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Exercise-based cardiac rehabilitation for coronary heart disease
Open accessAbstract
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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“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”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [333]
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“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.”
From European Guidelines on cardiovascular disease prevention in clinical practice (version 2012) (2012) · cites this paper as [333]
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Mertens, A., Becker, S., Theis, S., Rasche, P., Wille, M., Bröhl, C., Finken, L., & Schlick, C. (2017) · Advances in Intelligent Systems and Computing · doi:10.1007/978-3-319-41652-6_28 · Cited by 5
Metadata
- 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
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2011-07-06
- Volume
- 11
- Issue
- 7
- Pages
- CD001800-CD001800
- ISSN
- 1361-6137 (ISSN-L)
- PMC
- PMC4229995
- 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
- Update notices
- new_version (2016-01-05)
- Open access
- bronze
- doi.org
- 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 › Physiology (medical) › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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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