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Exercise-based cardiac rehabilitation for coronary heart disease - PubMed

  • ️Fri Jan 01 2021

Review

Exercise-based cardiac rehabilitation for coronary heart disease

Grace Dibben et al. Cochrane Database Syst Rev. 2021.

Abstract

Background: Coronary heart disease (CHD) is the most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people living with CHD may need support to manage their symptoms and prognosis. Exercise-based cardiac rehabilitation (CR) aims to improve the health and outcomes of people with CHD. This is an update of a Cochrane Review previously published in 2016.

Objectives: To assess the clinical effectiveness and cost-effectiveness of exercise-based CR (exercise training alone or in combination with psychosocial or educational interventions) compared with 'no exercise' control, on mortality, morbidity and health-related quality of life (HRQoL) in people with CHD.

Search methods: We updated searches from the previous Cochrane Review, by searching CENTRAL, MEDLINE, Embase, and two other databases in September 2020. We also searched two clinical trials registers in June 2021.

Selection criteria: We included randomised controlled trials (RCTs) of exercise-based interventions with at least six months' follow-up, compared with 'no exercise' control. The study population comprised adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or have angina pectoris, or coronary artery disease.

Data collection and analysis: We screened all identified references, extracted data and assessed risk of bias according to Cochrane methods. We stratified meta-analysis by duration of follow-up: short-term (6 to 12 months); medium-term (> 12 to 36 months); and long-term ( > 3 years), and used meta-regression to explore potential treatment effect modifiers. We used GRADE for primary outcomes at 6 to 12 months (the most common follow-up time point). MAIN RESULTS: This review included 85 trials which randomised 23,430 people with CHD. This latest update identified 22 new trials (7795 participants). The population included predominantly post-MI and post-revascularisation patients, with a mean age ranging from 47 to 77 years. In the last decade, the median percentage of women with CHD has increased from 11% to 17%, but females still account for a similarly small percentage of participants recruited overall ( < 15%). Twenty-one of the included trials were performed in low- and middle-income countries (LMICs). Overall trial reporting was poor, although there was evidence of an improvement in quality over the last decade. The median longest follow-up time was 12 months (range 6 months to 19 years). At short-term follow-up (6 to 12 months), exercise-based CR likely results in a slight reduction in all-cause mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.73 to 1.04; 25 trials; moderate certainty evidence), a large reduction in MI (RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence), and a large reduction in all-cause hospitalisation (RR 0.58, 95% CI 0.43 to 0.77; 14 trials; NNTB 12, 95% CI 9 to 21; moderate certainty evidence). Exercise-based CR likely results in little to no difference in risk of cardiovascular mortality (RR 0.88, 95% CI 0.68 to 1.14; 15 trials; moderate certainty evidence), CABG (RR 0.99, 95% CI 0.78 to 1.27; 20 trials; high certainty evidence), and PCI (RR 0.86, 95% CI 0.63 to 1.19; 13 trials; moderate certainty evidence) up to 12 months' follow-up. 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 (RR 0.80, 95% CI 0.41 to 1.59; low certainty evidence). There was evidence of substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%), and of small study bias for all-cause hospitalisation, but not for all other outcomes. At medium-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.90, 95% CI 0.80 to 1.02; 15 trials), MI (RR 1.07, 95% CI 0.91 to 1.27; 12 trials), PCI (RR 0.96, 95% CI 0.69 to 1.35; 6 trials), CABG (RR 0.97, 95% CI 0.77 to 1.23; 9 trials), and all-cause hospitalisation (RR 0.92, 95% CI 0.82 to 1.03; 9 trials), a large reduction in cardiovascular mortality was found (RR 0.77, 95% CI 0.63 to 0.93; 5 trials). Evidence is uncertain for difference in risk of cardiovascular hospitalisation (RR 0.92, 95% CI 0.76 to 1.12; 3 trials). At long-term follow-up, although there may be little to no difference in all-cause mortality (RR 0.91, 95% CI 0.75 to 1.10), exercise-based CR may result in a large reduction in cardiovascular mortality (RR 0.58, 95% CI 0.43 to 0.78; 8 trials) and MI (RR 0.67, 95% CI 0.50 to 0.90; 10 trials). Evidence is uncertain for CABG (RR 0.66, 95% CI 0.34 to 1.27; 4 trials), and PCI (RR 0.76, 95% CI 0.48 to 1.20; 3 trials). Meta-regression showed benefits in outcomes were independent of CHD case mix, type of CR, exercise dose, follow-up length, publication year, CR setting, study location, sample size or risk of bias. There was evidence that exercise-based CR may slightly increase HRQoL across several subscales (SF-36 mental component, physical functioning, physical performance, general health, vitality, social functioning and mental health scores) up to 12 months' follow-up; however, these may not be clinically important differences. The eight trial-based economic evaluation studies showed exercise-based CR to be a potentially cost-effective use of resources in terms of gain in quality-adjusted life years (QALYs).

