title: Exercise-based cardiac rehabilitation for coronary heart disease.
abstract: BACKGROUND
  The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise-based cardiac rehabilitation aims to restore patients with heart disease to health.
  
  
  OBJECTIVE
  To determine the effectiveness of exercise-based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health-related quality of life of patients with CHD.
  
  
  METHODS
  RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009).
  
  
  METHODS
  Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography.
  
  
  METHODS
  Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information.
  
  
  RESULTS
  This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise-based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow-up) exercise-based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow-up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta-analysis was not undertaken for health-related quality of life. In seven out of 10 trials reporting health-related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise-based cardiac rehabilitation than usual care.
  
  
  CONCLUSIONS
  Exercise-based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well-designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health-related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost-effectiveness.
authors: Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, 2176 Health Sciences Mall, Vancouver, British Columbia, Canada, V6T 1Z3.
authors: Balraj S
authors: BS
authors: Heran
authors: Jenny Mh
authors: JM
authors: Chen
authors: Shah
authors: S
authors: Ebrahim
authors: Tiffany
authors: T
authors: Moxham
authors: Neil
authors: N
authors: Oldridge
authors: Karen
authors: K
authors: Rees
authors: David R
authors: DR
authors: Thompson
authors: Rod S
authors: RS
authors: Taylor
mesh_terms: D003327:Coronary Disease / Q000401:mortality / Q000534:rehabilitation*; D005081:Exercise Therapy; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000534:rehabilitation; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic