Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis

Anderson, Lindsey, Oldridge, Neil, Thompson, David R., Zwisler, Ann-Dorthe, Rees, Karen, Martin, Nicole and Taylor, Rod S. (2016) Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis. Journal of the American College of Cardiology, 67 1: 1-12. doi:10.1016/j.jacc.2015.10.044


Author Anderson, Lindsey
Oldridge, Neil
Thompson, David R.
Zwisler, Ann-Dorthe
Rees, Karen
Martin, Nicole
Taylor, Rod S.
Title Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane systematic review and meta-analysis
Journal name Journal of the American College of Cardiology   Check publisher's open access policy
ISSN 0735-1097
1558-3597
Publication date 2016-01
Sub-type Article (original research)
DOI 10.1016/j.jacc.2015.10.044
Open Access Status Not Open Access
Volume 67
Issue 1
Start page 1
End page 12
Total pages 12
Place of publication San Diego, CA, United States
Publisher Elsevier
Collection year 2017
Language eng
Formatted abstract
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 healthrelated 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.
Keyword Coronary artery bypass graft
Exercise therapy
Exercise training
Myocardial infarction
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: HERDC Pre-Audit
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Created: Tue, 12 Jan 2016, 08:52:48 EST by Vicki Percival on behalf of School of Nursing, Midwifery and Social Work