Abstract
Purpose
To review the effectiveness of exercise-based cardiac rehabilitation in patients with
coronary heart disease.
Methods
A systematic review and meta-analysis of randomized controlled trials was undertaken.
Databases such as MEDLINE, EMBASE, and the Cochrane Library were searched up to March
2003. Trials with 6 or more months of follow-up were included if they assessed the
effects of exercise training alone or in combination with psychological or educational
interventions.
Results
We included 48 trials with a total of 8940 patients. Compared with usual care, cardiac
rehabilitation was associated with reduced all-cause mortality (odds ratio [OR] =
0.80; 95% confidence interval [CI]: 0.68 to 0.93) and cardiac mortality (OR = 0.74;
95% CI: 0.61 to 0.96); greater reductions in total cholesterol level (weighted mean
difference, –0.37 mmol/L [–14.3 mg/dL]; 95% CI: –0.63 to –0.11 mmol/L [–24.3 to –4.2
mg/dL]), triglyceride level (weighted mean difference, –0.23 mmol/L [–20.4 mg/dL];
95% CI: –0.39 to –0.07 mmol/L [–34.5 to –6.2 mg/dL]), and systolic blood pressure
(weighted mean difference, –3.2 mm Hg; 95% CI: –5.4 to –0.9 mm Hg); and lower rates
of self-reported smoking (OR = 0.64; 95% CI: 0.50 to 0.83). There were no significant
differences in the rates of nonfatal myocardial infarction and revascularization,
and changes in high- and low-density lipoprotein cholesterol levels and diastolic
pressure. Health-related quality of life improved to similar levels with cardiac rehabilitation
and usual care. The effect of cardiac rehabilitation on total mortality was independent
of coronary heart disease diagnosis, type of cardiac rehabilitation, dose of exercise
intervention, length of follow-up, trial quality, and trial publication date.
Conclusion
This review confirms the benefits of exercise-based cardiac rehabilitation within
the context of today's cardiovascular service provision.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to The American Journal of MedicineAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Exercise standards for testing and training.Circulation. 2001; 104: 1694-1740
- Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute.Clin Pract Guide. 1995; 17: 1-23
Cardiac Rehabilitation. SIGN Publication No. 57. Edinburgh, United Kingdom: Scottish Intercollegiate Guidelines Network; 2002. Available at: http://www.show.scot.nhs.uk/sign/guidelines/fulltext/57/index.html. Accessed June 11, 2003
- Canadian guidelines for cardiac rehabilitation and atherosclerotic heart disease prevention.Can J Cardiol. 2001; 17: 3B-30B
- Cardiac rehabilitation after myocardial infarction. Combined experience of randomized clinical trials.JAMA. 1988; 260: 945-950
- An overview of randomised trials of rehabilitation with exercise after myocardial infarction.Circulation. 1989; 80: 234-244
- Does myocardial infarction rehabilitation prolong survival? A meta-analytic survey.G Ital Cardiol. 1989; 19: 1059-1067
- Evaluation of cardiac rehabilitation programmes.in: Jones D. West R. Cardiac Rehabilitation. BMJ Publishing, London, United Kingdom1995: 184-206
- Cardiac rehabilitation.Eff Health Care. 1998; 4: 1-12
- Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses?.Lancet. 1998; 352: 609-613
- European Action on Secondary Prevention through Intervention to Reduce Events.Eur Heart J. 1997; 18: 1569-1582
- Methodology and reports of systematic reviews and meta-analyses.JAMA. 1998; 280: 278-280
- Meta-analysis.BMJ. 1997; 315: 1533-1537
- Variance imputation for overviews of clinical trials with continuous response.J Clin Epidemiol. 1992; 45: 769-773
- Meta analysis in clinical trials.Control Clin Trials. 1986; 7: 177-188
- Bias in meta-analysis detected by a simple graphical test.BMJ. 1997; 315: 629-634
