Exploration of the methodological quality and clinical usefulness of a cross-sectional sample of published guidance about exercise training and physical activity for the secondary prevention of coronary heart disease

Abstract

BackgroundClinicians are encouraged to use guidelines to assist in providing evidence-based secondary prevention to patients with coronary heart disease. However, the expanding number of publications providing guidance about exercise training may confuse cardiac rehabilitation clinicians. We therefore sought to explore the number, scope, publication characteristics, methodological quality, and clinical usefulness of published exercise-based cardiac rehabilitation guidance.MethodsWe included publications recommending physical activity, exercise or cardiac rehabilitation for patients with coronary heart disease. These included systematically developed clinical practice guidelines, as well as other publications intended to support clinician decision making, such as position papers or consensus statements. Publications were obtained via electronic searches of preventive cardiology societies, guideline databases and PubMed, to November 2016. Publication characteristics were extracted, and two independent assessors evaluated quality using the 23-item Appraisal of Guidelines Research and Evaluation II (AGREE) tool.ResultsFifty-four international publications from 1994 to 2016 were identified. Most were found on preventive cardiology association websites (n = 35; 65%) and were freely accessible (n = 50; 93%). Thirty (56%) publications contained only broad recommendations for physical activity and cardiac rehabilitation referral, while 24 (44%) contained the necessary detailed exercise training recommendations. Many were labelled as “guidelines”, however publications with other titles (e.g. scientific statements) were common (n = 24; 44%). This latter group of publications contained a significantly greater proportion of detailed exercise training recommendations than clinical guidelines (p = 0.017). Wide variation in quality also existed, with ‘applicability’ the worst scoring AGREE II domain for clinical guidelines (mean score 53%) and ‘rigour of development’ rated lowest for other guidance types (mean score 33%).ConclusionsWhile a large number of guidance documents provide recommendations for exercise-based cardiac rehabilitation, most have limitations in either methodological quality or clinical usefulness. The lack of rigorously developed guidelines which also contain necessary detail about exercise training remains a substantial problem for clinicians.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-017-0589-z) contains supplementary material, which is available to authorized users.

Comparison of the pathways of care and life courses between first-time ST-elevation myocardial infarction (STEMI) and STEMI with prior MI: findings from the OSCAR registry

“…21 The literature has also highlighted that secondary prevention strategies after a STEMI episode are still far from being optimal 23 and also denoted substantial problem of guidance documents for clinicians. 24 These results potentially counterbalance the prognostic benefits of the reperfusion therapy. Literature also suggested the need to integrate post-discharge health support with cardiac rehabilitation to facilitate recovery after primary PCI, 25 with post-discharge home visits at 4 weeks and at 6 months for instance.…”

Systematic review of cardiac rehabilitation guidelines: Quality and scope

“…Prior to this report, there have been three reviews of CR guidelines to our knowledge, 11–13 two of which considered quality (one only in guidelines >10 years old; 12 the Abell et al. review was on exercise guidance for cardiovascular disease, not CR specifically, and did not report quality in accordance with scoring instructions) 11 and two reviews focused on comparability of exercise recommendations only. 11,13 The search from the most recent review, again on exercise guidance but not CR specifically, went to 2016.…”

“…review was on exercise guidance for cardiovascular disease, not CR specifically, and did not report quality in accordance with scoring instructions) 11 and two reviews focused on comparability of exercise recommendations only. 11,13 The search from the most recent review, again on exercise guidance but not CR specifically, went to 2016. 11 As part of the WHO PRI initiative, an updated systematic review of CR guidelines was undertaken, with an eye to identifying the highest quality, multi-professional, comprehensive (i.e.…”

Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts

“…12,13 (Supporting Information Appendix S1). 8 By not being an industry-sponsored pharmacological intervention, its development program has been driven mainly by investigator-initiated trials without clear recommendations about the best type of exercise and the most appropriate intensity, frequency, and duration. 31 In order to clarify the real effects of exercise as a therapeutic intervention and to optimize its use in managing PD, the knowledge and rigor of a formal drug development program should be used in clinical exercise research.…”

“…[5][6][7] Furthermore, the level of standardization of the interventions and the methodological quality of the trials are usually low, frequently leading to conflicting or inconclusive results, which hamper the possibility of generating recommendations based on high levels of evidence. 2,8,9 In order to improve the available evidence and establish its real efficacy, we believe that exercise in PD should be approached as a therapeutic intervention and prescribed with the same rigor as pharmacological interventions. For this to happen, collaboration between the fields of movement disorders and sports science is needed.…”