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Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials.

Abstract

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.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Division of Cardiology, Jewish General Hospital/McGill University, Montreal, Quebec, Canada.

    ,

    Source

    American heart journal 162:4 2011 Oct pg 571-584.e2

    MeSH

    Exercise Therapy
    Humans
    Myocardial Infarction
    Randomized Controlled Trials as Topic

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Review
    Systematic Review

    Language

    eng

    PubMed ID

    21982647

    Citation

    Lawler, Patrick R., et al. "Efficacy of Exercise-based Cardiac Rehabilitation Post-myocardial Infarction: a Systematic Review and Meta-analysis of Randomized Controlled Trials." American Heart Journal, vol. 162, no. 4, 2011, pp. 571-584.e2.
    Lawler PR, Filion KB, Eisenberg MJ. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. Am Heart J. 2011;162(4):571-584.e2.
    Lawler, P. R., Filion, K. B., & Eisenberg, M. J. (2011). Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. American Heart Journal, 162(4), pp. 571-584.e2. doi:10.1016/j.ahj.2011.07.017.
    Lawler PR, Filion KB, Eisenberg MJ. Efficacy of Exercise-based Cardiac Rehabilitation Post-myocardial Infarction: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Am Heart J. 2011;162(4):571-584.e2. PubMed PMID: 21982647.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials. AU - Lawler,Patrick R, AU - Filion,Kristian B, AU - Eisenberg,Mark J, Y1 - 2011/09/03/ PY - 2011/04/10/received PY - 2011/07/21/accepted PY - 2011/10/11/entrez PY - 2011/10/11/pubmed PY - 2011/12/13/medline SP - 571 EP - 584.e2 JF - American heart journal JO - Am. Heart J. VL - 162 IS - 4 N2 - 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. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/21982647/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(11)00559-X DB - PRIME DP - Unbound Medicine ER -