Author + information
- Received July 14, 2015
- Revision received October 12, 2015
- Accepted October 14, 2015
- Published online January 5, 2016.
- Lindsey Anderson, PhD∗,
- Neil Oldridge, PhD†,
- David R. Thompson, PhD‡,
- Ann-Dorthe Zwisler, MD§,
- Karen Rees, PhD‖,
- Nicole Martin, MA¶ and
- Rod S. Taylor, PhD∗∗ ()
- ∗Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
- †College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
- ‡Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia
- §National Centre of Rehabilitation and Palliation, University Hospital Odense, and University of Southern Denmark, Odense, Denmark
- ‖Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- ¶Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
- ↵∗Reprint requests and correspondence:
Prof. Rod S. Taylor, Institute of Health Services Research, University of Exeter Medical School, South Cloisters, St Luke's Campus, Exeter EX1 2LU, United Kingdom.
Background Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).
Objectives The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.
Methods The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.
Results A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.
Conclusions This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
- coronary artery bypass graft
- exercise therapy
- exercise training
- myocardial infarction
- percutaneous coronary intervention
Dr. Anderson is funded by the University of Exeter Medical School. Prof. Taylor is partly funded by the U.K. National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust; and is currently the cochief investigator of a research program with the overarching aims of developing and evaluating a home-based cardiac rehabilitation intervention for people with heart failure and their careers (PGfAR RP-PG-0611-12004). Dr. Rees is supported by the NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands at University Hospitals Birmingham NHS Foundation Trust. Dr. Zwisler is principal investigator of an included (DAHREHAB) and ongoing cardiac rehabilitation trials (CopenHeart trials). Prof. Taylor, Drs. Rees and Oldridge, and Prof. Thompson were authors of the original Cochrane review; and Prof. Taylor and Drs. Rees and Zwisler are authors on a number of other Cochrane cardiac rehabilitation reviews. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health in England. Ms. Martin has reported that she has no relationships relevant to the contents of this paper to disclose.
- Received July 14, 2015.
- Revision received October 12, 2015.
- Accepted October 14, 2015.
- American College of Cardiology Foundation