New Cochrane Review: Cardiac Rehab Should Be an Easy Yes for Way More People
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- In an updated meta-analysis by Cochrane reviewers, exercise-based cardiac rehabilitation in CHD resulted in large reductions in heart attacks and other benefits in the long and short term.
- The evidence for cardiac rehabilitation has been strengthened by the inclusion of more female study participants and people in low- and middle-income countries.
- Study authors endorse exercise-based cardiac rehabilitation, at home or center-based, as part of integrated CHD care in tandem with modern invasive and pharmacological therapy.
The benefits of cardiac rehabilitation (CR) in coronary heart disease (CHD) held up better than ever in an updated Cochrane review, and they looked increasingly applicable to more people and exercise programs.
A meta-analysis covering 107 trials and 26,886 adults with a broad range of CHD — namely post-myocardial infarction (MI) with and without percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) surgery and stable angina — found that exercise-based CR was tied to short-term (6-12 months) benefits compared with no structured exercise:
- Borderline significant reduction in risk of all-cause mortality (risk ratio [RR] 0.86, 95% CI 0.74-1.00)
- Little to no difference in cardiovascular mortality (RR 0.87, 95% CI 0.68-1.11)
- A large reduction in MI (RR 0.72, 95% CI 0.54-0.95)
- Little to no difference in CABG (RR 1.00, 95% CI 0.78-1.28)
- Little to no difference in PCI (RR 0.86, 95% CI 0.65-1.13)
- Large reduction in all-cause hospital admissions (RR 0.65, 95% CI 0.51-0.82)
Studies going out over 36 months showed that CR was still associated with lower risks of cardiovascular mortality (RR 0.58, 95% CI 0.43-0.78) and fatal or non-fatal MI (RR 0.67, 95% CI 0.51-0.87).
Cost-effectiveness and quality of life measures also favored CR in the meta-analysis, reported Rod Taylor, MSc, PhD, of the University of Glasgow in Scotland, and colleagues in Cochrane Database of Systematic Reviews.
“Thus, this latest Cochrane review of [randomized controlled trials] reinforces the importance of exercise-based cardiac rehabilitation as part of integrated CHD care alongside modern invasive and pharmacological therapy,” Taylor’s group wrote.
Of note, the observed lower risk of all-cause mortality in the short-term fell into the realm of statistical significance for the first time in this meta-analysis of CR studies. “However, given the proven survival advantage of contemporary medical treatments and the limited opportunity for additional mortality gain in this patient population, any incremental benefit of exercise-based cardiac rehabilitation is likely to be small,” the authors noted.
The previous Cochrane review on the subject had been released in 2021. That report comprised 85 trials (with 23,430 people with CHD) available at the time.
Since then, the newer CR trials have boosted generalizability by enrolling more women, testing home-and digital-based CR programs, and recruiting in low- and middle-income countries.
“By adding newer studies to this update, we’re able to see that digital programs work as well as in-person programs, which really changes the game here. These approaches may help us reach people who cannot attend traditional center-based services,” said Taylor in a press release.
“Exercise-based cardiac rehabilitation is an inexpensive and cost-effective intervention, but right now it’s underfunded and unprioritized,” added study co-author Grace Dibben, PhD, also of the University of Glasgow, in a statement. “We want this option to be available to everyone. This new research shows you don’t even have to go into a rehab center to benefit – you can participate from home and still see the benefits.”
The Cochrane reviewers acknowledged that some analyses, such as health-related quality of life and cardiovascular hospitalization, were limited by the small number of contributing trials.
“Many people lose confidence after a heart attack or cardiac procedure and worry that physical activity could be dangerous,” Dibben maintained. “Appropriately prescribed exercise is not only safe for most patients, but can play a vital role in recovery and long-term heart health.”
Researchers have also tied exercise-based cardiac rehab to benefits in atrial fibrillation and heart failure.
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