Author + information
- Received March 15, 2019
- Revision received April 26, 2019
- Accepted April 29, 2019
- Published online July 29, 2019.
- Rod S. Taylor, PhDa,∗ (, )
- Linda Long, PhDb,
- Ify R. Mordi, MDc,
- Michael Tvilling Madsen, PhDd,
- Edward J. Davies, MDe,
- Hasnain Dalal, MDf,g,
- Karen Rees, PhDh,
- Sally J. Singh, PhDi,
- Christian Gluud, DrMedScij and
- Ann-Dorthe Zwisler, PhDk
- aInstitute of Health and Wellbeing, University of Glasgow, Glasgow, and Institute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom
- bInstitute of Health Research, University of Exeter College of Medicine and Health, Exeter, United Kingdom
- cMolecular and Clinical Medicine, University of Dundee, Dundee, United Kingdom
- dDepartment of Surgery, Zealand University Hospital, Køge, Denmark, and University of Copenhagen, Koege, Denmark
- eCardiothoracic Department, University Hospital Plymouth, Plymouth, United Kingdom
- fDepartment of Primary Care, University of Exeter Medical School, Truro Campus, Knowledge Spa, Royal Cornwall Hospitals Trust, Truro, United Kingdom
- gInstitute of Health Research, Exeter College of Medicine and Health School, University of Exeter, Exeter, United Kingdom
- hDivision of Health Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
- iDepartment of Respiratory Sciences, University of Leicester College of Life Sciences, National Institute for Health Research, Leicester Biomedical Research Center – Respiratory, Glenfield Hospital, Leicester, United Kingdom
- jCopenhagen Trial Unit, Center for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- kREHPA Danish Knowledge Center for Rehabilitation and Palliative Care, University of Southern and Odense University Hospital, Copenhagen, Denmark
- ↵∗Address for correspondence:
Prof. Rod Taylor, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Top floor, 200 Renfield Street, Glasgow G2 3AX, United Kingdom.
Objectives This study performed a contemporary systematic review and meta-analysis of exercise-based cardiac rehabilitation (ExCR) for heart failure (HF).
Background There is an increasing call for trials of models of ExCR for patients with HF that provide alternatives to conventional center-based provision and recruitment of patients that reflect a broader HF population.
Methods The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, and PsycINFO databases were searched between January 2013 and January 2018. Randomized trials comparing patients undergoing ExCR to control patients not undergoing exercise were included. Study outcomes were pooled using meta-analysis. Metaregression examined potential effect modification according to ExCR program characteristics, and risk of bias, trial sequential analysis (TSA), and Grading of Recommendations Assessment Development and Evaluation (GRADE) were applied.
Results Across 44 trials (n = 5,783; median follow-up of 6 months), compared with control subjects, ExCR did not reduce the risk of all-cause mortality (relative risk [RR]: 0.89; 95% confidence interval [CI]: 0.66 to 1.21; TSA-adjusted CI: 0.26 to 3.10) but did reduce all-cause hospitalization (RR: 0.70; 95% CI: 0.60 to 0.83; TSA-adjusted CI: 0.54 to 0.92) and HF-specific hospitalization (RR: 0.59; 95% CI: 0.42 to 0.84; TSA-adjusted CI: 0.14 for 2.46), and patients reported improved Minnesota Living with Heart Failure questionnaire overall scores (mean difference: −7.1; 95% CI: −10.5 to −3.7; TSA-adjusted CI: −13.2 to −1.0). No evidence of differential effects across different models of delivery, including center- versus home-based programs, were found.
Conclusions This review supports the beneficial effects of ExCR on patient outcomes. These benefits appear to be consistent across ExCR program characteristics. GRADE and TSA assessments indicated that further high-quality randomized trials are needed.
- exercise training
- heart failure
- randomized controlled trials
- trial sequential analysis
This article is based on a Cochrane Review published in the Cochrane Database of Systematic Reviews (CDSR) Long L, Mordi IR, Bridges C, Sagar VA, Davies EJ, Coats AJS, Dalal H, Rees K, Singh SJ, Taylor RS. Exercise-based cardiac rehabilitation for adults with heart failure. Cochrane Database of Systematic Reviews 2019, Issue 1. Art. No.: CD003331. DOI: 10.1002/14651858.CD003331.pub5. Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review. Drs. Taylor, Singh, Zwisler, and Dalal received research funding from governmental research grants. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received March 15, 2019.
- Revision received April 26, 2019.
- Accepted April 29, 2019.
- 2019 The Authors