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.
Method: 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.
Conclusion: 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.