Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler A-D, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub4.
Picture this…
Charlotte is 55 and lives an inactive lifestyle. She has never enjoyed exercise or felt that she benefitted from it. Charlotte also works from home, at her desk, her life has become more sedentary as she has grown older. Charlotte has recently been diagnosed with the early stages of coronary heart disease (CHD) (this is where arteries become blocked by a fatty substance which can lead to illnesses such as a heart attack) and her doctor has encouraged her to take part in physical activity to help with her symptoms. Charlotte recognises that her lifestyle is ‘unhealthy’, but she struggles to see how exercise can fit into her busy work schedule and how it will make a real difference to her heart disease. She wants to know if there is evidence behind this or if alternatives, such as drug therapies, may prove more helpful.
Summary messages –
- Regular exercise such as stationary cycling, walking or circuit training showed important benefits to health, including a reduction in the risk of death, heart attack, and hospital visits, and improvements in health-related quality of life, compared with those not undertaking exercise as part of their usual care.
- Many of the studies in this review took place in different countries (including low and middle-income countries), and included women as well as men, which increases the certainty of this research.
What the research says –
The review team wanted to update previous evidence collected in 2016 to see if exercise treatments improved the health and quality of life in people living with coronary heart disease (CHD). If benefits of exercise are seen in people with CHD, then it would provide a safe, easy and cost-effective treatment for the disease. By gaining further insight into this area of research, it is possible to improve the health and prognosis of people living with CHD and reduce risk factors in those at risk of developing the disease in the future.
Data was collected from research published up until September 2020 which reported randomised controlled trials examining if exercise interventions improved health outcomes in people of all ages suffering with CHD. Factors that were measured included morbidity (suffering symptoms from a disease), risk of death, hospitalisation rates and quality of life along with associated healthcare costs. These measures were also compared over differing time periods to see if the benefits of the exercise were sustained or reduced over time.
This review included 85 studies which took place in a variety of different countries. The results were consistent with the previous Cochrane Review and demonstrated that people with CHD have a reduced risk of death, heart attack, hospital admission, and better quality of life if they take part in regular exercise than with those that did not. At short-term follow-up (6 to 12 months), exercise treatments specifically showed large reductions in heart attack (myocardial infarction) (RR 0.72, 95% CI 0.55 to 0.93; 22 trials) and all-cause hospitalisations (RR 0.58, 95% CI 0.43 to 0.77; 14 trials). At long-term follow-up ( > 36 months), although there was minor differences in mortality rates, exercise therapies did demonstrate large reductions in deaths specific to cardiovascular problems (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and heart attack (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). There was also a small number of studies (eight trial-based economic evaluations) that pointed towards this treatment being cost-effective. Twenty-one trials in this review took place across different countries (including low and middle-income countries) which increased the certainty of these results.
Although some of the methods used in some studies was poorly reported, making it difficult to assess the overall quality, the level of evidence presented by this review highlights the importance of exercise as a cost-effective and easily implemented treatment in people with CHD. The findings of this updated review reiterate the previous conclusion that exercise provides important health and well-being benefits for people with CHD. However, it important to note that some of these benefits have little to no different with medium to longer-term follow-up, such as all-cause mortality, but there is no evidence that exercise is harmful.
Better reporting of the research methods used, costs, and some outcomes such as mortality and hospital admissions, especially in the long-term, could help research to develop effective and accessible exercise treatments for people with CHD.
Where is Charlotte now…
Charlotte decided to take up swimming to improve both her physical health and her overall wellbeing. She has noticed an improvement in her physical fitness, as well as in her attitudes toward her lifestyle. Charlotte also hopes to make positive changes to her diet which she knows will make even bigger improvements to her physical health and reduce her risk of further damage to her heart in the future. Charlotte is happy that these changes have made a positive impact on both her physical and mental health and she can see the benefits of exercise interventions in improving her CHD. Charlotte is even considering joining her neighbour Barbra in attending yoga classes at the local leisure centre to further reduce her inactivity and spend time exercising with others.
Postgraduate Student, NIHR Applied Research Collaboration South West Peninsula (PenARC)
College of Medicine and Health
University of Exeter
Please note: the stories and pictures used do not represent specific individuals – they are merely utilised to contextualise the data into a more digestible format
Reference points –
Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler A-D, Taylor RS. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews 2021, Issue 11. Art. No.: CD001800. DOI: 10.1002/14651858.CD001800.pub4
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