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Exercise-based cardiac rehabilitation for coronary heart disease
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Anderson, Lindsey, Oldridge, Neil B., Thompson, David R., Zwisler, Ann-Dorthe, Rees, Karen, Martin, Nicole and Taylor, Rod S. (2016) Exercise-based cardiac rehabilitation for coronary heart disease. Journal of the American College of Cardiology, 67 (1). pp. 1-12. doi:10.1016/j.jacc.2015.10.044 ISSN 0735-1097.
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Official URL: http://dx.doi.org/10.1016/j.jacc.2015.10.044
Abstract
Background
Although recommended in guidelines for the management of coronary heart disease (CHD), concerns have been raised about the applicability of evidence from existing meta-analyses of exercise-based cardiac rehabilitation (CR).
Objectives
The goal of this study is to update the Cochrane systematic review and meta-analysis of exercise-based CR for CHD.
Methods
The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, and Science Citation Index Expanded were searched to July 2014. Retrieved papers, systematic reviews, and trial registries were hand-searched. We included randomized controlled trials with at least 6 months of follow-up, comparing CR to no-exercise controls following myocardial infarction or revascularization, or with a diagnosis of angina pectoris or CHD defined by angiography. Two authors screened titles for inclusion, extracted data, and assessed risk of bias. Studies were pooled using random effects meta-analysis, and stratified analyses were undertaken to examine potential treatment effect modifiers.
Results
A total of 63 studies with 14,486 participants with median follow-up of 12 months were included. Overall, CR led to a reduction in cardiovascular mortality (relative risk: 0.74; 95% confidence interval: 0.64 to 0.86) and the risk of hospital admissions (relative risk: 0.82; 95% confidence interval: 0.70 to 0.96). There was no significant effect on total mortality, myocardial infarction, or revascularization. The majority of studies (14 of 20) showed higher levels of health-related quality of life in 1 or more domains following exercise-based CR compared with control subjects.
Conclusions
This study confirms that exercise-based CR reduces cardiovascular mortality and provides important data showing reductions in hospital admissions and improvements in quality of life. These benefits appear to be consistent across patients and intervention types and were independent of study quality, setting, and publication date.
Item Type: | Journal Article | ||||||
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Divisions: | 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 |
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Journal or Publication Title: | Journal of the American College of Cardiology | ||||||
Publisher: | Elsevier Inc. | ||||||
ISSN: | 0735-1097 | ||||||
Official Date: | 4 January 2016 | ||||||
Dates: |
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Volume: | 67 | ||||||
Number: | 1 | ||||||
Page Range: | pp. 1-12 | ||||||
DOI: | 10.1016/j.jacc.2015.10.044 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published |
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