SYSTEMATIC REVIEW   Open access

European Journal of Physical and Rehabilitation Medicine 2024 April;60(2):361-72

DOI: 10.23736/S1973-9087.23.08165-0

Copyright © 2023 THE AUTHORS

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language: English

Exercise-based cardiac rehabilitation for patients with coronary heart disease: a systematic review and evidence mapping study

Zijun LI ¹, Ke GUO ¹, Yongqi YANG ², Yuxi SHUAI ², Rui FAN ², Yanfei LI ³, Jiawei DU ⁴, Junqiang NIU ^{3, 5}, Kehu YANG ^{1, 3} ✉

¹ Evidence-Based Social Science Research Center/Health Technology Assessment Center, School of Public Health, Lanzhou University, Lanzhou, China; ² First Clinical Medical College, University of Lanzhou, Lanzhou, China; ³ Evidence-Based Medicine Center, School of Basic Medical Sciences, University of Lanzhou, Lanzhou, China; ⁴ Second Clinical Medical College, University of Lanzhou, Lanzhou, China; ⁵ First Hospital of Lanzhou University, Lanzhou, China

INTRODUCTION: Exercise-based cardiac rehabilitation (CR) plays a critical role in coronary heart disease (CHD) management. There is a heritage in the effect of exercise-based CR with different exercise programs or intervention settings. This study developed an evidence matrix that systematically assesses, organizes, and presents the available evidence regarding exercise-based CR in CHD management.
EVIDENCE ACQUISITION: A comprehensive literature search was conducted across six databases. Two reviewers screened the identified literature, extracted relevant data, and assessed the quality of the studies. An evidence-mapping framework was established to present the findings in a structured manner. Bubble charts were used to represent the included systematic reviews (SRs). The charts incorporated information, exercise prescriptions, outcome indicators, associated P values, research quality, and the number of original studies. A descriptive analysis summarized the types of CR, intervention settings, influential factors, and adverse events.
EVIDENCE SYNTHESIS: Sixty-two SRs were included in this analysis, focusing on six exercise types in addition to assessing major adverse cardiovascular events (MACE), cost and rehabilitation outcomes. The most commonly studied exercise types were unspecified (28 studies, 45.2%) and aerobic (11 studies, 17.7%) exercises. All-cause mortality was the most frequently reported MACE outcome (22 studies). Rehabilitation outcomes primarily centered around changes in cardiac function (135 outcomes from 39 SRs). Only 8 (12.9%) studies were rated as “high quality.” No significant adverse events were observed in the intervention group. Despite some variations among the included studies, most SRs demonstrated the benefits of exercise in improving one or more MACE or rehabilitation outcomes among CHD patients.
CONCLUSIONS: The proportion of high-quality evidence remains relatively low. Limited evidence is available regarding the effectiveness of specific exercise types and specific populations, necessitating further evaluation.

KEY WORDS: Cardiac rehabilitation; Exercise; Systematic review; Coronary disease