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, 2 (1), e000163

Exercise-based Rehabilitation for Heart Failure: Systematic Review and Meta-Analysis


Exercise-based Rehabilitation for Heart Failure: Systematic Review and Meta-Analysis

Viral A Sagar et al. Open Heart.


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.



Figure 1
Figure 1
Summary of study inclusion/exclusion process.
Figure 2
Figure 2
(A) Pooled all cause mortality for trials up to 12 months follow up. (B) Pooled all cause mortality for trials with more than 12 months follow up.
Figure 3
Figure 3
(A) Pooled all hospitalisations up to 12 months follow up. (B) Pooled all hospitalisations more than 12 months follow up. (C) Pooled heart failure hospitalisations.
Figure 4
Figure 4
(A) Pooled Minnesota Living with Heart Failure score up to 12 months follow up. (B) Pooled Minnesota Living with Heart Failure score more than 12 months follow up (C) All quality of life scores up to 12 months follow up.

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