Fletcher 1994.

Methods	Study design: Single centre RCT Country: US Dates patients recruited: NR Maximum follow up: 6 months.
Participants	Inclusion criteria: ≤ 73 years; CAD and physical disability. CAD documented by history of MI, coronary artery bypass surgery, PCI or angiographically demonstrated CAD; have the functional use of more than 2 extremities, 1 being an arm, in order to perform the exercise test and training protocols. Exclusion criteria: Uncontrolled hypertension or diabetes mellitus, clinically significant cardiac dysrhythmias, unstable angina pectoris, cognitive deficits, or other problems that would interfere with compliance to the prescribed exercise and diet protocol. N Randomised: total: 88; intervention: 41; comparator: 47 Diagnosis (% of pts): CAD and a physical disability Age (mean ±SD): intervention: 62 ± 8; comparator: 63 ± 7 Percentage male: intervention: 100%; comparator: 100% Ethnicity: NR
Interventions	Intervention: Participants were provided with a wheelchair ramp with rollers and a telephone electrocardiographic recording device. They were instructed to exercise using the ramp which essentially transformed their wheelchair into a stationary wheelchair ergometer. Specific instructions were to exercise 5 days/week for 20 minutes a day for a total of 100 minutes each week. Components: exercise plus education. Setting: home. Aerobic exercise: Modality: stationary wheelchair ergometer. Length of session: 20 min. Frequency: 5 days/week. Intensity: 85% of predicted maximal heart rate. Resistance training included? no. Total duration: 6 months. Co‐interventions: Both groups received didactic and written dietary instruction from a registered dietitian on the American Heart Association Step I low‐cholesterol, low‐saturated fat diet. Comparator: usual care. Co‐interventions: Participants in the control group received dietary instruction and were instructed to follow activity guidelines provided by their primary physician and health care team.
Outcomes	Total mortality, non fatal MI at 6 months.
Source of funding	United States Department of Education.
Conflicts of interest	NR
Notes	The treatment programme decreased myocardial oxygen demand.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	"randomized"
Allocation concealment (selection bias)	Unclear risk	Not reported.
Blinding of outcome assessment (detection bias) All outcomes	Low risk	"The same experienced cardiologist interpreted all echocardiograms and was unaware of randomization procedures".
Incomplete outcome data (attrition bias) All outcomes	High risk	32% lost to follow up, no description of withdrawals or dropouts.
Selective reporting (reporting bias)	Low risk	All outcomes reported for all time points.
Groups balanced at baseline	High risk	“Despite randomization procedures, the treatment group was further from their physical disability event than the control Group”.
Intention‐to‐treat analysis conducted	Low risk	Yes
Groups received same treatment (apart from the intervention)	Low risk	“Eighty eight men …… were randomized to either a 6 month home exercise training program using wheelchair ergometry or to a control group that received usual and customary care….Both groups received dietary instructions and were requested to follow a fat‐controlled diet.”