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. 2025 Aug 9;17(1):233.
doi: 10.1186/s13102-025-01270-8.

Effect of exercise-based cardiac rehabilitation in patients with acute coronary syndrome: a systematic review and meta-analysis

Kasra Shokri  1 , Azin Karimian  1 , Azar Radfar  2 , Abbas Mohammadi  3 , Atefeh Amerizadeh  1 , Raheleh Karimi  4 , Masoumeh Sadeghi  5   6
Affiliations

Effect of exercise-based cardiac rehabilitation in patients with acute coronary syndrome: a systematic review and meta-analysis

Kasra Shokri et al. BMC Sports Sci Med Rehabil. .

Abstract

Acute Coronary Syndrome (ACS) poses a significant threat to cardiovascular health. This study evaluates the effects of structured exercise cardiac rehabilitation (CR) both center-based and home-based on incidence of major adverse cardiovascular events (MACE) and 6 min Walk Test (6MWT) in ACS patients.A systematic literature search was conducted across major databases to identify randomized controlled trials (RCT) published from 2000 to March 2024. Random-effects model was applied for meta-analysis. Cochran's Q and I2 values were applied to determine heterogeneity, followed by subgroup analyses for exploring sources of heterogeneity. Sensitivity and publication bias analyses were performed.Ten RCTs showed that rehabilitation significantly reduced the odds of MACE compared to usual care (OR: 0.16, 95% CI: 0.07-0.38; p = 0.00). In terms of type of rehabilitation, center-based CR had a lower odd of MACE (OR: 0.13) than home-based CR (OR: 0.37), though the difference was not statistically significant (p = 0.24). In terms of follow-up duration, studies with ≤ 1 year follow-up reported lower MACE odds (OR: 0.10) compared to those > 1 year (OR: 0.28), also not statistically significant (p = 0.33). For functional capacity, analysis of seven studies showed that rehabilitation significantly improved 6MWT performance. Exercise-based rehabilitation led to an average increase of 86.24 m, Home-based rehabilitation showed a smaller gain of 37.63 m, with a significant difference between the two groups (p = 0.04).This meta-analysis provides strong evidence that CR, particularly structured exercise-based programs, significantly reduces the risk of MACE and improves functional capacity in patients with cardiovascular disease.

Keywords: Acute coronary syndrome; Exercise; Myocardial infarction; Rehabilitation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This article does not contain any studies with human participants performed by any of the authors. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study
Fig. 2
Fig. 2
Forrest plot of MACE incidence in the control group and the CR group
Fig. 3
Fig. 3
Forrest plot of rate of MACE incidence in the center-based and home-based CR groups
Fig. 4
Fig. 4
Forrest plot of MACE in the control group and the CR group in terms of CR duration time
Fig. 5
Fig. 5
Forrest plot of 6 min walk test (6MWT) in the control group and the CR group
Fig. 6
Fig. 6
Forrest plot of 6 min walk test (6MWT) in the center-based and home-based CR groups
Fig. 7
Fig. 7
Forrest plot of 6 min walk test (6MWT) in the control and the CR groups in terms of CR duration time
Fig. 8
Fig. 8
Funnel plots of publication bias in terms of MACE incidence
Fig. 9
Fig. 9
Funnel plots of publication bias in terms of 6 min walk test (6MWT)
Fig. 10
Fig. 10
The risk of bias
Fig. 11
Fig. 11
Sensitivity analyses to evaluate the impact of outlier studies for MACE
Fig. 12
Fig. 12
Sensitivity analyses to evaluate the impact of outlier studies for 6MWT
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