Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: a meta-regression analysis

Uddin, J., Zwisler, A.-D., Lewinter, C., Moniruzzaman, M., Lund, K., Tang, L. H. and Taylor, R. S. (2016) Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: a meta-regression analysis. European Journal of Preventive Cardiology, 23(7), pp. 683-693. (doi: 10.1177/2047487315604311) (PMID:26330205)

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Abstract

Background: The aim of this study was to undertake a comprehensive assessment of the patient, intervention and trial-level factors that may predict exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure. Design: Meta-analysis and meta-regression analysis. Methods: Randomized controlled trials of exercise-based rehabilitation were identified from three published systematic reviews. Exercise capacity was pooled across trials using random effects meta-analysis, and meta-regression used to examine the association between exercise capacity and a range of patient (e.g. age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias) factors. Results: 55 trials (61 exercise-control comparisons, 7553 patients) were included. Following exercise-based rehabilitation compared to control, overall exercise capacity was on average 0.95 (95% CI: 0.76–1.41) standard deviation units higher, and in trials reporting maximum oxygen uptake (VO2max) was 3.3 ml/kg.min−1 (95% CI: 2.6–4.0) higher. There was evidence of a high level of statistical heterogeneity across trials (I2 statistic > 50%). In multivariable meta-regression analysis, only exercise intervention intensity was found to be significantly associated with VO2max (P = 0.04); those trials with the highest average exercise intensity had the largest mean post-rehabilitation VO2max compared to control. Conclusions: We found considerable heterogeneity across randomized controlled trials in the magnitude of improvement in exercise capacity following exercise-based rehabilitation compared to control among patients with coronary heart disease or heart failure. Whilst higher exercise intensities were associated with a greater level of post-rehabilitation exercise capacity, there was no strong evidence to support other intervention, patient or trial factors to be predictive.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Taylor, Professor Rod
Authors: Uddin, J., Zwisler, A.-D., Lewinter, C., Moniruzzaman, M., Lund, K., Tang, L. H., and Taylor, R. S.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:European Journal of Preventive Cardiology
Publisher:SAGE Publications
ISSN:2047-4873
ISSN (Online):2047-4881
Published Online:01 September 2015

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