Review: exercise-based cardiac rehabilitation reduces all-cause and cardiac mortality in coronary heart disease.

M e t h o d s Data sources: Previously published systematic reviews and meta-analyses; MEDLINE, EMBASE/Excerpta Medica, CINAHL, and SciSearch (to March 2003); the Cochrane Library; specialized rehabilitation databases; health technology assessment Web sites; clinical trial registries; bibliographies of selected articles; and contact with experts and agencies. Study selection and assessment: Randomized controlled trials (RCTs) comparing exercisebased cardiac rehabilitation (alone or combined with psychosocial or educational interventions) with usual care that did not include any form of structured exercise training or advice in patients with CHD and had ≥ 6-month follow-up. Study quality was assessed in terms of the method of randomization, allocation concealment, blinding of outcome assessment, and loss to follow-up. Outcomes: All-cause mortality, cardiac mortality, nonfatal myocardial infarction (MI), revascularization, change from baseline in modifiable cardiac risk factors (lipid levels, triglyceride levels, blood pressure, and smoking), and health-related quality of life (HRQOL). M a i n r e s u l t s 48 RCTs (8940 patients, mean age 55 y) met the inclusion criteria. The median intervention duration was 3 months (range 0.25 to 30 mo), and the median follow-up was 15 months (range 6 to 72 mo). Patients who received exercise-based cardiac rehabilitation had less all-cause and cardiac mortality than did patients who received usual care (Table). Groups did not differ for rates of nonfatal MI (odds ratio [OR] 0.79, 95% CI 0.59 to 1.09), coronary artery bypass grafting (OR 0.87, CI 0.65 to 1.06), or percutaneous coronary intervention (OR 0.81, CI 0.49 to 1.34). Cardiac rehabilitation was associated with reductions in total cholesterol and triglyceride levels (Table); no differences were seen in lowor high-density lipoprotein levels. Systolic blood pressure and patient-reported smoking were also reduced with cardiac rehabilitation. HRQOL was assessed in 12 RCTs: All trials showed an improvement in HRQOL in both cardiac rehabilitation and usual care groups, with greater improvement with cardiac rehabilitation seen in only 2 RCTs.