{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T12:52:06Z","timestamp":1782996726864,"version":"3.54.5"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007352","name":"Staatssekretariat f\u00fcr Bildung, Forschung und Innovation","doi-asserted-by":"publisher","award":["15.0139"],"award-info":[{"award-number":["15.0139"]}],"id":[{"id":"10.13039\/501100007352","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010661","name":"Horizon 2020 Framework Programme","doi-asserted-by":"publisher","award":["634439"],"award-info":[{"award-number":["634439"]}],"id":[{"id":"10.13039\/100010661","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"Objectives<\/jats:title>Guidelines for exercise intensity prescription in Cardiac Rehabilitation (CR) are inconsistent and have recently been discussed controversially. We aimed (1) to compare training intensities between European CR centres and (2) to assess associations between training intensity and improvement in peak oxygen consumption (V<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>) in elderly CR patients.<\/jats:p><\/jats:sec>Methods<\/jats:title>PeakV<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>, heart rate and work rate (WR) at the first and second ventilatory thresholds were measured at start of CR. Training heart rate was measured during three sessions spread over the CR. Multivariate models were used to compare training characteristics between centres and to assess the effect of training intensity on change in peakV<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>.<\/jats:p><\/jats:sec>Results<\/jats:title>Training intensity was measured in 1011 out of 1633 EU-CaRE patients in 7 of 8 centers and the first and secondary ventilatory threshold were identified in 1166 and 817 patients, respectively. The first and second ventilatory threshold were found at 44% (SD 16%) and 78% (SD 9%) of peak WR and 78% (SD 9%) and 89% (SD 5%) of peak heart rate, respectively. Training intensity and session duration varied significantly between centres but change in peakV<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>over CR did not. Training above the first individual threshold (\u03b2 0.62, 95% confidence interval [0.25\u20131.02]) and increase in training volume per hour (\u03b2 0.06, 95%CI [0.01\u20130.12]) were associated with a higher change in peakV<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>.<\/jats:p><\/jats:sec>Conclusion<\/jats:title>While training intensity and volume varied greatly amongst current European CR programs, changes in peakV<\/mml:mi><\/mml:mrow>\u02d9<\/mml:mo><\/mml:mover><\/mml:math><\/jats:alternatives><\/jats:inline-formula>O2<\/jats:sub>were similar and the effect of training characteristics on these changes were small.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0242503","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T18:33:52Z","timestamp":1605292432000},"page":"e0242503","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":19,"title":["Training intensity and improvements in exercise capacity in elderly patients undergoing European cardiac rehabilitation \u2013 the EU-CaRE multicenter cohort study"],"prefix":"10.1371","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7229-5985","authenticated-orcid":true,"given":"Thimo","family":"Marcin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9734-0682","authenticated-orcid":true,"given":"Prisca","family":"Eser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva","family":"Prescott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonie F.","family":"Prins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evelien","family":"Kolkman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3287-1321","authenticated-orcid":true,"given":"Wendy","family":"Bruins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astrid E.","family":"van der Velde","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Pe\u00f1a Gil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Christine","family":"Iliou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diego","family":"Ardissino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uwe","family":"Zeymer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esther P.","family":"Meindersma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnoud W. J.","family":"Van\u2019t Hof","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ed P.","family":"de Kluiver","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Wilhelm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"issue":"12","key":"pone.0242503.ref001","doi-asserted-by":"crossref","first-page":"1644","DOI":"10.1016\/j.mayocp.2014.07.011","article-title":"Prognostic value of exercise capacity in patients with coronary artery disease: the FIT (Henry Ford ExercIse Testing) project","volume":"89","author":"RK Hung","year":"2014","journal-title":"Mayo Clin Proc"},{"issue":"2","key":"pone.0242503.ref002","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/0735-1097(94)90420-0","article-title":"Prognostic significance of peak exercise capacity in patients with coronary artery disease","volume":"23","author":"L Vanhees","year":"1994","journal-title":"J Am Coll Cardiol"},{"issue":"16","key":"pone.0242503.ref003","doi-asserted-by":"crossref","first-page":"1715","DOI":"10.1177\/2047487316657669","article-title":"A review of guidelines for cardiac rehabilitation exercise programmes: Is there an international consensus?","volume":"23","author":"KJ Price","year":"2016","journal-title":"Eur J Prev