BACKGROUND: Exercise-based cardiac rehabilitation (CR) remains an underused tool for secondary prevention post-myocardial infarction (MI). In part, this arises from uncertainty regarding the efficacy of CR, particularly with respect to reinfarction, where previous studies have failed to show consistent benefit. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) to (1) estimate the effect of CR on cardiovascular outcomes and (2) examine the effect of CR program characteristics on the magnitude of CR benefits. METHODS: We systematically searched MEDLINE as well as relevant bibliographies to identify all English-language RCTs examining the effects of exercise-based CR among post-MI patients. Data were aggregated using random-effects models. Stratified analyses were conducted to examine the impact of RCT-level characteristics on treatment benefits. RESULTS: We identified 34 RCTs (N = 6,111). Overall, patients randomized to exercise-based CR had a lower risk of reinfarction (odds ratio [OR] 0.53, 95% CI 0.38-0.76), cardiac mortality (OR 0.64, 95% CI 0.46-0.88), and all-cause mortality (OR 0.74, 95% CI 0.58-0.95). In stratified analyses, treatment effects were consistent regardless of study periods, duration of CR, or time beyond the active intervention. Exercise-based CR had favorable effects on cardiovascular risk factors, including smoking, blood pressure, body weight, and lipid profile. CONCLUSIONS: Exercise-based CR is associated with reductions in mortality and reinfarction post-MI. Our secondary analyses suggest that even shorter CR programs may translate into improved long-term outcomes, although these results need to be confirmed in an RCT.
BACKGROUND: Exercise-based cardiac rehabilitation (CR) remains an underused tool for secondary prevention post-myocardial infarction (MI). In part, this arises from uncertainty regarding the efficacy of CR, particularly with respect to reinfarction, where previous studies have failed to show consistent benefit. We therefore undertook a meta-analysis of randomized controlled trials (RCTs) to (1) estimate the effect of CR on cardiovascular outcomes and (2) examine the effect of CR program characteristics on the magnitude of CR benefits. METHODS: We systematically searched MEDLINE as well as relevant bibliographies to identify all English-language RCTs examining the effects of exercise-based CR among post-MI patients. Data were aggregated using random-effects models. Stratified analyses were conducted to examine the impact of RCT-level characteristics on treatment benefits. RESULTS: We identified 34 RCTs (N = 6,111). Overall, patients randomized to exercise-based CR had a lower risk of reinfarction (odds ratio [OR] 0.53, 95% CI 0.38-0.76), cardiac mortality (OR 0.64, 95% CI 0.46-0.88), and all-cause mortality (OR 0.74, 95% CI 0.58-0.95). In stratified analyses, treatment effects were consistent regardless of study periods, duration of CR, or time beyond the active intervention. Exercise-based CR had favorable effects on cardiovascular risk factors, including smoking, blood pressure, body weight, and lipid profile. CONCLUSIONS: Exercise-based CR is associated with reductions in mortality and reinfarction post-MI. Our secondary analyses suggest that even shorter CR programs may translate into improved long-term outcomes, although these results need to be confirmed in an RCT.
Authors: Alan S Go; Dariush Mozaffarian; Véronique L Roger; Emelia J Benjamin; Jarett D Berry; Michael J Blaha; Shifan Dai; Earl S Ford; Caroline S Fox; Sheila Franco; Heather J Fullerton; Cathleen Gillespie; Susan M Hailpern; John A Heit; Virginia J Howard; Mark D Huffman; Suzanne E Judd; Brett M Kissela; Steven J Kittner; Daniel T Lackland; Judith H Lichtman; Lynda D Lisabeth; Rachel H Mackey; David J Magid; Gregory M Marcus; Ariane Marelli; David B Matchar; Darren K McGuire; Emile R Mohler; Claudia S Moy; Michael E Mussolino; Robert W Neumar; Graham Nichol; Dilip K Pandey; Nina P Paynter; Matthew J Reeves; Paul D Sorlie; Joel Stein; Amytis Towfighi; Tanya N Turan; Salim S Virani; Nathan D Wong; Daniel Woo; Melanie B Turner Journal: Circulation Date: 2013-12-18 Impact factor: 29.690
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690