: Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982, 14:377-381.
• [56]Williams MA, Haskell WL, Ades PA, Amsterdam EA, Bittner V, Franklin BA, Gulanick M, Laing ST, Stewart KJ, American Heart Association Council on Clinical Cardiology: Resistance exercise in individuals with and without cardiovascular disease: 2007 update: a scientific statement from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Circulation 2007, 116:572-584.
• [57]Petersen CB, Severin M, Hansen AW, Curtis T, Gronbaek M, Tolstrup JS: A population-based randomized controlled trial of the effect of combining a pedometer with an intervention toolkit on physical activity among individuals with low levels of physical activity or fitness. Prev Med 2012, 54:125-130.
• [58]Parse RR: The human becoming school of thought: a perspective for nurses and other health professionals. Thousand Oaks, CA: Sage; 1998.
• [59]Berg SK: Comprehensive rehabilitation for patients with ICD: PhD dissertation: [Aarhus]. Aarhus: Aarhus University, Faculty of Health Sciences; 2011.
• [60]Mezzani A, Agostoni P, Cohen-Solal A, Corra U, Jegier A, Kouidi E, Mazic S, Meurin P, Piepoli M, Simon A, Laethem CV, Vanhees L: Standards for the use of cardiopulmonary exercise testing for the functional evaluation of cardiac patients: a report from the Exercise Physiology Section of the European Association for Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2009, 16:249-267.
• [61]McHorney CA, Ware JE Jr, Raczek AE: The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care 1993, 31:247-263.
• [62]Andersen TF, Madsen M, Jorgensen J, Mellemkjoer L, Olsen JH: The Danish National Hospital Register. A valuable source of data for modern health sciences. Dan Med Bull 1999, 46:263-268.
• [63]Lynge E, Sandegaard JL, Rebolj M: The Danish National Patient Register. Scand J Public Health 2011, Suppl 7:30-33.
• [64]Andersen JS, Olivarius Nde F, Krasnik A: The Danish National Health Service Register. Scand J Public Health 2011, Suppl 7:34-37.
• [65]Helweg-Larsen K: The Danish Register of Causes of Death. Scand J Public Health 2011, Suppl 7:26-29.
• [66]Baadsgaard M, Quitzau J: Danish registers on personal income and transfer payments. Scand J Public Health 2011, Suppl 7:103-105.
• [67]Petersson F, Baadsgaard M, Thygesen LC: Danish registers on personal labour market affiliation. Scand J Public Health 2011, Suppl 7:95-98.
• [68]Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W, American Society of Echocardiography’s Nomenclature and Standards Committee: Recommendations for chamber quantification. Eur J Echocardiogr 2006, 7:79-108.
• [69]Anonymous: EuroQol--a new facility for the measurement of health-related quality of life. The EuroQol Group. Health Policy 1990, 16:199-208.
• [70]Brooks R: EuroQol: the current state of play. Health Policy 1996, 37:53-72.
• [71]Wittrup-Jensen KU, Lauridsen J, Gudex C, Pedersen KM: Generation of a Danish TTO value set for EQ-5D health states. Scand J Public Health 2009, 37:459-466.
• [72]Drummond MF: Methods for the economic evaluation of health care programmes. 3rd edition. Oxford: Oxford University Press; 2005.
• [73]Fox-Rushby JA, Cairns J: Economic evaluation. Maidenhead: Open University Press; 2005.
• [74]Fenwick E, Claxton K, Sculpher M: Representing uncertainty: the role of cost-effectiveness acceptability curves. Health Econ 2001, 10:779-787.
• [75]DeSouza CM, Legedza AT, Sankoh AJ: An overview of practical approaches for handling missing data in clinical trials. J Biopharm Stat 2009, 19:1055-1073.
• [76]Dmitrienko A, Wiens BL, Tamhane AC, Wang X: Tree-structured gatekeeping tests in clinical trials with hierarchically ordered multiple objectives. Stat Med 2007, 26:2465-2478.
• [77]Wood L, Egger M, Gluud LL, Schulz KF, Jüni P, Altman DG, Gluud C, Martin RM, Wood AJG, Sterne JAC: Empirical evidence of bias in treatment effect estimates in controlled trials with different interventions and outcomes: meta-epidemiological study. BMJ 2008, 336:601-605.
• [78]Savovic J, Jones H, Altman D, Harris R, Juni P, Pildal J, Als-Nielsen B, Balk E, Gluud C, Gluud L, Ioannidis J, Schulz K, Beynon R, Welton N, Wood L, Moher D, Deeks J, Sterne J: Influence of reported study design characteristics on intervention effect estimates from randomised controlled trials: combined analysis of meta-epidemiological studies. Health Technol Assess 2012, 16:1-82.
• [79]Gluud L: Bias in clinical intervention research. Am J Epidemiol 2006, 163:493-501.
• [80]Rowland T, Unnithan V, Barker P, Lindley M, Roche D, Garrard M: Time-of-day effect on cardiac responses to progressive exercise. Chronobiol Int 2011, 28:611-616.
• [81]Piotrowicz E, Baranowski R, Bilinska M, Stepnowska M, Piotrowska M, Wojcik A, Korewicki J, Chojnowska L, Malek LA, Klopotowski M, Piotrowski W, Piotrowicz R: A new model of home-based telemonitored cardiac rehabilitation in patients with heart failure: effectiveness, quality of life, and adherence. Eur J Heart Fail 2010, 12:164-171.
• [82]Zwisler AD, Soja AM, Rasmussen S, Frederiksen M, Abedini S, Appel J, Rasmussen H, Gluud C, Iversen L, Sigurd B, Madsen M, Fischer-Hansen J, DANREHAB Group: Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. Am Heart J 2008, 155:1106-1113.
• [83]Berg SK, Pedersen BD, Svendsen JH, Zwisler AD, Kristensen L, Pedersen PU: COPE-ICD: Patient experience of participation in an ICD specific rehabilitation programme. Eur J Cardiovasc Nurs 2012, 11:207-15.
• [84]World Health Organization: The new European policy for health - Health 2020: Vision, values, main directions and approaches. Copenhagen: World Health Organization, Regional office for Europe; 2011. EUR/RC61/9: 1–16
• [85]Gibbons RJ, Balady GJ, Beasley JW, Bricker JT, Duvernoy WF, Froelicher VF, Mark DB, Marwick TH, McCallister BD, Thompson PD Jr, Winters WL, Yanowitz FG, Ritchie JL, Gibbons RJ, Cheitlin MD, Eagle KA, Gardner TJ, Garson A Jr, Lewis RP, O'Rourke RA, Ryan TJ: ACC/AHA Guidelines for Exercise Testing. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Exercise Testing). J Am Coll Cardiol 1997, 30:260-311.
• [86]Pavy B, Iliou MC, Meurin P, Tabet JY, Corone S, Functional Evaluation and Cardiac Rehabilitation Working Group of the French Society of Cardiology: Safety of exercise training for cardiac patients: results of the French registry of complications during cardiac rehabilitation. Arch Intern Med 2006, 166:2329-2334.