Cardiol"},{"issue":"3","key":"pone.0242503.ref004","doi-asserted-by":"crossref","first-page":"442","DOI":"10.1177\/2047487312460484","article-title":"Aerobic exercise intensity assessment and prescription in cardiac rehabilitation: a joint position statement of the European Association for Cardiovascular Prevention and Rehabilitation, the American Association of Cardiovascular and Pulmonary Rehabilitation and the Canadian Association of Cardiac Rehabilitation","volume":"20","author":"A Mezzani","year":"2013","journal-title":"Eur J Prev Cardiolog"},{"key":"pone.0242503.ref005","article-title":"Exercise training intensity determination in cardiovascular rehabilitation: Should the guidelines be reconsidered?","author":"D Hansen","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"pone.0242503.ref006","article-title":"Do we have to reconsider the guidelines for exercise intensity determination in cardiovascular rehabilitation?","author":"CH Davos","year":"2019","journal-title":"Eur J Prev Cardiol"},{"issue":"21","key":"pone.0242503.ref007","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1136\/bjsports-2018-099153","article-title":"What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis","volume":"53","author":"BL Mitchell","year":"2019","journal-title":"British Journal of Sports Medicine"},{"issue":"4","key":"pone.0242503.ref008","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/0735-1097(95)00267-1","article-title":"Low intensity exercise training in patients with chronic heart failure","volume":"26","author":"R Belardinelli","year":"1995","journal-title":"J Am Coll Cardiol"},{"issue":"1","key":"pone.0242503.ref009","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1097\/HJR.0b013e3283313592","article-title":"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","volume":"17","author":"MF Piepoli","year":"2010","journal-title":"Eur J Cardiovasc Prev Rehabil"},{"key":"pone.0242503.ref010","volume-title":"Principles of exercise testing and interpretation: Including pathophysiology and clinical applications","author":"K Wasserman","year":"2012","edition":"5"},{"issue":"10","key":"pone.0242503.ref011","doi-asserted-by":"crossref","first-page":"1052","DOI":"10.1177\/2047487319839819","article-title":"Cardiac rehabilitation in the elderly patient in eight rehabilitation units in Western Europe: Baseline data from the EU-CaRE multicentre observational study","volume":"26","author":"E Prescott","year":"2019","journal-title":"Eur J Prev Cardiol"},{"key":"pone.0242503.ref012","article-title":"Cardiac rehabilitation of elderly patients in 8 rehabilitation units in Western Europe: Outcome data from the EU-CaRE multicentre observational study","author":"E Prescott","journal-title":"Eur J Prev Cardiol"},{"issue":"1","key":"pone.0242503.ref013","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1016\/S0167-5273(02)00059-1","article-title":"Individual assessment of intensity-level for exercise training in patients with coronary artery disease is necessary","volume":"84","author":"W Nieuwland","year":"2002","journal-title":"Int J Cardiol"},{"issue":"1","key":"pone.0242503.ref014","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2165\/11595460-000000000-00000","article-title":"Endurance exercise intensity determination in the rehabilitation of coronary artery disease patients: a critical re-appraisal of current evidence","volume":"42","author":"D Hansen","year":"2012","journal-title":"Sports Med"},{"issue":"5","key":"pone.0242503.ref015","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.mayocp.2013.02.013","article-title":"Cardiovascular fitness and mortality after contemporary cardiac rehabilitation","volume":"88","author":"B-J Martin","year":"2013","journal-title":"Mayo Clin Proc"},{"key":"pone.0242503.ref016","first-page":"1105","article-title":"Differences in exercise intensity seems to influence the affective responses in self-selected and imposed exercise: a meta-analysis","volume":"6","author":"BRR Oliveira","year":"2015","journal-title":"Front Psychol"},{"issue":"8","key":"pone.0242503.ref017","doi-asserted-by":"crossref","first-page":"641","DOI":"10.2165\/11590680-000000000-00000","article-title":"The pleasure and displeasure people feel when they exercise at different intensities: decennial update and progress towards a tripartite rationale for exercise intensity prescription","volume":"41","author":"P Ekkekakis","year":"2011","journal-title":"Sports Med"},{"issue":"12","key":"pone.0242503.ref018","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1016\/j.pec.2018.07.010","article-title":"Patient preferences for the delivery of cardiac rehabilitation","volume":"101","author":"M Boyde","year":"2018","journal-title":"Patient Educ Couns"},{"issue":"1","key":"pone.0242503.ref019","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.jacc.2019.03.008","article-title":"Home-Based Cardiac Rehabilitation: A Scientific Statement From the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Heart Association, and the American College of Cardiology","volume":"74","author":"RJ Thomas","year":"2019","journal-title":"J Am Coll Cardiol"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242503","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,14]],"date-time":"2021-04-14T05:58:31Z","timestamp":1618379911000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0242503"}},"subtitle":[],"editor":[{"given":"Corstiaan","family":"den Uil","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":19,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,11,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0242503","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]}}}