Evidence map›Paper›PMID 29540415›Full record

SynthesisBMJ open2018

Is exercise-based cardiac rehabilitation effective? A systematic review and meta-analysis to re-examine the evidence.

Richard Powell, Gordon McGregor, Stuart Ennis, Peter K Kimani, Martin Underwood

Erratum issuedAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in BMJ open, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 45 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
45citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

45 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
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  3. Exercise-based cardiac rehabilitation for coronary heart disease.The Cochrane database of systematic reviews · 2021
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  4. Preclinical techniques to investigate exercise training in vascular pathophysiology.American journal of physiology. Heart and circulatory physiology · 2021
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  8. Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis.Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation · 2020
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

5 authors.

Richard PowellDepartment of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK.
Gordon McGregorDepartment of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK.
Stuart EnnisDepartment of Cardiac Rehabilitation, Centre for Exercise & Health, University Hospitals, Coventry, UK.
Peter K KimaniStatistics and Epidemiology Unit, Warwick Medical School, University of Warwick, Coventry, UK.
Martin UnderwoodWarwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesTo 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

methodsTwo 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).

resultsWe 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

findingsOur 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.

Indexed as

AgedCardiac RehabilitationCase-Control StudiesCoronary Artery DiseaseExercise TherapyFemaleHumansMaleMiddle AgedOutcome Assessment, Health CarePatient AdmissionSecondary Preventionall-cause mortalitycardiovascular mortalitycoronary artery diseaseexercise-based cardiac rehabilitationhospital admissions.

Identifiers

PMID29540415
PMCPMC5857699

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.