title: Exercise-Based Cardiac Rehabilitation for Coronary Heart Disease: Cochrane Systematic Review and Meta-Analysis.
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).
  
  
  OBJECTIVE
  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.
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom.
authors.forename: Lindsey
authors.initials: L
authors.lastname: Anderson
authors.affiliation: College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin.
authors.forename: Neil
authors.initials: N
authors.lastname: Oldridge
authors.affiliation: Centre for the Heart and Mind, Australian Catholic University, Melbourne, Australia.
authors.forename: David R
authors.initials: DR
authors.lastname: Thompson
authors.affiliation: National Centre of Rehabilitation and Palliation, University Hospital Odense, and University of Southern Denmark, Odense, Denmark.
authors.forename: Ann-Dorthe
authors.initials: AD
authors.lastname: Zwisler
authors.affiliation: Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom.
authors.forename: Karen
authors.initials: K
authors.lastname: Rees
authors.affiliation: Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom.
authors.forename: Nicole
authors.initials: N
authors.lastname: Martin
authors.affiliation: Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom. Electronic address: r.taylor@exeter.ac.uk.
authors.forename: Rod S
authors.initials: RS
authors.lastname: Taylor
mesh_terms: D003327:Coronary Disease / Q000401:mortality / Q000534:rehabilitation*; D015444:Exercise; D006801:Humans; D011788:Quality of Life; D016896:Treatment Outcome
keywords: coronary artery bypass graft; exercise therapy; exercise training; myocardial infarction; percutaneous coronary intervention; revascularization