- Rehabilitation for young women with coronary artery disease.Eur Heart J. 2000; 21: 1395
- Quality of life following cardiac rehabilitation.Heart. 2001; 85: P48
- Improved exercise tolerance and quality of life with cardiac rehabilitation of older patients after myocardial infarction.Circulation. 2003; 107: 2201-2206
- Improvements of the lipoprotein profile after coronary bypass surgery.Eur Heart J. 1989; 10: 451-458
- Vaerdien af regelmaessig og overvaget fysisk traening efter akut myokardieinfarkt [The value of regular, supervised training after acute myocardial infarction].Ugeskr Laeger. 1981; 143: 2952-2955
- The effect of moderate physical exercise on the plasma lipoprotein subfractions of male survivors of myocardial infarction.Circulation. 1982; 65: 913-918
- The effect of a home-based, case-managed, multifactorial risk-reduction program on reducing psychological distress in patients with cardiovascular disease.J Cardiopulm Rehabil. 1997; 17: 157-162
- Exercise training intervention after coronary angioplasty.J Am Coll Cardiol. 2001; 37: 1891-1900
- A Comparison of a Multi-Disciplinary Home Based Cardiac Rehabilitation Programme with Comprehensive Conventional Rehabilitation in Post-Myocardial Infarction Patients.([PhD thesis]) University of London, London, United Kingdom1998
- Rehabilitation after myocardial infarction. A controlled study.Scand J Rehabil Med. 1983; 15: 1-9
- A controlled trial of community based coronary rehabilitation.Br Heart J. 1990; 64: 370-375
- Benefits and weaknesses of a cardiac rehabilitation programme.J R Coll Physicians Lond. 1992; 26: 147-151
- Influence of coronary nursing management follow-up on lifestyle after acute myocardial infarction.Heart. 1997; 77: 256-259
- Serum cholesterol, lifestyle, working capacity and quality of life in patients with coronary artery disease. Experiences from a hospital-based secondary prevention programme.Scand Cardiovasc J Suppl. 1998; 50: 1-20
- Exercise after myocardial infarction.J R Coll Physicians Lond. 1982; 16: 147-151
- Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme.Heart. 1999; 81: 359-366
- Coronary heart disease risk factors before and after bypass surgery.Eur Heart J. 1992; 13: 232-237
- Predictability of beneficial effects in cardiac rehabilitation.J Cardiopulm Rehabil. 1986; 6: 206-213
- Exercise testing and training in physically disabled men with clinical evidence of coronary artery disease.Am J Cardiol. 1994; 73: 170-174
- Recovery after myocardial infarction. Effects of a caring rehabilitation programme.Scand J Caring Sci. 1991; 5: 23-32
- Effects of intensive multiple risk factor reduction on coronary atherosclerosis and clinical cardiac events in men and women with coronary artery disease. The Stanford Coronary Risk Intervention Project (SCRIP).Circulation. 1994; 89: 975-990
- Randomised training after myocardial infarction.Scand Cardiovasc J. 2000; 34: 59-64
- Secondary prevention after acute myocardial infarction.Am J Cardiol. 1993; 72: 759-762
- Rehabilitation outcomes following percutaneous coronary interventions (PCI).Patient Educ Couns. 2001; 43: 219-230
- Training after myocardial infarction.Arch Phys Med Rehabil. 1994; 75: 551-554
- Reduction in sudden deaths by a multifactorial intervention programme after acute myocardial infarction.Lancet. 1979; 2: 1091-1094
- Physical fitness and feasibility of physical rehabilitation after myocardial infarction in men of working age.Ann Clin Res. 1972; 4: 1-84
- Trace elements in coronary heart disease.Biol Trace Elem Res. 1997; 60: 175-185
- Effects of self-help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services.Lancet. 1992; 339: 1036-1040
- Sundin
![Math Eq]()
- et al.
