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Review
. 2023 Feb 7;44(6):452-469.
doi: 10.1093/eurheartj/ehac747.

Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis

Grace O Dibben  1 , James Faulkner  2 , Neil Oldridge  3 , Karen Rees  4 , David R Thompson  5 , Ann-Dorthe Zwisler  6   7   8 , Rod S Taylor  1   9
Affiliations
Review

Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis

Grace O Dibben et al. Eur Heart J. .

Abstract

Aims: Coronary heart disease is the most common reason for referral to exercise-based cardiac rehabilitation (CR) globally. However, the generalizability of previous meta-analyses of randomized controlled trials (RCTs) is questioned. Therefore, a contemporary updated meta-analysis was undertaken.

Methods and results: Database and trial registry searches were conducted to September 2020, seeking RCTs of exercise-based interventions with ≥6-month follow-up, compared with no-exercise control for adults with myocardial infarction, angina pectoris, or following coronary artery bypass graft, or percutaneous coronary intervention. The outcomes of mortality, recurrent clinical events, and health-related quality of life (HRQoL) were pooled using random-effects meta-analysis, and cost-effectiveness data were narratively synthesized. Meta-regression was used to examine effect modification. Study quality was assessed using the Cochrane risk of bias tool. A total of 85 RCTs involving 23 430 participants with a median 12-month follow-up were included. Overall, exercise-based CR was associated with significant risk reductions in cardiovascular mortality [risk ratio (RR): 0.74, 95% confidence interval (CI): 0.64-0.86, number needed to treat (NNT): 37], hospitalizations (RR: 0.77, 95% CI: 0.67-0.89, NNT: 37), and myocardial infarction (RR: 0.82, 95% CI: 0.70-0.96, NNT: 100). There was some evidence of significantly improved HRQoL with CR participation, and CR is cost-effective. There was no significant impact on overall mortality (RR: 0.96, 95% CI: 0.89-1.04), coronary artery bypass graft (RR: 0.96, 95% CI: 0.80-1.15), or percutaneous coronary intervention (RR: 0.84, 95% CI: 0.69-1.02). No significant difference in effects was found across different patient groups, CR delivery models, doses, follow-up, or risk of bias.

Conclusion: This review confirms that participation in exercise-based CR by patients with coronary heart disease receiving contemporary medical management reduces cardiovascular mortality, recurrent cardiac events, and hospitalizations and provides additional evidence supporting the improvement in HRQoL and the cost-effectiveness of CR.

Keywords: Cardiac rehabilitation; Coronary heart disease; Exercise training; Physical activity; Prevention.

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Conflict of interest statement

Conflict of interest: N.O. declares being an author of a study that is eligible for inclusion in the work (funding source: European Society of Cardiology & European Association of Preventive Cardiology). D.R.T. declares being an author of a study that is eligible for inclusion in the work. A.D.Z. declares being an author of a study that is eligible for inclusion in the work.

Figures

Structured graphical abstract
Structured graphical abstract
Exercise-based CR is recognized as a key component of comprehensive disease management. CABG, coronary artery bypass graft; CHD, coronary heart disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; RCTs, randomized controlled trials.
Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram of study selection process.
Figure 2
Figure 2
Forest plot: exercise-based cardiac rehabilitation vs. control for overall mortality.
Figure 3
Figure 3
Forest plot: exercise-based cardiac rehabilitation vs. control for cardiovascular mortality.
Figure 4
Figure 4
Forest plot: exercise-based cardiac rehabilitation vs. control for myocardial infarction.
Figure 5
Figure 5
Forest plot: exercise-based cardiac rehabilitation vs. control for coronary artery bypass graft.
Figure 6
Figure 6
Forest plot: exercise-based cardiac rehabilitation vs. control for percutaneous coronary intervention.
Figure 7
Figure 7
Forest plot: exercise-based cardiac rehabilitation vs. control for overall hospitalization.
Figure 8
Figure 8
Forest plot: exercise-based cardiac rehabilitation vs. control for cardiovascular hospitalization.
Figure 9
Figure 9
Forest plot: exercise-based cardiac rehabilitation vs. control for health-related quality of life (short-form-36 summary component scores).
Figure 10
Figure 10
Forest plot: exercise-based cardiac rehabilitation vs. control for health-related quality of life (short-form-36 individual domain scores).
Figure 11
Figure 11
Forest plot: exercise-based cardiac rehabilitation vs. control for health-related quality of life (EQ-5D).
See this image and copyright information in PMC

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