Authors' conclusions: This updated Cochrane Review supports the conclusions of the previous version, that exercise-based CR provides important benefits to people with CHD, including reduced risk of MI, a likely small reduction in all-cause mortality, and a large reduction in all-cause hospitalisation, along with associated healthcare costs, and improved HRQoL up to 12 months' follow-up. Over longer-term follow-up, benefits may include reductions in cardiovascular mortality and MI. In the last decade, trials were more likely to include females, and be undertaken in LMICs, increasing the generalisability of findings. Well-designed, adequately-reported RCTs of CR in people with CHD more representative of usual clinical practice are still needed. Trials should explicitly report clinical outcomes, including mortality and hospital admissions, and include validated HRQoL outcome measures, especially over longer-term follow-up, and assess costs and cost-effectiveness.

Trial registration: ClinicalTrials.gov NCT02584192 NCT02778165 NCT03415841 NCT03704025 NCT04271566 NCT04294940 NCT04313777 NCT04330560 NCT04407624 NCT04409210 NCT04441086.

Copyright © 2021 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Conflict of interest statement

GD declares no conflicts of interest.

JF declares no conflicts of interest.

NO declares work as Professor at the University of Wisconsin‐Milwaukee, USA. NO also declares being an author of a study that is eligible for inclusion in the work (funding source: European Society of Cardiology & European Association of Preventive Cardiology).

KR declares no conflicts of interest.

DRT declares being an author of a study that is eligible for inclusion in the work.

A‐DZ declares being an author of a study that is eligible for inclusion in the work.

RST declares no conflicts of interest.

Figures

1
1

PRISMA flow diagram of study selection process

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Risk of bias summary: review authors' judgements about each risk of bias item for each included study

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3

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: all‐cause mortality at 6 to 12 months' follow‐up

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4

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: all‐cause mortality at > 36 months' follow‐up

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5

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: all‐cause mortality at > 12 to 36 months' follow‐up

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Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.2: cardiovascular mortality at 6 to 12 months' follow‐up

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7

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.3: myocardial infarction at 6 to 12 months' follow‐up

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8

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: myocardial infarction at > 12 to 36 months' follow‐up

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9

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: myocardial infarction at > 36 months' follow‐up

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10

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: CABG at 6 to 12 months' follow‐up

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11

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: PCI at 6 to 12 months' follow‐up

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12

Funnel plot of comparison: exercise‐based rehabilitation versus usual care, outcome 1.1: all‐cause hospitalisation at 6 to 12 months' follow‐up

1.1
1.1. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 1: All‐cause mortality

1.2
1.2. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 2: Cardiovascular mortality

1.3
1.3. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 3: Fatal and/or nonfatal MI

1.4
1.4. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 4: CABG

1.5
1.5. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 5: PCI

1.6
1.6. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 6: All‐cause hospital admissions

1.7
1.7. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 7: Cardiovascular hospital admissions

1.8
1.8. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 8: HRQoL SF‐36 summary scores at 6 to 12 months follow up

1.9
1.9. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 9: HRQoL SF‐36 8 domains at 6 to 12 months follow up

1.10
1.10. Analysis

Comparison 1: Exercise‐based rehabilitation versus control, Outcome 10: HRQoL EQ‐5D at 6 to 12 months follow up

Update of

  • Exercise-based cardiac rehabilitation for coronary heart disease.

