Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Grace O Dibben, Hasnain Dalal, Rod S. Taylor, Patrick Doherty, Lars Hermann Tang, Melvyn Hillsdon

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Abstract

Objective To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

Original languageEnglish
JournalHeart
Volume104
Issue number17
Pages (from-to)1394-1402
ISSN1355-6037
DOIs
Publication statusPublished - Sep 2018

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Meta-Analysis
Exercise
Cardiac Rehabilitation
Randomized Controlled Trials
MEDLINE
Language
Databases

Bibliographical note

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Keywords

  • Cardiac Rehabilitation/methods
  • Coronary Disease/physiopathology
  • Exercise Therapy/methods
  • Exercise/physiology
  • Heart Failure/physiopathology
  • Humans
  • Quality of Life
  • Recovery of Function
  • Secondary Prevention

Cite this

Dibben, G. O., Dalal, H., Taylor, R. S., Doherty, P., Tang, L. H., & Hillsdon, M. (2018). Cardiac rehabilitation and physical activity: systematic review and meta-analysis. Heart, 104(17), 1394-1402. https://doi.org/10.1136/heartjnl-2017-312832
Dibben, Grace O ; Dalal, Hasnain ; Taylor, Rod S. ; Doherty, Patrick ; Tang, Lars Hermann ; Hillsdon, Melvyn. / Cardiac rehabilitation and physical activity : systematic review and meta-analysis. In: Heart. 2018 ; Vol. 104, No. 17. pp. 1394-1402.
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abstract = "Objective To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26{\%} (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95{\%} CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95{\%} CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.",
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Dibben, GO, Dalal, H, Taylor, RS, Doherty, P, Tang, LH & Hillsdon, M 2018, 'Cardiac rehabilitation and physical activity: systematic review and meta-analysis', Heart, vol. 104, no. 17, pp. 1394-1402. https://doi.org/10.1136/heartjnl-2017-312832

Cardiac rehabilitation and physical activity : systematic review and meta-analysis. / Dibben, Grace O; Dalal, Hasnain; Taylor, Rod S. ; Doherty, Patrick; Tang, Lars Hermann; Hillsdon, Melvyn.

In: Heart, Vol. 104, No. 17, 09.2018, p. 1394-1402.

Research output: Contribution to journalReviewResearchpeer-review

TY - JOUR

T1 - Cardiac rehabilitation and physical activity

T2 - systematic review and meta-analysis

AU - Dibben, Grace O

AU - Dalal, Hasnain

AU - Taylor, Rod S.

AU - Doherty, Patrick

AU - Tang, Lars Hermann

AU - Hillsdon, Melvyn

N1 - © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

PY - 2018/9

Y1 - 2018/9

N2 - Objective To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

AB - Objective To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

KW - Cardiac Rehabilitation/methods

KW - Coronary Disease/physiopathology

KW - Exercise Therapy/methods

KW - Exercise/physiology

KW - Heart Failure/physiopathology

KW - Humans

KW - Quality of Life

KW - Recovery of Function

KW - Secondary Prevention

U2 - 10.1136/heartjnl-2017-312832

DO - 10.1136/heartjnl-2017-312832

M3 - Review

C2 - 29654095

VL - 104

SP - 1394

EP - 1402

JO - Heart

JF - Heart

SN - 1355-6037

IS - 17

ER -