Lifestyle modification programmes for patients with coronary heart disease: a systematic review and meta-analysis of randomized controlled trials

Abstract

Background: Lifestyle modification programmes for coronary heart disease patients have been shown to effectively improve risk factors and related health behaviours, quality of life, reincidence, and mortality. However, improvements in routine cardiac care over the recent years may offset the incremental benefit associated with older programmes.

Purpose: To determine the efficacy of lifestyle modification programmes for coronary heart disease patients developed over the last decade (1999-2009) by means of a systematic review and meta-analysis.

Results: The study included 23 trials (involving 11,085 randomized patients). Lifestyle modification programmes were associated with reduced all-cause mortality (summary OR 1.34, 95% CI 1.10-1.64), cardiac mortality (summary OR 1.48, 95% CI 1.17-1.88), and cardiac readmissions and non-fatal reinfarctions (summary OR 1.35, 95% CI 1.17-1.55). Furthermore, lifestyle modification programmes positively affected risk factors and related lifestyle behaviours at posttreatment (M = 10.2 months), and some of these benefits were maintained at long-term follow up (M = 33.7 months). Improvements in dietary and exercise behaviour were greater for programmes incorporating all four self-regulation techniques (i.e. goal setting, self-monitoring, planning, and feedback techniques) compared to interventions that included none of these techniques.

Conclusion: The evidence summarized in this meta-analysis confirms the benefits of lifestyle modification programmes - over and above benefits achieved by routine clinical care alone.

Keywords: Cardiac rehabilitation; coronary heart disease; lifestyle modification; meta-analysis; secondary prevention; self-regulation.