{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T10:43:38Z","timestamp":1789469018254,"version":"build-2803163510"},"reference-count":354,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T00:00:00Z","timestamp":1626048000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"German Society for Prevention and Rehabilitation of Cardiovascular Diseases, DGPR","award":["no Grant Number"],"award-info":[{"award-number":["no Grant Number"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Scientific guidelines have been developed to update and harmonize exercise based cardiac rehabilitation (ebCR) in German speaking countries. Key recommendations for ebCR indications have recently been published in part 1 of this journal. The present part 2 updates the evidence with respect to contents and delivery of ebCR in clinical practice, focusing on exercise training (ET), psychological interventions (PI), patient education (PE). In addition, special patients\u2019 groups and new developments, such as telemedical (Tele) or home-based ebCR, are discussed as well. Methods: Generation of evidence and search of literature have been described in part 1. Results: Well documented evidence confirms the prognostic significance of ET in patients with coronary artery disease. Positive clinical effects of ET are described in patients with congestive heart failure, heart valve surgery or intervention, adults with congenital heart disease, and peripheral arterial disease. Specific recommendations for risk stratification and adequate exercise prescription for continuous-, interval-, and strength training are given in detail. PI when added to ebCR did not show significant positive effects in general. There was a positive trend towards reduction in depressive symptoms for \u201cdistress management\u201d and \u201clifestyle changes\u201d. PE is able to increase patients\u2019 knowledge and motivation, as well as behavior changes, regarding physical activity, dietary habits, and smoking cessation. The evidence for distinct ebCR programs in special patients\u2019 groups is less clear. Studies on Tele-CR predominantly included low-risk patients. Hence, it is questionable, whether clinical results derived from studies in conventional ebCR may be transferred to Tele-CR. Conclusions: ET is the cornerstone of ebCR. Additional PI should be included, adjusted to the needs of the individual patient. PE is able to promote patients self-management, empowerment, and motivation. Diversity-sensitive structures should be established to interact with the needs of special patient groups and gender issues. Tele-CR should be further investigated as a valuable tool to implement ebCR more widely and effectively.<\/jats:p>","DOI":"10.3390\/jcm10143071","type":"journal-article","created":{"date-parts":[[2021,7,12]],"date-time":"2021-07-12T01:41:07Z","timestamp":1626054067000},"page":"3071","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Cardiac Rehabilitation in German Speaking Countries of Europe\u2014Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH\u2014Part 2"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4801-1107","authenticated-orcid":false,"given":"Bernhard","family":"Schwaab","sequence":"first","affiliation":[{"name":"Curschmann Klinik, D-23669 Timmendorfer Strand, Germany"},{"name":"Medizinische Fakult\u00e4t, Universit\u00e4t zu L\u00fcbeck, D-23562 L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Birna","family":"Bjarnason-Wehrens","sequence":"additional","affiliation":[{"name":"Institute for Cardiology and Sports Medicine, Department of Preventive and Rehabilitative Sport- and Exercise Medicine, German Sportuniversity Cologne, D-50933 K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karin","family":"Meng","sequence":"additional","affiliation":[{"name":"Institute for Clinical Epidemiology and Biometry (ICE-B), University of W\u00fcrzburg, D-97080 W\u00fcrzburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Albus","sequence":"additional","affiliation":[{"name":"Department of Psychosomatics and Psychotherapy, Faculty of Medicine, University Hospital, D-50937 K\u00f6ln, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2530-2673","authenticated-orcid":false,"given":"Annett","family":"Salzwedel","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, D-14469 Potsdam, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9008-8274","authenticated-orcid":false,"given":"Jean-Paul","family":"Schmid","sequence":"additional","affiliation":[{"name":"Klinik Barmelweid AG, CH-5017 Barmelweid, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Werner","family":"Benzer","sequence":"additional","affiliation":[{"name":"Reha-Klinik Montafon, A-6780 Schruns, Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthes","family":"Metz","sequence":"additional","affiliation":[{"name":"Institute of Medical Biometry and Informatics 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D-82152 Martinsried, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten","family":"Sch\u00fctt","sequence":"additional","affiliation":[{"name":"Diabetologische Schwerpunktpraxis, D-23552 L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0067-389X","authenticated-orcid":false,"given":"Konrad","family":"Schultz","sequence":"additional","affiliation":[{"name":"Klinik Bad Reichenhall, Zentrum f\u00fcr Rehabilitation, Pneumologie und Orthop\u00e4die, D-83435 Bad Reichenhall, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eva-Maria","family":"Skoda","sequence":"additional","affiliation":[{"name":"Clinic for Psychosomatic Medicine and Psychotherapy, LVR University Hospital, University of Duisburg-Essen, D-45147 Essen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diethard","family":"Steube","sequence":"additional","affiliation":[{"name":"Private 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Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronja","family":"Westphal","sequence":"additional","affiliation":[{"name":"Herzzentrum Segeberger Kliniken, D-23795 Bad Segeberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,7,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Rauch, B., Salzwedel, A., Bjarnason-Wehrens, B., Albus, C., Meng, K., Schmid, J.P., Benzer, W., Hackbusch, M., Jensen, K., and Schwaab, B. 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