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Background: The COVID-19 pandemic has forced many cardiac rehabilitation centres to focus more on the remote delivery of cardiac rehabilitation (CR) components. This increased focus and the lessons learned from this period could enhance the implementation of telerehabilitation and increase the participation in CR in Belgium., Methods: We conducted a survey between April and May 2020 about the implementation of telerehabilitation services during the COVID-19 pandemic. The electronic questionnaire was sent via email to the heads of 42 Belgian CR centres. Three reminders via email were sent during the study period., Results: 27 CR centres (64%) returned completed questionnaires after three mailings. 52% of the CR centres provided remote CR services during the lockdown due to the COVID-19 pandemic. All CR centres that provided remote CR services delivered exercise training. The most used medium to deliver the CR components were online videos (71%) followed by online information on the website (64%) and emails (64%)., Conclusion: It is interesting that the COVID-19 pandemic has encouraged many CR centres to implement remote delivery of CR components. This can help to speed up the research and implementation of telerehabilitation in daily clinical practice. The COVID-19 pandemic could be the push for a large multicentre implementation study that could prove that telerehabilitation is feasible and effective in the Belgian setting.

Cardiovascular disease is one of the main causes of morbidity and sick leave in Belgium, imposing a great socio-economic burden on the contemporary healthcare system and society. Cardiac rehabilitation is an evidence-based treatment strategy that not only improves the cardiac patients' health state but also holds promise so as to facilitate vocational reintegration in the society. This position paper was developed and endorsed by the Belgian Working Group of Cardiovascular Prevention and Rehabilitation. It provides an overview of the currently available Belgian data with regard to the role of cardiac rehabilitation in return to work after an initial cardiac event. It identifies the relevant barriers and facilitators of vocational integration of cardiac patients and summarises the contemporary Belgian legal and medical framework in this regard. Cardiac rehabilitation remains a primordial component of the post-acute event management of the cardiac patient, facilitating vocational reintegrating and thereby decreasing the pressure on social security. Despite the availability of a relevant legislative framework, there is a need for well-defined algorithms to assess readiness for return to work that can be used in daily clinical practice.

Background: Coronary artery bypass graft (CABG) surgery is known to induce significant muscle wasting. It remains to be investigated whether muscle wasting after CABG surgery relates to a worse clinical status at entry of rehabilitation and exercise-based rehabilitation remediates such muscle wasting. Design: Prospective observational study. Methods: In 21 males, changes in lean tissue mass (LTM) after CABG surgery were assessed and during a 12-week endurance exercise-based rehabilitation intervention. Changes in blood parameters and cardiopulmonary exercise capacity were assessed, and relations with changes in LTM were analysed. Results: LTM decreased by -1.9 ± 2.5 kg ( p  < .05) within 3 weeks after CABG surgery: greater LTM loss related to a lower ventilatory threshold at entry of rehabilitation ( r  = 0.58-0.61, p  < .05). LTM was fully restored (+2.1 ± 2.4 kg, p  < .05) during rehabilitation. Conclusion: In males, CABG-induced LTM reduction was associated with a worse aerobic exercise tolerance at entry of rehabilitation, but this LTM reduction was fully remediated by endurance exercise-based rehabilitation.

Background: Electrical assisted bicycles (EAB's) could be used to overcome barriers and difficulties to outdoor cycling and thus assist in achieving a sufficient physical activity level in coronary artery disease (CAD) patients, but it is unknown whether sufficient exercise intensities and volumes could be elicited during cycling on EAB's. In this study we examined, for the first time, the acute physiological impact of electrical support during outdoor cycling in CAD patients (ISRCTN32238279)., Methods: Fifteen CAD patients (13 males), aged 64 ± 7 years executed a maximal cardiopulmonary exercise test and afterwards cycled a predefined outdoor route of 10 km, in three different conditions: classical cycling (no support), EAB with low support (EAB low ) and high support (EAB high ). Oxygen uptake (VO 2 ) and carbon dioxide output (VCO 2 ) was measured continuously by a portable gas-analysing system. Cycling time was recorded and ratings of perceived exertion (RPE) was assessed at 3 and 7 km., Results: Mean VO 2 during EAB high (1721 ± 537 ml•min -1 ) was significantly lower compared to EAB low (1890 ± 619 ml•min -1 , p < .05), but no differences were found between EAB low and classical cycling (1846 ± 523 ml•min -1 ). EAB low and EAB high elicited a sufficient volume and intensity (6.6 ± 2.0 MET's (74 ± 6% VO 2peak ) and 6.0 ± 1.8 MET's (68 ± 7% VO 2peak ), respectively) to adhere to the guidelines for secondary prevention in CAD. RPE was significantly lower p < .05) during EAB high (9 ± 2), than during EAB low (11 ± 2) or classical cycling (11 ± 2)., Conclusions: Outdoor cycling with electrical support leads to a sufficiently high exercise intensity and volume in CAD patients, and may be considered as an alternative exercise modality.

Background: Cardiac rehabilitation for ischaemic heart disease effectively reduces cardiovascular readmission rate and mortality. Current uptake rates however, remain low. This study assesses the social and economic impact of increasing centre-based cardiac rehabilitation uptake and the additional value of cardiac telerehabilitation using cost-benefit analysis (CBA) in Belgium., Methods: Cost-benefit analysis was conducted to analyse three scenarios: (1) current situation: 20% uptake rate of cardiac rehabilitation; (2) alternative scenario one: 40% uptake rate of cardiac rehabilitation; and (3) alternative scenario two: 20% uptake of cardiac rehabilitation and 20% uptake of both cardiac rehabilitation and telerehabilitation. Impacts considered included cardiac (tele)rehabilitation programme costs, direct inpatient costs, productivity losses and burden of disease., Results: Compared to the current situation, there was a net total monetised benefit of 9.18 M€ and 9.10 M€ for scenarios one and two, respectively. Disability Adjusted Life Years were 12,805-12,980 years lower than the current situation. This resulted in a benefit-cost ratio of 1.52 and 1.43 for scenarios one and two, respectively., Conclusions: Increased cardiac rehabilitation uptake rates can reduce the burden of disease, and the resulting benefits exceed its costs. This research supports the necessity for greater promotion and routine referral to cardiac rehabilitation to be made standard practice. The implementation of telerehabilitation as an adjunct is to be encouraged, especially for those patients unable to attend centre-based cardiac rehabilitation.