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Cardiac rehabilitation (CR) has been defined as:
‘the coordinated sum of activities required to influence favourably the underlying cause of cardiovascular disease, as well as to provide the best possible physical, mental and social conditions, so that the patients may, by their own efforts, preserve or resume optimal functioning in their community and through improved health behaviour, slow or reverse progression of disease’.1While exercise training is a cornerstone of CR, it is recommended that ‘comprehensive’ programmes also include education (eg, provision of information about a healthy lifestyle) and psychological intervention (eg, counselling to reduce stress).
The first systematic reviews and meta-analyses of CR were published more than 20 years ago, and reported a 20%–25% reduction in all-cause and cardiovascular mortality, pooling data from up to 22 randomised trials, comparing exercise-based CR and no-exercise control in over 4300 patients with postmyocardial infarction. In 2001, Jolliffe et al2 published the first Cochrane review of exercise-based CR, including 32 randomised controlled trials (RCTs) in 8440 patients with postmyocardial infarction and revascularisation. Since then, a further five Cochrane reviews of CR have been published—exercise-based rehabilitation for heart failure, home-based versus centre-based CR, psychological interventions for coronary heart disease, patient education in the management of coronary heart disease and promoting patient uptake and adherence in CR. The portfolio of Cochrane CR review remains dynamic with the publication of regular review updates.
The development of this portfolio of Cochrane reviews reflects many of the key areas of evolution in the model provision of CR, and how this model can vary across international healthcare jurisdictions. These include …