Exercise-based cardiac rehabilitation for stable angina: systematic review and meta-analysis

Abstract

ObjectiveA systematic review was undertaken to assess the effects of exercise-based cardiac rehabilitation (CR) for patients with stable angina.MethodsDatabases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL) were searched up to October 2017, without language restriction. Randomised trials comparing CR programmes with no exercise control in adults with stable angina were included. Where possible, study outcomes were pooled using meta-analysis. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of evidence. The protocol was published on the Cochrane Database of Systematic Reviews.ResultsSeven studies (581 patients), with a median of 12-month follow-up, were included. The effect of exercise-based CR on all-cause mortality (risk ratio (RR) 1.01, 95 % CI: 0.18 to 5.67), acute myocardial infarction (RR 0.33, 95% CI: 0.07 to 1.63) and cardiovascular-related hospital admissions (RR 0.14, 95% CI: 0.02 to 1.1) relative to control were uncertain. We found low-quality evidence that exercise-based CR results in a moderate improvement in exercise capacity (standard mean difference 0.45, 95% CI: 0.20 to 0.70). There was limited and very low-quality evidence for the effect of exercise-based CR on health-related quality of life (HRQoL), adverse events and costs. No data were identified on cost-effectiveness or return to work.ConclusionsExercise-based CR may improve the short-term exercise capacity of patients with stable angina pectoris. Well-designed randomised controlled trials are needed to definitely determine the impact of CR on outcomes including mortality, morbidity, HRQoL, and costs in the population of patients with stable angina receiving contemporary medical therapy.

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

“…However, for stable angina the level of evidence is quite low, due to limited randomized trials. 36 Despite a potential benefit, stable coronary patients and post elective PCI patients have lower participation (referral) rates than ACS, 37 especially in those with multiple risk factors and/or low functional capacity. Patient participation in cardiac rehabilitation remains far too low, particularly in women, the elderly and the socio-economically deprived.…”

Current Insights into Exercise-based Cardiac Rehabilitation in Patients with Coronary Heart Disease and Chronic Heart Failure

“…Although the effects of exercise training in patients with angina are under reported [13], systematic reviews and meta-analyses conducted in 2011 and 2016 have reported that exercise-based CR reduces cardiovascular mortality and hospital admissions by up to 26 % and 18 % respectively, over 12 months in patients with CHD [7,14]. Nevertheless, the effect of exercise-based CR in the era of contemporary medical care has been brought in to question by a recent systematic review and meta-analysis of trials conducted after the year 2000 [15].…”

Molecular Mechanisms of Cardiac Remodeling and Regeneration in Physical Exercise

“…Different acute and chronic changes in autonomic regulation, cardiac metabolism, signaling pathways, and protein expression in exercising hearts leading to cardiac growth and cellular reprogramming have been discovered over recent years. Especially, the beneficial effects of sports in heart failure and stable angina pectoris on patient outcomes, hospital admission, quality of life, and exercise capacity have been demonstrated [9,10,11]. However, the exact mechanisms of how physical activity delays the development of cardiovascular diseases remain unclear.…”