    Anderson L, Thompson DR, Oldridge N, Zwisler AD, Rees K, Martin N, Taylor RS. Anderson L, et al. Cochrane Database Syst Rev. 2016 Jan 5;2016(1):CD001800. doi: 10.1002/14651858.CD001800.pub3. Cochrane Database Syst Rev. 2016. PMID: 26730878 Free PMC article. Updated. Review.

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Maroto 2005 {published data only}
    1. Maroto MJ, Artigao Ramirez R, Morales Duran MD, Pablo Zarzosa C, Abraira V. Cardiac rehabilitation in patients with myocardial infarction: a 10-year follow-up study. Revista Espanola de Cardiologia 2005;58:1181-7. - PubMed
Miller 1984 {published data only}
    1. DeBusk RF, Haskell WL, Miller NH, Berra K, Taylor CB, Berger WE, et al. Medically directed at-home rehabilitation soon after clinically uncomplicated acute myocardial infarction: a new model for patient care. American Journal of Cardiology 1985;55(4):251-7. - PubMed
    1. Miller NH, Haskell WL, Berra K, DeBusk RF. Home versus group exercise training for increasing functional capacity after myocardial infarction. Circulation 1984;70(4):645-9. - PubMed
    1. Taylor CB, Houston-Miller N, Ahn DK, Haskell WL, DeBusk RF. The effects of exercise training programs on psychosocial improvement in uncomplicated postmyocardial infarction patients. Journal of Psychosomatic Research 1986;30(5):581-7. - PubMed
    1. Taylor CB, Houston-Miller N, Haskell WL, DeBusk RF. Smoking cessation after acute myocardial infarction: the effects of exercise training. Addictive Behaviors 1988;13(4):331-5. - PubMed
Munk 2009 {published data only}
    1. Munk PS, Breland UM, Aukrust P, Ueland T, Kvaloy JT, Larsen AI. High intensity interval training reduces systemic inflammation in post-PCI patients. European Journal of Cardiovascular Prevention & Rehabilitation 2011;18:850-7. - PubMed
    1. Munk PS, Staal EM, Butt N, Isaksen K, Larsen AI. High-intensity interval training may reduce in-stent restenosis following percutaneous coronary intervention with stent implantation. American Heart Journal 2009;158:734-41. - PubMed
Mutwalli 2012 {published data only}
    1. Mutwalli HA, Fallows SJ, Arnous AA, Zamzami MS. Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program. Saudi Medical Journal 2012;33:152-9. - PubMed
Oerkild 2012 {published data only}
    1. Oerkild B, Frederiksen M, Hansen JF, Prescott E. Home-based cardiac rehabilitation is an attractive alternative to no cardiac rehabilitation for elderly patients with coronary heart disease: results from a randomised clinical trial. BMJ Open 2012;2:e001820. - PMC - PubMed
Oldridge 1991 {published and unpublished data}
    1. Oldridge N, Furlong W, Feeny D, Torrance G, Guyatt G, Crowe J, et al. Economic evaluation of cardiac rehabilitation soon after acute myocardial infarction. American Journal of Cardiology 1993;72:154-61. - PubMed
    1. Oldridge N, Guyatt G, Jones N, Crowe J, Singer J, Feeny D, et al. Effects on quality of life with comprehensive rehabilitation after acute myocardial infarction. American Journal of Cardiology 1991;67(13):1084-9. - PubMed
    1. Oldridge N, Streiner D, Hoffmann R, Guyatt G. Profile of mood states and cardiac rehabilitation after acute myocardial infarction. Medicine and Science in Sports and Exercise 1995;27(6):900-5. - PubMed
Ornish 1990 {published data only}
    1. Ornish D, Brown SE, Scherwitz LW, Billings JH, Armstrong WT, Ports TA, et al. Can lifestyle changes reverse coronary heart disease? The Lifestyle Heart Trial. Lancet 1990;336(8708):129-33. - PubMed
    1. Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998;280(23):2001-7. - PubMed
    1. Pischke CR, Scherwitz L, Weidner G, Ornish D. Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients. Health Psychology 2008;27(5):584-92. - PubMed
Pal 2013 {published data only}
