Specchia 1996.

Study characteristics
Methods	Study design: single‐centre RCT Country: Italy Dates participants recruited: NR (40‐month period) Maximum follow‐up: mean 34.5 months
Participants	Inclusion criteria: participants < 65 years of age who had not had previous MI, admitted due to chest pain lasting > 30 minutes and because they had a diagnosis of AMI based on evolutionary ECG changes and serum kinase elevation. Exclusion criteria: complicated in‐hospital clinical course e.g. post‐infarction angina requiring urgent revascularisation; evidence of congestive HF; chronic concomitant illnesses or musculoskeletal handicaps that would prevent them from finishing the exercise training period. N randomised: total: 256; intervention: 125; comparator: 131 Diagnosis (% of participants): MI: 100% Prior angina: 42% Age (Mean ± SD): intervention: 51.5 ± 7; comparator: 54.3 ± 8 Percentage male: 91% intervention: 91%; comparator: 91% Ethnicity: NR
Interventions	Intervention: participants underwent a 4‐week physical training period consisting of supervised training sessions of 30 minutes of bicycle ergometry five times a week combined with callisthenics. Training intensity was graded according to 75% of maximal work capacity reached in the previous exercise test. At the end of the 4‐week training period, a second symptom‐limited exercise test was performed. Participants were then discharged with the instructions to continue the callisthenics daily and to walk for ≥ 30 minutes every 2 days. Components: exercise, education and psychology. Setting: centre and then home. Exercise programme modality: bicycle ergometry in centre followed by callisthenics and walking at home. Length of session: ≥ 30 minutes. Frequency: five times a week in centre followed by daily callisthenics and walking every other day. Intensity: 75% of maximal work capacity. Resistance training included? Callisthenics. Total duration: 4 weeks supervised and then continued at home. Co‐interventions: All participants went to the Rehabilitation Center for 3 weeks and underwent a symptom‐limited exercise test (28 ± 2 days after myocardial infarction), 24‐hour Holter monitoring, and coronary arteriography (31 ± 3 days after the acute episode). All participants attended colloquial sessions, held by a cardiologist and a psychologist, dealing with secondary prevention of cardiovascular diseases and stressing dietary changes and smoking cessation. Comparator: Discharged after rehab centre and clinically re‐examined 1 month later when they underwent a second symptom‐limited exercise test. Co‐interventions: as above
Outcomes	CHD mortality, revascularisations
Source of funding	NR
Conflicts of interest	NR
Notes	Ejection fraction (EF) was the only prognostic factor. Among 51 participants with EF < 41%, relative risk for the 27 untrained participants was 8.63 times higher than for 24 trained ones. (P = 0.04) If EF > 40%, estimated risk for untrained participant was 1.07 times higher than for trained.
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	Unclear risk	Blinding not described.
Incomplete outcome data (attrition bias) All outcomes	Low risk	No losses to follow‐up.
Selective reporting (reporting bias)	High risk	While survival data is provided, detailed clinical information was obtained from all participants at 3‐ to 4‐month intervals and these data are not reported.