Clinical studyExercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials☆
Section snippets
Literature search
Randomized controlled trials were identified from previously published systematic reviews and meta-analyses 5, 6, 7, 8. This list of studies was updated by searching a number of clinical databases, including MEDLINE, EMBASE, CINAHL, and SciSearch, up to March 2003. The Cochrane Library was also searched. The search strategy was developed to maximize sensitivity of article identification and was not restricted by language. It used both controlled vocabulary (e.g., Medical Subject Headings
Results
Over 5000 titles were retrieved from the various search sources and 425 full papers were identified for possible inclusion. Studies were excluded for a variety of reasons: nonrandomized design (18%), inappropriate patient group(s) (9%), inappropriate intervention (22%), the control group received an exercise intervention (14%), inappropriate outcome(s) (21%), inadequate follow-up (14%), and preliminary results available only in abstract form (2%) 17, 18. One trial published after the search
Discussion
This systematic review confirms the findings of previous meta-analyses that exercise-based cardiac rehabilitation reduces both cardiac and total mortality but not the risk of recurrent myocardial infarction or revascularization 5, 6, 7, 8. In fact, our review shows that the mortality effects of exercise therapy appear to be consistent across a number of coronary heart disease groups (e.g., post–myocardial infarction, postrevascularization, angina) as well as a range of exercise-based
Acknowledgements
We thank the Cochrane Heart Group for their administrative support. We also acknowledge the various external reviewers for their comments on subsequent reports on which this paper is based.
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This study was supported by the Canadian Coordinating Office for Health Technology Assessment, the British Heart Foundation, and the UK Physiotherapy Research Foundation. Dr. Taylor is a former Chair of the British Association of Cardiac Rehabilitation Scientific Committee. Dr. Stone is past president of the Canadian Association of Cardiac Rehabilitation.