Sagar, Viral A., Davies, Ed J., Briscoe, Simon, Coats, Andrew J. S., Dalal, Hasnain M., Lough, Fiona, Rees, Karen, Singh, Sally and Taylor, Rod (Rod S.) (2015) Exercise-based rehabilitation for heart failure : systematic review and meta-analysis. Open Heart, Volume 2 (Number 1). Article number e000163. doi:10.1136/openhrt-2014-000163 ISSN 2053-3624.

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Abstract

Objective: To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.

Methods: A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control.

Results: 33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: −5.8 points, −9.2 to −2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date.

Conclusions: This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.

Item Type:	Journal Article
Subjects:	R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Statistics and Epidemiology Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Heart failure -- Exercise therapy
Journal or Publication Title:	Open Heart
Publisher:	B M J Group
ISSN:	2053-3624
Official Date:	28 January 2015
Dates:	Date Event 28 January 2015 Published 4 November 2014 Accepted 20 June 2014 Submitted
Volume:	Volume 2
Number:	Number 1
Article Number:	Article number e000163
DOI:	10.1136/openhrt-2014-000163
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	28 July 2016
Date of first compliant Open Access:	28 July 2016
Funder:	National Institute for Health Research (Great Britain) (NIHR)
Grant number:	RP-PG-1210-12004 (NIHR)
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