    1. Pal A, Srivastava N, Narain VS, Agrawal GG, Rani M. Effect of yogic intervention on the autonomic nervous system in the patients with coronary artery disease: a randomized controlled trial. Eastern Mediterranean Health Journal 2013;19(5):453-8. - PubMed
Pomeshkina 2017 {published data only (unpublished sought but not used)}
    1. Pomeshkina S, Loktionova E, Arkhipova N, Barbarash O. Home-based walking training and adherence to medical therapy in patients undergoing coronary artery bypass grafting. European Heart Journal 2015;36:634.
    1. Pomeshkina SA, Loktionova EB, Bezzubova VA, Arkhipova NV, Borovik IV, Barbarash OL. The comparative analysis of the influence of the supervised exercise training and home-based exercise training on the psychological status of the following coronary artery bypass grafting. Problems of Balneology, Physiotherapy, and Exercise Therapy 2017;94(6):10-7. - PubMed
Pomeshkina 2019 {published data only (unpublished sought but not used)}
    1. Pomeshkina SA, Barbarash OL, Pomeshkin EV. Exercise training and erectile dysfunction in patients after coronary artery bypass grafting. Therapeutic Archive 2019;91(9):16-20. - PubMed
Prabhakaran 2020 {published data only}
    1. Chandrasekaran AM, Kinra S, Ajay VS, Chattopadhyay K, Singh K, Singh K, et al. Effectiveness and cost-effectiveness of a yoga-based cardiac rehabilitation (Yoga-CaRe) program following acute myocardialinfarction: study rationale and design of a multi-center randomized controlled trial. International Journal of Cardiology 2019;280:14-8. - PubMed
    1. Chattopadhyay K, Chandrasekaran AM, Praveen PA, Manchanda SC, Madan K, Ajay VS, et al. Development of a yoga-based cardiac rehabilitation (Yoga-CaRe) programme for secondary prevention of myocardial infarction. Evidence-Based Complementary and Alternative Medicine 2019;2019:1-7. - PMC - PubMed
    1. CTRI/2012/02/002408. A study on effectiveness of yoga based cardiac rehabilitation programme in India and United Kingdom. apps.who.int/trialsearch/Trial2.aspx?TrialID=CTRI/2012/02/002408 (date of registration 8 February 2012).
    1. Prabhakaran D, Chandrasekaran AM, Singh K, Mohan B, Chattopadhyay K, Chadha DS, et al. Yoga-based cardiac rehabilitation after acute myocardial infarction. Journal of the American College of Cardiology 2020;75(13):1551-61. - PMC - PubMed
Reid 2012 {published data only}
    1. Reid DR, Morrin LI, Beaton LJ, Papadakis S, Kocourek J, McDonnell L, et al. Randomized trial of an internet-based computer-tailored expert system for physical activity in patients with heart disease. European Journal of Preventive Cardiology 2012;19(6):1357–64. - PubMed
Roman 1983 {published data only}
    1. Roman O, Gutierrez M, Luksic I, Chavez E, Camuzzi AL, Villalon E, et al. Cardiac rehabilitation after acute myocardial infarction. 9-year controlled follow-up study. Cardiology 1983;70:223-31. - PubMed
Sandström 2005 {published data only}
    1. Sandström L, Ståhle A. Rehabilitation of elderly with coronary heart disease - Improvement in quality of life at a low cost. Advances in Physiotherapy 2005;7:60-6.
Santaularia 2017 {published data only}
    1. Santaularia N, Caminal J, Arnau A, Perramon M, Montesinos J, Abenoza Guardiola M, et al. The efficacy of a supervised exercise training programme on readmission rates in patients with myocardial ischemia: results from a randomised controlled trial. European Journal of Cardiovascular Nursing : Journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology 2017;16(3):201-12. - PubMed
    1. Santaularia N, Caminal J, Arnau A, Perramon M, Montesinos J, Trape J, et al. Randomized clinical trial to evaluate the effect of a supervised exercise training program on readmissions in patients with myocardial ischemia: a study protocol. BMC Cardiovascular Disorders 2013;13(1):32. - PMC - PubMed
Schuler 1992 {published data only}
