Original Investigation
Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis

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Abstract

Background

Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).

Objectives

The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.

Methods

The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.

Results

A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.

Conclusions

This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.

Key Words

coronary artery bypass graft
exercise therapy
exercise training
myocardial infarction
percutaneous coronary intervention
revascularization

Abbreviations and Acronyms

CABG
coronary artery bypass graft
CHD
coronary heart disease
CI
confidence interval
CR
cardiac rehabilitation
CV
cardiovascular
HRQL
health-related quality of life
MI
myocardial infarction
PCI
percutaneous coronary intervention
RCT
randomized controlled trial
RR
relative risk

Cited by (0)

Dr. Anderson is funded by the University of Exeter Medical School. Prof. Taylor is partly funded by the U.K. National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust; and is currently the cochief investigator of a research program with the overarching aims of developing and evaluating a home-based cardiac rehabilitation intervention for people with heart failure and their careers (PGfAR RP-PG-0611-12004). Dr. Rees is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands at University Hospitals Birmingham NHS Foundation Trust. Dr. Zwisler is principal investigator of an included (DAHREHAB) and ongoing cardiac rehabilitation trials (CopenHeart trials). Prof. Taylor, Drs. Rees and Oldridge, and Prof. Thompson were authors of the original Cochrane review; and Prof. Taylor and Drs. Rees and Zwisler are authors on a number of other Cochrane cardiac rehabilitation reviews. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health in England. Ms. Martin has reported that she has no relationships relevant to the contents of this paper to disclose.

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