Cardiac rehabilitation and physical activity: systematic review and meta-analysis

Dibben, G. O. , Dalal, H. M., Taylor, R. S. , Doherty, P., Tang, L. H. and Hillsdon, M. (2018) Cardiac rehabilitation and physical activity: systematic review and meta-analysis. Heart, 104(17), pp. 1394-1402. (doi: 10.1136/heartjnl-2017-312832) (PMID:29654095) (PMCID:PMC6109237)

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Objective: To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies. Methods: Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis. Results: Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor. Conclusion: Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Dibben, Dr Grace and Taylor, Professor Rod
Authors: Dibben, G. O., Dalal, H. M., Taylor, R. S., Doherty, P., Tang, L. H., and Hillsdon, M.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:Heart
Publisher:BMJ Publishing Group
ISSN (Online):1468-201X
Published Online:13 April 2018
Copyright Holders:Copyright © 2018 The Authors
First Published:First published in Heart 104(17):1394-1402
Publisher Policy:Reproduced under a Creative Commons License

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