Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Abstract

ObjectiveTo undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.MethodsDatabases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.ResultsForty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.ConclusionOverall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

“…A recent scientific statement on home-based cardiac rehabilitation, which reviewed 23 studies, extensively analysed the core component of exercise training (home-based or centre-based CR) and its effect on the levels of physical activity in patients undergoing rehabilitation [35]. Increased levels of physical activity leading to an upsurge in functional capacity were noted although recommended use of alternate modes of training due to certain barriers (safety, infrastructure) was alternately advocated [47].…”

Advances in rehabilitation for chronic diseases: improving health outcomes and function

“…Much of the research has focused on the exercise component of cardiac rehabilitation, with a meta-analysis showing that people who participate in a program increase their structured exercise significantly more than those who do not participate,32 and that such interventions are cost effective 31. A 2013 international consensus statement that focused on recommendations for choice of workload intensity in cardiac rehabilitation generally favored higher intensity over light to moderate intensity workloads to maximize benefit 33.…”

“…An analysis of more than 33 000 Medicare beneficiaries with COPD from 1 January 2003 to 31 December 2012 showed that only 1239 people (3.7%) used pulmonary rehabilitation in 2012, with a dismal 1.1% increase in use over the 10 years 90. There is geographic disparity in availability because most programs are located at tertiary care centers and require patients to travel to the program two or three times a week 293032. In the National Emphysema Treatment Trial, participants who lived more than 36 miles from the treatment facility were less likely to complete pulmonary rehabilitation.…”

Heartbeat: The ongoing controversy of intervention for chronic total coronary occlusions

“…The evidence for each component of CR was quite variable, particularly for psychological intervention and telehealth 7. While exercise was cost-effective across all studies, there was considerable uncertainly in the data (as found for measures of PA in the meta-analysis by Dibben and colleagues 5. This data will be useful for health policy decisions but additional studies are needed to determine the most cost-effective CR design.…”

“…However, it remains uncertain whether CR actually improves physical activity (PA) levels in these patients. In a systematic review and meta-analysis of 40 randomised controlled trials, including almost 6000 cardiac patients, an improvement in PA was seen in 26% of studies with CR compared with controls 5. Metrics of PA showed improvement in steps/day and in the proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001).…”