Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis

Abstract

ObjectivesTo determine the effect of contemporary exercise-based cardiac rehabilitation on generic and disease-specific health related quality of life for people with coronary artery disease.DesignSystematic review and meta-analysis.Study eligibility criteriaRandomised controlled trials testing exercise-based cardiac rehabilitation versus no exercise control that recruited after 31 December 1999. On 30 July 2019, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases.Study appraisal and synthesisStudies were screened for inclusion by two independent reviewers. Risk of bias was assessed using the Cochrane risk of bias tool. Data were reported as pooled means (95% CI for between-group difference.ResultsWe identified 24 studies (n=4890). We performed meta-analyses for 15 short-term and 9 medium-term outcomes (36-Item Short Form Survey Instrument (SF-36), EuroQol-5D (EQ-5D) and MacNew, a cardiac-specific outcome). Six short-term and five medium-term SF-36 domains statistically favoured exercise-based cardiac rehabilitation. Only for two short-term SF-36 outcomes, ‘physical function’ (mean difference 12.0, 95% CI 4.4 to 19.6) and ‘role physical’ (mean difference 16.9, 95% CI 2.4 to 31.3), did the benefit appear to be clinically important. Meta-analyses of the short-term SF-36 physical and mental component scores, EQ-5D and MacNew and the medium-term SF-36 physical component score, did not show statistically significant benefits. Only two studies had a low risk of bias (n=463 participants).Conclusions and implications of key findingsThere is some evidence of a short-term benefit of contemporary exercise-based cardiac rehabilitation on quality of life for people with coronary artery disease. However, the contemporary data presented in this review are insufficient to support its routine use.

Exercise-Based Cardiac Rehabilitation in Patients with Coronary Artery Disease : Attendance, Adherence and the Added Value of a Behavioural Medicine Intervention

“…It is difficult to compare the results from Study B relating to aerobic exercise capacity with previous research using behavioural change components in exCR, due to the lack of objective outcome measures of physical fitness. The improvements in HRQoL at the four-month follow-up found in Study B are consistent with the results of two recently published meta-analyses, which showed that several SF-36 domain scores improved after exCR 41,42 . Favourable changes in domains of SF-36 have also been reported for both men and women who participated in a group-mediated cognitive behavioural physical activity intervention.…”

“…ExCR may also have favourable effects on psychological well-being including the health-related quality of life (HRQoL) 41,42 , and anxiety and depression 43 . These effects have been measured by patient-reported outcome measures, which serve as a valuable tool for collecting patientcentred data 44 .…”

Cardiac Rehabilitation in German Speaking Countries of Europe—Evidence-Based Guidelines from Germany, Austria and Switzerland LLKardReha-DACH—Part 2

“…In addition, these meta-analyses could not control for the effects of modern ebCR, pharmacotherapy and coronary interventions, and effects on morbidity/mortality might be overestimated. Complementary meta-analyses on ebCR also reported at least short time positive effects on depressive and anxious symptoms, and “mental health” [ 217 , 219 , 220 , 221 , 222 ], but due to methodological limitations they could not rule out the specific contribution of psychological interventions on these effects. For that reason, we performed a systematic review in order to evaluate the current efficacy of additional, well defined psychological interventions compared with ebCR alone on depression, anxiety, QoL, cardiovascular morbidity, cardiovascular mortality, and total mortality in CVD patients [ 212 ].…”

Comparison of cardiac rehabilitation (exercise + education), exercise only, and usual care for patients with coronary artery disease: A non‐randomized retrospective analysis

“…However, a crossover trial on heterogeneous myocardial infarction individuals reported that cardiac rehabilitation program reduced mortality and maintained risk factors compared to usual care 1 . Also, in China 2 and outside of China, 10 the benefits of the cardiac rehabilitation program have been supported by large numbers of evidence‐based randomized trials. However, the Rehabilitation After Myocardial Infarction Trial (RAMIT) reported that cardiac rehabilitation program does not affect mortality, risk factors control, and morbidity of patients after myocardial infarction 11 .…”