    1. Hambrecht R, Niebauer J, Marburger C, Grunze M, Kalberer B, Hauer K, et al. Various intensities of leisure time physical activity in patients with coronary artery disease: effects on cardiorespiratory fitness and progression of coronary atherosclerotic lesions. Journal of the American College of Cardiology 1993;22(2):468-77. - PubMed
    1. Niebauer J, Hambrecht R, Marburger C, Hauer K, Velich T, Hodenberg E, et al. Impact of intensive physical exercise and low-fat diet on collateral vessel formation in stable angina pectoris and angiographically confirmed coronary artery disease. American Journal of Cardiology 1995;76(11):771-5. - PubMed
    1. Niebauer J, Hambrecht R, Velich T, Hauer K, Marburger C, Kalberer B, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation 1997;96(8):2534-41. - PubMed
    1. Niebauer J, Hambrecht R, Velich T, Marburger C, Hauer K, Kreuzer J, et al. Predictive value of lipid profile for salutary coronary angiographic changes in patients on a low-fat diet and physical exercise program. American Journal of Cardiology 1996;78(2):163-7. - PubMed
    1. Nikolaus T, Schlierf G, Vogel G, Schuler G, Wagner I. Treatment of coronary heart disease with diet and exercise: problems of compliance. Annals of Nutrition and Metabolism 1991;35:1-7. - PubMed
Seki 2003 {published data only}
    1. Seki E, Watanabe Y, Sunayama S, Iwama Y, Shimada K, Kawakami K, et al. Effects of phase III cardiac rehabilitation programs on health-related quality of life in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP). Circulation Journal 2003;67(1):73-7. - PubMed
Seki 2008 {published data only}
    1. Seki E, Watanabe Y, Shimada K, Sunayama S, Onishi T, Kawakami K, et al. Effects of a phase III cardiac rehabilitation program on physical status and lipid profiles in elderly patients with coronary artery disease: Juntendo Cardiac Rehabilitation Program (J-CARP). Circulation Journal 2008;72(8):1230-4. - PubMed
Shaw 1981 {published data only}
    1. Dorn J, Naughton J, Imamura D, Trevisan M. Results of a multicenter randomized clinical trial of exercise and long-term survival in myocardial infarction patients: the National Exercise and Heart Disease Project (NEHDP). Circulation 1999;100:1764-9. - PubMed
    1. Naughton J. The National Exercise and Heart Disease Project. The pre-randomization exercise program. Report number 2. Cardiology 1978;63(6):352-67. - PubMed
    1. Shaw LW. Effects of a prescribed supervised exercise program on mortality and cardiovascular morbidity in patients after a myocardial infarction. The National Exercise and Heart Disease Project. American Journal of Cardiology 1981;48(1):39-46. - PubMed
    1. Stern MJ, Cleary P. The National Exercise and Heart Disease Project: long-term psychosocial outcome. Archives of Internal Medicine 1982;142(6):1093-7. - PubMed
Sivarajan 1982 {published data only}
    1. Ott CR, Sivarajan ES, Newton KM, Almes MJ, Bruce RA, Bergner M, et al. A controlled randomized study of early cardiac rehabilitation: the sickness impact profile as an assessment tool. Heart & Lung 1983;12(2):162-70. - PubMed
    1. Sivarajan ES, Bruce RA, Almes MJ, Green B, Belanger L, Lindskog BD, et al. In-hospital exercise after myocardial infarction does not improve treadmill performance. New England Journal of Medicine 1981;305(7):357-62. - PubMed
    1. Sivarajan ES, Bruce RA, Lindskog BD, Almes MJ, Belanger L, Green B. Treadmill test responses to an early exercise program after myocardial infarction: a randomized study. Circulation 1982;65(7):1420-8. - PubMed
    1. Sivarajan ES, Newton KM, Almes MJ, Kempf TM, Mansfield LW, Bruce RA. Limited effects of outpatient teaching and counselling after myocardial infarction: A controlled study. Heart & Lung 1983;12(1):65-73. - PubMed
Snoek 2020 {published data only}
