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Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence
  1. Richard Powell1,2,
  2. Gordon McGregor1,3,
  3. Stuart Ennis1,4,
  4. Peter K Kimani5,
  5. Martin Underwood2
  1. 1 Department of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK
  2. 2 Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
  3. 3 Faculty of Health and Life Sciences, Coventry University, Coventry, UK
  4. 4 Cardiff Centre for Exercise & Health, Cardiff Metropolitan University, Cardiff, UK
  5. 5 Statistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK
  1. Correspondence to Richard Powell; richard.powell{at}


Objectives To determine the contemporary effectiveness of exercise-based cardiac rehabilitation (CR) in terms of all-cause mortality, cardiovascular mortality and hospital admissions.

Data sources Studies included in or meeting the entry criteria for the 2016 Cochrane review of exercise-based CR in patients with coronary artery disease.

Study eligibility criteria Randomised controlled trials (RCTs) of exercise-based CR versus a no-exercise control whose participants were recruited after the year 2000.

Study appraisal and synthesis methods Two separate reviewers independently screened the characteristics of studies. One reviewer quality appraised any new studies and assessed their risk of bias using the Cochrane Collaboration’s recommended risk of bias tool. Data were reported as the risk difference (95% CI).

Results We included 22 studies with 4834 participants (mean age 59.5 years, 78.4% male). We found no differences in outcomes between exercise-based CR and a no-exercise control at their longest follow-up period for: all-cause mortality (19 studies; n=4194; risk difference 0.00, 95% CI −0.02 to 0.01, P=0.38) or cardiovascular mortality (9 studies; n=1182; risk difference −0.01, 95% CI −0.02 to 0.01, P=0.25). We found a small reduction in hospital admissions of borderline statistical significance (11 studies; n=1768; risk difference −0.05, 95% CI −0.10 to −0.00, P=0.05).

Conclusions and implications of key findings Our analysis indicates conclusively that the current approach to exercise-based CR has no effect on all-cause mortality or cardiovascular mortality, when compared with a no-exercise control. There may be a small reduction in hospital admissions following exercise-based CR that is unlikely to be clinically important.

PROSPERO registration number CRD42017073616.

  • coronary artery disease
  • exercise-based cardiac rehabilitation
  • all-cause mortality
  • cardiovascular mortality
  • hospital admissions.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

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  • Contributors RP and MU were principally responsible for the study concept and design. RP and GM were responsible for study selection, data extraction and risk of bias assessment. With the assistance of University Hospital Coventry & Warwickshire library services, RP updated and ran the searches. RP, MU and PKK were responsible for statistical analysis and interpretation of data. GM and SE provided clinical advice. RP and MU wrote the first draft of the review, and all coauthors contributed to review and editing of drafts of the report. All authors approved the final manuscript. RP is the study guarantor and had full access to all trial level data in the review, takes responsibility for the integrity of the data, and accuracy of the data analysis, and had final responsibility to submit for publication.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer This review was not funded, and hence no role was played by funders in the conception, data synthesis, analysis, interpretation or in the drafting of the manuscript.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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