Behavioural effects of a comprehensive, multifactorial program for lifestyle change after percutaneous transluminal coronary angioplasty.J Psychosom Res. 1999; 46: 143-154- Sundin
- Retardation of coronary atherosclerosis with yoga lifestyle intervention.J Assoc Physicians India. 2000; 48: 687-694
- Home versus group exercise training for increasing functional capacity after myocardial infarction.Circulation. 1984; 70: 645-649
- Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction.Am J Cardiol. 1991; 67: 1084-1089
- Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial.Lancet. 1990; 336: 129-133
- Comparison of a rehabilitation programme, a counselling programme and usual care after an acute myocardial infarction.Eur Heart J. 1991; 12: 612-616
- Influence of a cardiac rehabilitation program on the cardiovascular, psychological, and social functioning of cardiac patients.J Behav Med. 1984; 7: 61-81
- Regular physical exercise and low-fat diet. Effects on progression of coronary artery disease.Circulation. 1992; 86: 1-11
- Effects of phase II cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease.Circ J. 2003; 67: 73-77
- Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after myocardial infarction. The National Exercise and Heart Disease Project.Am J Cardiol. 1981; 48: 39-46
- Treadmill test responses to an early exercise program after myocardial infarction.Circulation. 1982; 65: 1420-1428
- Interaction between exercise training and ejection fraction in predicting prognosis after a first myocardial infarction.Circulation. 1996; 94: 978-982
- Important factors for physical activity among elderly patients one year after an acute myocardial infarction.Scand J Rehabil Med. 2000; 32: 111-116
- The group counseling v exercise therapy study. A controlled intervention with subjects following myocardial infarction.Arch Intern Med. 1983; 143: 1719-1725
- Physiologic and related behavioural outcomes from the Women's Lifestyle Heart Trial.Ann Behav Med. 2000; 22: 1-9
- Valutazione funzionale precoce e riabilitazione fisica nei pazienti con infarto miocardico esteso [Early functional evaluation and physical rehabilitation in patients with myocardial infarction].G Ital Cardiol. 1981; 11: 419-429
- Effects of cardiac rehabilitation after myocardial infarction.Am Heart J. 1983; 105: 798-801
- Controlled trial of physical training after myocardial infarction. Effects on risk factors, nonfatal reinfarction, and death.Prev Med. 1975; 4: 491-508
World Health Organization. Rehabilitation and comprehensive secondary prevention after acute myocardial infarction. EURO Rep Stud. 1983;84
- A comparison of the effects of strength and aerobic exercise training on exercise capacity and lipids after coronary artery bypass surgery.Eur Heart J. 1996; 17: 854-863
- Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profile after a cardiac rehabilitation program in obese patients with coronary heart disease.Am J Cardiol. 2003; 91: 321-325
- Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease.Circulation. 2003; 107: 3109-3116
- Heart rate and arterial blood pressure during exercise in patients with angina pectoris.Circulation. 1976; 53: 436-442
- Effect of exercise on coronary endothelial function in patients with coronary artery disease.N Engl J Med. 2000; 342: 454-460
- The assessment of recovery in post-myocardial infarction patients using three generic quality of life measures.J Cardiopulm Rehabil. 1998; 18: 139-144
- Assessing health-related quality of life.J Cardiopulm Rehabil. 2003; 23: 26-28
- Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction.Lancet. 2000; 355: 1575-1581
- Randomized controlled trial of long-term moderate exercise training in chronic heart failure.Circulation. 1999; 99: 1173-1182
- Carinex Working Group.J Cardiopulm Rehabil. 2002; 22: 264-272
- Retrospective study of influence of deprivation on uptake of cardiac rehabilitation.BMJ. 1996; 313: 267-268
Article info
Publication history
Accepted:
December 15,
2003
Received:
September 19,
2003
Footnotes
☆This study was supported by the Canadian Coordinating Office for Health Technology Assessment, the British Heart Foundation, and the UK Physiotherapy Research Foundation. Dr. Taylor is a former Chair of the British Association of Cardiac Rehabilitation Scientific Committee. Dr. Stone is past president of the Canadian Association of Cardiac Rehabilitation.
Identification
Copyright
© 2004 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
