Efficacy of Different Types of Exercise-Based Cardiac Rehabilitation on Coronary Heart Disease: a Network Meta-analysis

Abstract

Current evidence suggests that center-based CR is acceptable for patients with CHD. As home- and tele-based CR can save time, money, effort, and resources and may be preferred by patients, their efficacy should be investigated further in subsequent studies.

Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology

“…In 2020 telerehabilitation could be more than a 'future perspective' and available information supports the continued expansion of evidence-based, homebased cardiac rehabilitation programmes. Recent network meta-analysis has shown favourable results on mortality for centre-based cardiac rehabilitation only; 167 however, given the limitations of network meta-analyses this study does not question the value of telerehabilitation in general. The choice of participating in a more traditional and supervised centrebased programme or a home-based programme may reflect local availability and consider the preference of the individual patient.…”

Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017

“…In addition to resource increases, innovative solutions might be further developed toward increasing access to essential, quality rehabilitation services for locations with suboptimal or unevenly distributed rehabilitation resources. That includes rehabilitation delivered at home, the community or via tele-means -in complement or alternative to more traditional settings-based rehabilitation [43,86,[88][89][90][91][92][93]. Task-shifting to healthcare assistants or team-based community care, especially in LMICs, also remains a venue for future research and development [94].…”

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

“…6 7 Multiple meta-analyses incorporating trials spanning 1975-2018 reported favourable effects on functional capacity, hospital readmissions and mortality. [8][9][10][11][12] Nevertheless, our 2018 systematic review (22 randomised controlled trials (RCTs), N=4834), which only included RCTs of 'contemporary' exercise-based CR that recruited after the end of 1999, found that the CR programmes tested had no effect on all-cause mortality (risk difference 0.0, 95% CI −0.02 to 0.01), and only a small effect on hospital readmissions of borderline statistical significance. 13 A 2018 network meta-analysis, while showing a reduction in mortality when including studies from 1975 to present day, found a non-significant reduction in mortality for studies published after 2001.…”

“…13 A 2018 network meta-analysis, while showing a reduction in mortality when including studies from 1975 to present day, found a non-significant reduction in mortality for studies published after 2001. 12 Existing data do not support the continued delivery of exercise-based CR in its current form where the intention is to reduce mortality or prevent hospital readmissions in CAD. For the continued use of these programmes to be justified for people with CAD, a paradigm shift in their stated aims is required.…”