Oldridge 1991.

Methods	Study design: Multicentre RCT (6 sites) Country: Canada Dates patients recruited: NR Maximum follow up: 1 year
Participants	Inclusion criteria: Diagnosis of AMI and scoring > 5 on the short form of the Beck Depression Inventory or > 43 on the Spielberger State Anxiety Inventory or > 42 on the Spielberger Trait Anxiety Inventory while still in hospital. Exclusion criteria: Residence > 30 miles from the Health Sciences Centre; inability to exercise due to uncontrolled dysrhythmias, heart failure or unstable angina; neurologic, orthopedic, peripheral vascular or respiratory disease; and inability to complete the quality of life questionnaires due to cognitive or language problems. N Randomised: total: 201; intervention: 99; comparator: 102 Diagnosis (% of pts): MI: 100% Age (mean ± SD): intervention: 52.9 ± 9.5; comparator: 52.7 ± 9.5 Percentage male: intervention: 88%; comparator: 90% Ethnicity: NR
Interventions	Intervention: Participants attended 50 min exercise sessions twice a week for 8 consecutive weeks. These sessions were held in a hospital gymnasium under the direct supervision of a cardiologist and qualified exercise specialists. There was a I0 min group warm‐up at the beginning of each session; stationary cycle ergometry, treadmill walking and arm ergometry followed for 20 to 30 minutes. A cool‐down, involving low‐intensity activities, concluded the exercise session. Components: exercise and behavioural counselling. Setting: centre. Aerobic exercise: Modality: stationary cycle ergometry, treadmill walking and arm ergometry. Length of session: 50 min. Frequency: twice a week. Intensity: initially on 65% of the maximal heart rate. Resistance training included? No. Total duration: 8 weeks. Co‐interventions: The cognitive behavioural group intervention, facilitated by group leaders without formal training in counselling, consisted of 8 sessions of 90 minutes complemented by progressive relaxation training at the end of the session. Both patient and spouse were invited to attend the group sessions. Comparator: conventional care. Co‐interventions: none described.
Outcomes	Mortality Health‐related quality of life: QOLMI time trade‐off. Cost data reported in Oldridge 1993
Source of funding	This work was supported by the National Health Research and Development Programme, Health and Welfare, Canada
Conflicts of interest	NR
Notes	Both groups improved over 12 months, with the biggest changes occurring in the first 8 weeks.
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	High risk	"the investigators were not blinded to allocation"
Incomplete outcome data (attrition bias) All outcomes	High risk	For the primary outcome ‐HRQL‐ 9% lost to follow up, no description of withdrawals or dropouts.
Selective reporting (reporting bias)	Low risk	All outcomes were reported at all time points.
Groups balanced at baseline	Low risk	“Randomization was successful, in that patients allocated to rehabilitation and conventional care groups were essentially comparable.”
Intention‐to‐treat analysis conducted	High risk	No.
Groups received same treatment (apart from the intervention)	High risk	“Eligible patients were ..... randomized to either community care (control) or an experimental (treatment) group in which small groups of patients received an exercise prescription and behavioural counselling.”