Cited by 1,844Cardiac Health and Mental HealthCardiovascular and exercise physiologyPhysical Activity and Health

Exercise-based cardiac rehabilitation for coronary heart disease

Open access
Heran, Balraj S, Chen, Jenny MH, Ebrahim, Shah, Moxham, Tiffany, Oldridge, Neil, Rees, Karen, Thompson, David R, Taylor, Rod S·2011·Cochrane Database of Systematic Reviews

Abstract

BACKGROUND: Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016. OBJECTIVES: To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD. SEARCH METHODS: We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021. SELECTION CRITERIA: We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease. DATA COLLECTION AND ANALYSIS: = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs). AUTHORS' CONCLUSIONS: This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.

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Crossref · 10.1002/14651858.cd001800.pub2

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  • In patients with prior acute myocardial infarction, CABG, PTCA, or stable angina (mainly middle-aged men), aerobic exercise training programmes lasting at least 3 months reduce total cardiovascular mortality by 30% and CHD mortality by 35%.

    “a meta-analysis including mainly middle-aged men, most of whom had a previous acute myocardial infarction and the rest with a previous CABG or percutaneous transluminal coronary angioplasty or affected by stable angina pectoris, showed a 30% reduction in total cardiovascular mortality for aerobic exercise training programmes of at least 3-months' duration; this percentage rose to 35% when only dea”
  • In patients with prior acute myocardial infarction, CABG, PTCA, or stable angina, aerobic exercise training has no effect on non-fatal myocardial infarction, and data are insufficient on revascularization rates.

    “Insufficient data were available as to the effects of aerobic exercise training on revascularization rates; moreover, aerobic exercise training did not show any effect on the occurrence of non-fatal myocardial infarction.”

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Research works printed but not linked: 3

  1. Bär FW Hoppener P Diederiks J Vonken H Bekkers J Hoofd W Appels A Cardiac rehabilitation contributes to the restoration of leisure and social activities Journal of Cardiopulmonary Rehabilitation 1992 12 (2 117 25
  2. Gao WG Hu DY Ma WL Tang CZ Li J Hasimu B Effect of health management on the rehabilitation of patients undergoing coronary artery bypass graft Journal of Clinical Rehabilitative Tissue Engineering Research 2007 11 25 4874 8
  3. Li H Guo L Sun JZ Feng JZ Wang P Wu GL Effect of exercise therapy on the quality of life in patients after successful percutaneous transluminal coronary angioplasty Chinese Journal of Clinical Rehabilitation 2004 8 (9 1601 3

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Authors
Heran, B. S., Chen, J. M., Ebrahim, S., Moxham, T., Oldridge, N., Rees, K., Thompson, D. R., & Taylor, R. S.
Affiliations
  • University of British Columbia (CA)
  • London School of Hygiene & Tropical Medicine (GB)
  • Florida Atlantic University (US)
  • Aurora St. Luke's Medical Center (US)
  • University of Warwick (GB)
  • Australian Catholic University (AU)
  • Peninsula College of Medicine and Dentistry (GB)
Venue
Cochrane Database of Systematic Reviews
Published
2011-07-06
Volume
11
Issue
7
Pages
CD001800-CD001800
ISSN
1361-6137 (ISSN-L)
OpenAlex
W1484454705
Cited by
1,844
References
347
Citations by year
2026: 9 · 2025: 46 · 2024: 113 · 2023: 147 · 2022: 123 · 2021: 141 · 2020: 163 · 2019: 153 · 2018: 124 · 2017: 139 · 2016: 144 · 2015: 143 · 2014: 134 · 2013: 134 · 2012: 81
Type
reference entry
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Research Bank (Australian Catholic University) (submittedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (submittedVersion)
  • Research Portal (Queen's University Belfast) (submittedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
Keywords
exercise-based cardiac rehabilitation, coronary artery disease, exercise training, psychosocial interventions, educational intervention, all-cause mortality, cardiovascular mortality, myocardial infarction, coronary artery bypass grafting, percutaneous coronary intervention, angina pectoris, all-cause hospitalization, cardiovascular hospitalization, health-related quality of life, cost-effectiveness, secondary prevention, exercise adherence
MeSH terms
Coronary Disease, Exercise Therapy, Female, Health Status, Humans, Male, Myocardial Infarction, Myocardial Revascularization, Quality of Life, Randomized Controlled Trials as Topic, Outcome Assessment, Health Care

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