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Cardiac rehabilitation and physical activity: systematic review and meta-analysis
  1. Grace Olivia Dibben1,
  2. Hasnain M Dalal1,2,
  3. Rod S Taylor2,
  4. Patrick Doherty3,
  5. Lars Hermann Tang4,
  6. Melvyn Hillsdon5
  1. 1 European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK
  2. 2 Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, UK
  3. 3 Department of Health Sciences, University of York, York, UK
  4. 4 National Knowledge Centre for Rehabilitation and Palliative Care, Odense University Hospital, University of Southern Denmark, Odense, Denmark
  5. 5 Department of Sport and Health Sciences, University of Exeter, Exeter, UK
  1. Correspondence to Grace Olivia Dibben, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro TR13HD, UK; gd318{at}


Objective To 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.

Methods Databases (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.

Results Forty 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.

Conclusion Overall, 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.

  • cardiac rehabilitation
  • coronary artery disease
  • heart failure
  • meta-analysis
  • systemic review

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  • Contributors GOD, HMD, RST and MH contributed to the conception, design, planning, conduct and reporting of the work described in this article. All authors contributed to the critical revision of the manuscript.

  • Funding This study was supported by a University of Exeter Postgraduate Studentship Grant.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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