    1. Snoek JA, Prescott EI, Van der Velde AE, Eijsvogels TM, Mikkelsen N, Prins LF, et al. Effectiveness of home-based mobile guided cardiac rehabilitation as alternative strategy for nonparticipation in clinic-based cardiac rehabilitation among elderly patients in Europe. A randomized clinical trial. JAMA Cardiology 2020;6(4):463–8. - PMC - PubMed
Specchia 1996 {published data only}
    1. Specchia G, De Servi S, Scirè A, Assandri J, Berzuini C, Angoli L, et al. Interaction between exercise training and ejection fraction in predicting prognosis after a first myocardial infarction. Circulation 1996;94(5):978-82. - PubMed
Ståhle 1999 {published data only}
    1. Hage C, Mattsson E, Ståhle A. Long term effects of exercise training on physical activity level and quality of life in elderly coronary patients - a three- to six-year follow-up. Physiotherapy Research International 2003;8(1):13-22. - PubMed
    1. Ståhle A, Lindquist I, Mattsson E. Important factors for physical activity among elderly patients one year after an acute myocardial infarction. Scandinavian Journal of Rehabilitation Medicine 2000;32(3):111-6. - PubMed
    1. Ståhle A, Mattsson E, Rydén L, Unden AL, Nordlander R. Improved physical fitness and quality of life following training of elderly patients after acute coronary events. A 1 year follow-up randomized controlled study. European Heart Journal 1999;20(20):1475-84. - PubMed
    1. Ståhle A, Nordlander R, Rydén L, Mattsson E. Effects of organized aerobic group training in elderly patients discharged after an acute coronary syndrome. A randomized controlled study. Scandinavian Journal of Rehabilitation Medicine 1999;31(2):101-7. - PubMed
    1. Ståhle A, Tollbäck A. Effects of aerobic group training on exercise capacity, muscular endurance and recovery in elderly patients with recent coronary events: a randomized, controlled study. Advances in Physiotherapy 2001;3:29-37.
Stern 1983 {published data only}
    1. Stern MJ, Gorman PA, Kaslow L. The group counseling v exercise therapy study. A controlled intervention with subjects following myocardial infarction. Archives of Internal Medicine 1983;143(9):1719-25. - PubMed
Sun 2016 {published data only}
    1. Sun P, Li Y, Song C, Chen D, Tao L, Shi L, Ma J, et al. Long-term effects of exercise rehabilitation on risk factors in elderly patients with stable coronary artery disease. Chinese Journal of Geriatric Heart Brain and Vessel Diseases 2016;5:491-5.
Toobert 2000 {published data only}
    1. Toobert DJ, Glasgow RE, Nettekoven LA, Brown JE. Behavioral and psychosocial effects of intensive lifestyle management for women with coronary heart disease. Patient Education and Counseling 1998;35(3):177-88. - PubMed
    1. Toobert DJ, Glasgow RE, Radcliffe JL. Physiologic and related behavioral outcomes from the Women's Lifestyle Heart Trial. Annals of Behavioral Medicine 2000;22(1):1-9. - PubMed
Uddin 2020 {published data only}
    1. Uddin J, Joshi VL, Moniruzzaman M, Karim R, Siraj M, Rashid MA, et al. Effect of home-based cardiac rehabilitation in a lower-middle income country: results from a controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention 2020;40(1):29-34. - PubMed
    1. Uddin J. Effects of cardiac rehabilitation on exercise capacity and WHO-quality of life undergoing CABG patients. A quasi-randomised controlled trial. European Journal of Heart Failure 2017;19:464.
Vecchio 1981 {published data only}
    1. Vecchio C, Cobelli F, Opasich C, Assandri J, Poggi G, Griffo R. Early functional evaluation and physical rehabilitation in patients with wide myocardial infarction [Valutazione funzionale precoce e riabilitazione fisica nei pazienti con infarto miocardico esteso]. Giornale Italiano di Cardiologia 1981;11:419-29. - PubMed
Vermeulen 1983 {published data only}
    1. Vermeulen A, Lie KI, Durrer D. Effects of cardiac rehabilitation after myocardial infarction: changes in coronary risk factors and long-term prognosis. American Heart Journal 1983;105(5):798-801. - PubMed
