Elsevier

American Heart Journal

Volume 162, Issue 4, October 2011, Pages 571-584.e2
American Heart Journal

Curriculum in Cardiology
Efficacy of exercise-based cardiac rehabilitation post–myocardial infarction: A systematic review and meta-analysis of randomized controlled trials

https://doi.org/10.1016/j.ahj.2011.07.017Get rights and content

Background

Exercise-based cardiac rehabilitation (CR) remains an underused tool for secondary prevention post–myocardial infarction (MI). In part, this arises from uncertainty regarding the efficacy of CR, particularly with respect to reinfarction, where previous studies have failed to show consistent benefit. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) to (1) estimate the effect of CR on cardiovascular outcomes and (2) examine the effect of CR program characteristics on the magnitude of CR benefits.

Methods

We systematically searched MEDLINE as well as relevant bibliographies to identify all English-language RCTs examining the effects of exercise-based CR among post-MI patients. Data were aggregated using random-effects models. Stratified analyses were conducted to examine the impact of RCT-level characteristics on treatment benefits.

Results

We identified 34 RCTs (N = 6,111). Overall, patients randomized to exercise-based CR had a lower risk of reinfarction (odds ratio [OR] 0.53, 95% CI 0.38-0.76), cardiac mortality (OR 0.64, 95% CI 0.46-0.88), and all-cause mortality (OR 0.74, 95% CI 0.58-0.95). In stratified analyses, treatment effects were consistent regardless of study periods, duration of CR, or time beyond the active intervention. Exercise-based CR had favorable effects on cardiovascular risk factors, including smoking, blood pressure, body weight, and lipid profile.

Conclusions

Exercise-based CR is associated with reductions in mortality and reinfarction post-MI. Our secondary analyses suggest that even shorter CR programs may translate into improved long-term outcomes, although these results need to be confirmed in an RCT.

Section snippets

Methods

We carried out this systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.8

Search results

Our search strategy identified 2,169 potentially relevant articles of which 369 were reviewed as abstracts and 147 as full articles (Figure 1). Thirty-four RCTs were included in the final analysis.10, 11,15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52 One study reported 15-year follow-up data27; these protracted follow-up data were not included, as they represented an outlier, and instead,

Discussion

Our study was designed to examine the therapeutic effects of exercise-based CR as secondary prevention post-MI. Our primary analysis focused on establishing the overall benefit of exercise-based CR. Our results demonstrate a statistically significant reduction in reinfarction, cardiac mortality, cardiovascular mortality, and all-cause mortality with exercise-based CR. To our knowledge, this is the first meta-analysis to show a statistically significant reduction in reinfarction with

Conclusion

Exercise-based CR reduces the risk of reinfarction and cardiac, cardiovascular, and all-cause mortality when used as secondary prevention post-MI. Even if more modest benefits are obtained when CR is used in everyday current practice, our results suggest that exercise-based CR is efficacious for secondary prevention. Our examination of RCT-level characteristics suggests that even short-term CR programs post-MI could be of benefit and that the overall observed benefits persisted beyond the

Disclosures

The authors declare no conflict of interest.

Acknowledgements

We would like to thank Tara Dourian for her help with data abstraction.

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    1

    Dr Eisenberg is a National Researcher of the Quebec Foundation for Health Research.

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