[Restructuring cardiovascular exercise therapy in Germany with reference to current international guidelines].
BACKGROUND
Exercise therapy has a well-established place in the primary and secondary prevention of cardiovascular disease. But its evidence-based application, or even its development, within the framework of planned disease management programs in Germany is hampered by the limitations in the structural quality of the health/fitness facilities.


METHODS
Review of the literature concerning the current structure of cardiovascular exercise therapy in Germany and the USA, including current guidelines for exercise therapy in primary and secondary prevention.


RESULTS
The "heart groups" represent the only organization in Germany to adhere to certain quality standards, although certain limitations in the procedural quality of their programs must be acknowledged (the evidence-based securing of the programs is relatively restricted), and their overall capacity is limited. Alternative organizations, such as fitness centers or sports clubs, do not yet offer standards of quality or safety. In the USA, in particular, there are established guidelines for exercise therapy which are edited, evidence-based, peer-reviewed and applicable to all suppliers of exercise therapy.


CONCLUSIONS
We suggest that such standards should be brought into operation within the German context and that,as far as possible, they should be extended to include statements of mode and duration of training. The resulting guidelines, after being implemented as standards, could serve as the basis for a certification procedure applicable to all health/fitness facilities.
Dürsch
Martin
M
Kardiologie Frankfurt-Sachsenhausen, Frankfurt/Main, Germany. praxis@kardio-ffm-sachs.de
Schulz
Olaf
O
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control; D002648:Child; D004562:Electrocardiography; D005081:Exercise Therapy / Q000592:standards; D005260:Female; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness; D011322:Primary Prevention; D011787:Quality of Health Care; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States