Fletcher 1994.

Study characteristics
Methods	Study design: single‐centre RCT Country: USA Dates participants 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 participants): 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 Exercise programme 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.