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. 2018 Sep;104(17):1394-1402.
doi: 10.1136/heartjnl-2017-312832. Epub 2018 Apr 13.

Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Grace Olivia Dibben  1 , Hasnain M Dalal  1   2 , Rod S Taylor  2 , Patrick Doherty  3 , Lars Hermann Tang  4 , Melvyn Hillsdon  5
Affiliations

Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Grace Olivia Dibben et al. Heart. 2018 Sep.

Abstract

Objective: To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.

Methods: Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.

Results: Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.

Conclusion: Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

Keywords: cardiac rehabilitation; coronary artery disease; heart failure; meta-analysis; systemic review.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-analyses flow chart of search process. CR, cardiac rehabilitation; PA, physical activity; RCT, randomised controlled trial.
Figure 2
Figure 2
Quality appraisal. + (green), low risk of bias; ? (yellow), unclear risk of bias; − (red), high risk of bias.
Figure 3
Figure 3
Impact of cardiac rehabilitation on mean steps/day at short-term follow-up (median 3 months, range 1.5–12 months). CR, cardiac rehabilitation, PA, physical activity; WMD, weighted mean difference.
Figure 4
Figure 4
Impact of cardiac rehabilitation on (A) min/day spent sedentary or sitting; (B) min/day spent in light intensity PA and (C) min/day spent in moderate–vigorous PA. CR, cardiac rehabilitation.
Figure 5
Figure 5
Impact of cardiac rehabilitation on proportion of patients categorised as physically active measured at (A) short-term follow-up (≤12 months) and (B) long-term follow-up (>12 months). CR, cardiac rehabilitation.
See this image and copyright information in PMC

References

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