VHSG 2003 {published data only}
    1. Schumacher A, Peersen K, Sommervoll L, Seljeflot I, Arnesen H, Otterstad JE. Physical performance is associated with markers of vascular inflammation in patients with coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 2006;13(3):356-62. - PubMed
    1. Vestfold Heartcare Study Group. Influence on lifestyle measures and five-year coronary risk by a comprehensive lifestyle intervention programme in patients with coronary heart disease. European Journal of Cardiovascular Prevention and Rehabilitation 2003;10(6):429-37. - PubMed
Wang 2012 {published data only}
    1. Wang W, Chair SY, Thompson DR, Twinn SF. Effects of home-based rehabilitation on health-related quality of life and psychological status in Chinese patients recovering from acute myocardial infarction. Heart & Lung 2012;41:15-25. - PubMed
West 2012 {published data only}
    1. West RR, Jones DA, Henderson AH. Rehabilitation after myocardial infarction trial (RAMIT): multi-centre randomised controlled trial of comprehensive cardiac rehabilitation in patients following acute myocardial infarction. Heart 2012;98:637-44. - PubMed
WHO 1983 {published data only}
    1. World Health Organization. Rehabilitation and comprehensive secondary prevention after acute myocardial infarction. EURO Reports and Studies 84 1983.
Wilhelmsen 1975 {published data only}
    1. Sanne H. Exercise tolerance and physical training of non-selected patients after myocardial infarction. Acta Medica Scandinavica 1973;Supplementum 551:1-124. - PubMed
    1. Wilhelmsen L, Sanne H, Elmfeldt D, Grimby G, Tibblin G, Wedel H. A controlled trial of physical training after myocardial infarction. Effects on risk factors, nonfatal reinfarction, and death. Preventive Medicine 1975;4(4):491-508. - PubMed
Xu 2017 {published data only}
    1. Xu Y, Feng Y, Su P, Li Y, Li C, Qiao J. Impact of exercise rehabilitation on cardiac function in coronary artery disease patients after percutaneous coronary intervention. Chinese Circulation Journal 2017;32:326-30.
Yu 2003 {published data only}
    1. Yu CM, Li LS, Ho HH, Lau CP. Long-term changes in exercise capacity, quality of life, body anthropometry, and lipid profiles after a cardiac rehabilitation program in obese patients with coronary heart disease. American Journal of Cardiology 2003;91(3):321-5. - PubMed
Yu 2004 {published data only}
    1. Yu C, Li L, Lam M, Siu D, Miu R, Lau C. Effect of a cardiac rehabilitation program on left ventricular diastolic function and its relationship to exercise capacity in patients with coronary heart disease: experience from a randomized, controlled study. American Heart Journal 2004;147(5):e24. - PubMed
    1. Yu CM, Lau CP, Chau J, McGhee S, Kong SL, Cheung BM, et al. A short course of cardiac rehabilitation program is highly cost effective in improving long-term quality of life in patients with recent myocardial infarction or percutaneous coronary intervention. Archives of Physical Medicine and Rehabilitation 2004;85(12):1915-22. - PubMed
Zhang 2018 {published data only}
    1. Zhang Y, Cao H, Jiang P, Tang H. Cardiac rehabilitation in acute myocardial infarction patients after percutaneous coronary intervention: a community-based study. Medicine 2018;97(8):1-5. - PMC - PubMed
Zwisler 2008 {published and unpublished data}
    1. Kruse M, Hochstrasser S, Zwisler AD, Kjellberg J. Comprehensive cardiac rehabilitation: a cost assessment based on a randomized clinical trial. International Journal of Technology Assessment in Health Care 2006;22(4):478-83. - PubMed
    1. Zwisler AD, Soja AM, Rasmussen S, Frederiksen M, Abedini S, Appel J, et al. Hospital-based comprehensive cardiac rehabilitation versus usual care among patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease: 12-month results of a randomized clinical trial. American Heart Journal 2008;155(6):1106-13. - PubMed

