This review aimed to determine the impact of cardiac rehabilitation on physical activity levels of people with coronary heart disease and heart failure. The review included 47 randomised controlled trials (n = 6480 participants; 5825 coronary heart disease, 655 heart failure) that compared cardiac rehabilitation to control interventions. Meta-analysis was undertaken where two or more studies reported the same units of physical activity measurement (45 different measures were used). Outcomes were grouped into short-term (< 12 months) and long-term (> 12 months). 25 studies did not adequately report the description of randomisation, 27 studies had issues with concealment of allocation, and 26 studies did not report blinding of outcome assessment. Participation in cardiac rehabilitation increased the number of steps/day (mean difference 1423 steps, 95% CI 757 to 2089, 5 studies) and energy expenditure (mean difference 878 kcal/week, 95% CI 433 to 1323, 3 studies) in the short-term, plus increased the proportion of patients categorised as being physically active in the short-term (relative risk 1.55, 95% CI 1.19 to 2.02, 9 studies) and long-term (relative risk 1.48, 95% CI 1.19 to 1.83, 5 studies). Pooling from two studies indicated no effect of cardiac rehabilitation on sedentary time (mean difference -10.9 min/day, 95% CI -39 to 17), time spent in light intensity physical activity (mean difference -6.6 min/week, 95% CI -45 to 31), and time spent in moderate intensity physical activity (mean difference 8.5 min/week, 95% CI -1.44 to 18.44). In summary, this systematic review provided moderate evidence that cardiac rehabilitation increases physical activity levels compared with control interventions in people with coronary heart disease and heart failure.
Dibben GO et al. Cardiac rehabilitation and physical activity: systematic review and meta-analysis. Heart 2018;104(17):1394-402