Exercise-based rehabilitation for heart failure: systematic review and meta-analysis

Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J.S., Dalal, H. M., Lough, F., Rees, K., Singh, S. and Taylor, R. S. (2015) Exercise-based rehabilitation for heart failure: systematic review and meta-analysis. Open Heart, 2(1), e000163. (doi: 10.1136/openhrt-2014-000163) (PMID:25685361) (PMCID:PMC4316592)

Abstract

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.

• Item Type: Articles
• Additional Information: This publication presents independent research funded by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research Programme (Grant Reference Number RP-PG-1210-12004).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Taylor, Professor Rod
• Authors: Sagar, V. A., Davies, E. J., Briscoe, S., Coats, A. J.S., Dalal, H. M., Lough, F., Rees, K., Singh, S., and Taylor, R. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
• Journal Name: Open Heart
• Publisher: BMJ Publishing Group
• ISSN: 2053-3624
• ISSN (Online): 2053-3624
• Published Online: 28 January 2015
• Copyright Holders: Copyright © 2015 The Authors
• First Published: First published in Open Heart 2(1):e000163
• Publisher Policy: Reproduced under a Creative Commons license