References to studies excluded from this review

ACTRN12617000312347 {unpublished data only}
    1. ACTRN12617000312347. Does the use of personal activity trackers in patients after a heart attack result in an increase in exercise capacity. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372376 (date submitted 17 February 2017).
ACTRN12618001458224 {unpublished data only}
    1. ACTRN12618001458224. Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM): a 21st Century Approach for Improving the Self-Management of Heart Disease. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374508 (date submitted 24 August 2018).
Agren 1989 {published data only}
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Ahmadi 2020 {published data only}
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Alharbi 2016 {published data only}
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Al Namat 2017 {published data only}
    1. Al Namat R, Aursulesei V, Felea MG, Costache II, Petris A, Mitu O, et al. Heart-type Fatty Acid-Binding Protein (H-FABP) in patients with coronary artery bypass graft surgery undergoing cardiac rehabilitation program. Revista de Chimie 2017;68(7):1485-89.
Alsaleh 2012 {published data only}
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An 2020 {published data only}
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Andersson 2010 {published data only}
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Asbury 2012 {published data only}
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Astengo 2010 {published data only}
    1. Astengo M, Dahl A, Karlsson T, Mattsson-Hulten L, Wiklund O, Wennerblom B. Physical training after percutaneous coronary intervention in patients with stable angina: effects on working capacity, metabolism, and markers of inflammation. European Journal of Cardiovascular Prevention & Rehabilitation 2010;17:349-54. - PubMed
Avila 2020 {published data only}
    1. Avila A, Claes J, Buys R, Azzawi M, Vanhees L, Cornelissen V. Home-based exercise with telemonitoring guidance in patients with coronary artery disease: does it improve long-term physical fitness? European Journal of Preventive Cardiology 2020;27(4):367-77. - PubMed
Ballantyne 1982 {published data only}
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Bär 1992 {published data only}
    1. Bär FW, Hoppener P, Diederiks J, Vonken H, Bekkers J, Hoofd W, et al. Cardiac rehabilitation contributes to the restoration of leisure and social activities. Journal of Cardiopulmonary Rehabilitation 1992;12(2):117-25.
Baumgarten 2017 {published data only}
    1. Baumgarten H, Steinmetz C, Borst C, Walther T, Walther C. Preoperative exercise training before elective coronary artery bypass graft surgery: a prospective randomized evaluation on feasibility and effects on operative outcomes. Thoracic and Cardiovascular Surgeon 2017;65:S1-S110.
Beland 2020 {published data only}
    1. