Efficacy and safety of traditional Chinese exercises in cardiac rehabilitation of patients after percutaneous coronary intervention: A systematic review and meta-analysis

Abstract

Purpose: Percutaneous coronary intervention (PCI) is one of the most important therapies in patients with coronary heart disease (CHD). However, there are still many problems, such as in-stent restenosis, recurrent angina pectoris, postoperative anxiety and depression. Traditional Chinese exercise (TCE) therapies belong to the aerobic exercise of low and medium intensity which movements are soft and the combination of movement and static, which may have a certain efficacy on cardiac rehabilitation of patients after PCI. Therefore, this study systematically reviewed the reported clinical studies of TCE on cardiac rehabilitation in patients after PCI to explore its efficacy and safety.

Methods: We searched for RCTs on patients after PCI in 8 Chinese and English databases from their inception to Aug 2024. We included patients after PCI, with the intervention group receiving TCE (alone and/or combined with conventional treatment and/or exercise) and the control group receiving only conventional treatment and/or exercise. We screened the literatures and extracted the data. And we used the Cochrane "Risk of bias" tool and GRADE tool to assess the quality of studies and evidence. We used RevMan 5.4 to analyze the results.

Results: Fifty-three studies involving 4700 patients after PCI were included. TCE therapy includes Baduanjin, Tai Chi, Wuqinxi and Yi Jinjing. Conventional treatment(CT) included basic drugs, routine nursing, nutritional guidance and psychological intervention. Conventional exercise (CE) included walking, jogging or other aerobic exercise, resistance training, balance and flexibility training. Methodological quality was of high risk of bias in blinding of participants and personnel as well as unclear of bias in blinding of outcome assessment and allocation concealment. Grade evaluation results suggested low or very low quality of evidence. For the incidence of major adverse cardiovascular events rate, left ventricular ejection fraction, NT-ProBNP, six-minute walk distance, left ventricular end diastolic diameter, left ventricular end-systolic diameter, VO₂ max, anaerobic threshold, metabolite equivalents, seattle angina questionnaire and short form 36 health survey questionnaire, treatment group is superior to control group (P＜0.05). For VO₂ peak, there was no significant difference between the two groups (P＞0.05).

Conclusions: The results of this study showed that TCE may have efficacy in reducing the incidence of MACE, improving the cardiac function, exercise endurance and quality of life of patients after PCI. And the efficacy of the TCE therapy combined with CT and/or CE may be better than that of the CT and/or CE and the safety may be better.

Keywords: Cardiac rehabilitation; Percutaneous coronary intervention; Systematic review; Traditional Chinese exercise.