PT  - JOURNAL ARTICLE
AU  - Richard Powell
AU  - Gordon McGregor
AU  - Stuart Ennis
AU  - Peter K Kimani
AU  - Martin Underwood
TI  - Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence
AID  - 10.1136/bmjopen-2017-019656
DP  - 2018 Mar 01
TA  - BMJ Open
PG  - e019656
VI  - 8
IP  - 3
4099  - http://bmjopen.bmj.com/content/8/3/e019656.short
4100  - http://bmjopen.bmj.com/content/8/3/e019656.full
SO  - BMJ Open2018 Mar 01; 8
AB  - 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.