Summary of findings 1. Exercise compared to no exercise for adults after heart valve surgery.
| Exercise compared to no exercise for adults after heart valve surgery | ||||||
| Patient or population: adults after heart valve surgery Setting: hospital‐ and home‐based Intervention: exercise Comparison: no exercise | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | №. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with no exercise | Risk with exercise | |||||
| All‐cause mortality Follow‐up range: 3 to 24 months |
Study population | RR 0.83 (0.26 to 2.68) | 131 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWa,b,c | ||
| 79 per 1000 | 66 per 1000 (21 to 213) | |||||
| Cardiovascular mortality | No study reported this outcome | |||||
| All‐cause hospitalisation Follow‐up: 6 months |
Study population | RR 2.72 (0.11 to 65.56) | 122 (1 RCT) | ⊕⊝⊝⊝ VERY LOWb,c,d | There were 0 events in the control group | |
| 0 per 1000 | 0 per 1000 (0 to 0) | |||||
| HRQoL (SF‐12/36 mental component) at end of intervention Follow‐up range: 2 to 3 months |
Mean HRQoL range (mental component) at end of intervention was 51.3 to 53.9 | MD 1.28 higher (1.60 lower to 4.16 higher) | ‐ | 150 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,c,d | |
| HRQoL (SF‐12/36 physical component) at end of intervention Follow‐up range: 2 to 3 months |
Mean HRQoL range (physical component) at end of intervention was 38 to 51 | MD 2.99 higher (5.24 lower to 11.21 higher) | ‐ | 150 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,c,d,e | |
| HRQoL (SF‐12/36 mental component) at maximum follow‐up Follow‐up range: 3 to 24 months |
Mean HRQoL range (mental component) at maximum follow‐up was 54.9 to 55.1 | MD 1.45 lower (4.70 lower to 1.80 higher) | ‐ | 139 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,c,d | |
| HRQoL (SF‐12/36 physical component) at maximum follow‐up Follow‐up range: 3 to 24 months |
Mean HRQoL range (physical component) at maximum follow‐up was 36.9 to 52.2 | MD 0.87 lower (3.57 lower to 1.83 higher) | ‐ | 139 (2 RCTs) | ⊕⊝⊝⊝ VERY LOWb,c,d | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; HRQoL: health‐related quality of life; MD: mean difference; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference. | ||||||
| GRADE Working Group grades of evidence. High certainty: we are very confident that the true effect lies close to that of the estimate of the effect. Moderate certainty: we are moderately confident in the effect estimate: the true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low certainty: our confidence in the effect estimate is limited: the true effect may be substantially different from the estimate of the effect. Very low certainty: we have very little confidence in the effect estimate: the true effect is likely to be substantially different from the estimate of effect. | ||||||
aAt least one trial has some concerns for overall risk of bias. Downgraded by one level for risk of bias.
bSmall sample size/number of events and optimal information size (OIS) criterion not reached, or OIS criterion reached but 95% CI includes RR/MD/SMD of 1/0. Downgraded by one level for inconsistency.
cConfidence interval includes possible benefit or harm (i.e. effect crosses RR of 0). Downgraded by one level for imprecision.
dAll trials providing data for this outcome have an overall risk of bias judged as 'high'. Downgraded by one level for risk of bias.
eSubstantial I2 (between 50% and 90%). Downgraded by one level for imprecision.