Summary of findings 1. Exercise‐based cardiac rehabilitation compared to 'no exercise' control for coronary heart disease.
| Exercise‐based cardiac rehabilitation compared to 'no exercise' control for coronary heart disease | ||||||
| Patient or population: people with coronary heart disease Setting: hospital‐based, community‐based and home‐based settings Intervention: exercise‐based cardiac rehabilitation Comparison: 'no exercise' control | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect (95% CI) | № of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Risk with 'no exercise' control | Risk with exercise‐based cardiac rehabilitation | |||||
| All‐cause mortality Follow‐up: range 6 months to 12 months | Study population | RR 0.87 (0.73 to 1.04) | 8823 (25 RCTs) | ⊕⊕⊕⊝ Moderatea | Exercise‐based cardiac rehabilitation likely results in a slight reduction in all‐cause mortality up to 12 months' follow‐up. 25 RCTs with 26 comparisons. 14 RCTs reported 0 events in both the intervention and control groups. | |
| 57 per 1000 | 50 per 1000 (42 to 59) | |||||
| Cardiovascular mortality Follow‐up: range 6 months to 12 months | Study population | RR 0.88 (0.68 to 1.14) | 5360 (15 RCTs) | ⊕⊕⊕⊝ Moderatea | Exercise‐based cardiac rehabilitation likely results in little to no difference in cardiovascular mortality up to 12 months' follow‐up. 5 RCTs reported 0 events in both the intervention and control groups. | |
| 45 per 1000 | 39 per 1000 (30 to 51) | |||||
| Fatal and/or non‐fatal MI Follow‐up: range 6 months to 12 months | Study population | RR 0.72 (0.55 to 0.93) | 7423 (22 RCTs) | ⊕⊕⊕⊕ High | Exercise‐based cardiac rehabilitation results in a large reduction in fatal and/or non‐fatal MI up to 12 months' follow‐up. 24 RCTs with 24 comparisons. 3 RCTs reported 0 events in both the intervention and control groups. NNTB 75 (95% CI 47 to 298) |
|
| 48 per 1000 | 35 per 1000 (27 to 45) | |||||
| Revascularisation ‐ CABG Follow‐up: range 6 months to 12 months | Study population | RR 0.99 (0.78 to 1.27) | 4473 (20 RCTs) | ⊕⊕⊕⊕ High | Exercise‐based CR results in little to no difference in CABG revascularisation up to 12 months' follow‐up. 20 RCTs with 22 comparisons. 2 RCTs reported 0 events in both the intervention and control groups. | |
| 56 per 1000 | 56 per 1000 (44 to 72) | |||||
| Revascularisation ‐ PCI Follow‐up: range 6 months to 12 months | Study population | RR 0.86 (0.63 to 1.19) | 3465 (13 RCTs) | ⊕⊕⊕⊝ Moderatea | Exercise‐based CR likely results in little to no difference in risk of PCI revascularisation up to 12 months' follow‐up. 13 RCTs with 14 comparisons. 3 RCTs reported 0 events in both the intervention and control groups. | |
| 60 per 1000 | 52 per 1000 (38 to 72) | |||||
| All‐cause hospital admissions Follow‐up: range 6 months to 12 months | Study population | RR 0.58 (0.43 to 0.77) | 2030 (14 RCTs) | ⊕⊕⊕⊝ Moderateb | Exercise‐based cardiac rehabilitation likely results in a large reduction in all‐cause hospital admissions up to 12 months' follow‐up. 14 RCTs with 16 comparisons. One RCT reported 0 events in both the intervention and control group. NNTB 12 (95% CI 9 to 21) |
|
| 214 per 1000 | 124 per 1000 (92 to 165) | |||||
| Cardiovascular hospital admissions Follow‐up: range 6 months to 12 months | Study population | RR 0.80 (0.41 to 1.59) | 1087 (6 RCTs) | ⊕⊕⊝⊝ Lowa,c | We are uncertain about the effects of exercise‐based CR on cardiovascular hospitalisation, with a wide confidence interval including considerable benefit as well as harm. | |
| 78 per 1000 | 62 per 1000 (32 to 123) | |||||
| *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; RR: risk ratio; OR: odds ratio; NNTB/H: number needed to treat for an additional beneficial/harmful outcome | ||||||
| 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. | ||||||
a95% CI is wide and overlaps no effect; therefore, downgraded by one level for imprecision. bP < 0.05 in the Egger test, and funnel plot asymmetry; therefore, downgraded by one level for suspected publication bias. cEvidence of heterogeneity in the I2 test; therefore, downgraded by one level for substantial heterogeneity.