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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' 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 “distress management” and “lifestyle changes”. PE is able to increase patients’ 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’ 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.
The present study focuses on Rulin waishi 儒林外史 (The Unofficial History of the Scholars), a well-known Qing novel, from the perspective of gender. It attempts to contribute to the discussion about Chinese masculinity by identifying the representation of the scholars' masculinity in Rulin waishi and offer a better understanding of the novel's position regarding femininity and women.
This project shows that the novel nevertheless reflects rather than challenges gender ideologies of its time. The ideal manhood showed in the novel comprises real virtues and authentic learning. It goes against the traditional, orthodox Confucian masculinity which advocates that officialdom is the glorious path to fulfill a learned man's masculinity. It is mainly due to Wu Jingzi's own failure in the civil service examinations and official careers. Regarding the relation of masculinity and sexuality, the novel reveals that a masculine man is not tempted by female charm but can enjoy a harmonious and companionate marriage. Besides, scholars show great anxiety about their masculinity since they are in a marginal position in society. Their manliness is challenged by officials, merchants, and even commoners, as well as their colleagues.
Through a careful examination of stories of Pinniang, Miss Lu, and Mrs. Wang, it reveals that the novel holds a conventional opinion on women although it criticizes widow suicide and shows an egalitarian husband-wife relationship. It praises Confucian womanly virtues, such as following and serving the husband, managing the household, and keeping chastity. Female sexuality is blamed as an evil temptation to lead men to go astray. Women’s learning gains legitimacy when serving to fulfill domestic responsibilities. It carries the Confucian message that men should take the lead and maintain order in the household and reinforces the rightful patriarchy.
In a word, rather than go ahead of its time, Rulin waishi holds a conservative attitude towards gender issues.