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Meta-Analysis
. 2011 Jul 6:(7):CD001800.
doi: 10.1002/14651858.CD001800.pub2.

Exercise-based cardiac rehabilitation for coronary heart disease

Balraj S Heran  1 , Jenny Mh Chen, Shah Ebrahim, Tiffany Moxham, Neil Oldridge, Karen Rees, David R Thompson, Rod S Taylor
Affiliations
Meta-Analysis

Exercise-based cardiac rehabilitation for coronary heart disease

Balraj S Heran et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health.

Objectives: To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD.

Search strategy: RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009).

Selection criteria: Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography.

Data collection and analysis: Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information.

Main results: This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health-related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise-based cardiac rehabilitation than usual care.

Authors' conclusions: Exercise-based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well-designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health-related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost-effectiveness.

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Figures

Figure 1
Figure 1. Study flow diagram
Figure 2
Figure 2. Funnel plot of exercise-based rehabilitation versus usual care for fatal and/or nonfatal MI
See this image and copyright information in PMC

Update of

Comment in

References

References to studies included in this review

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References to studies excluded from this review

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References to studies awaiting assessment

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Additional references

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References to other published versions of this review

    1. Jolliffe J, Rees K, Taylor RRS, Thompson DR, Oldridge N, Ebrahim S. Exercise-based rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews. 2001;(1) DOI: 10.1002/14651858.CD001800. - PubMed
    1. Taylor RS, Brown A, Ebrahim S, Jolliffe J, Noorani H, Rees K, et al. Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. American Journal of Medicine. 2004;116((110):682–92. - PubMed

    1. * Indicates the major publication for the study

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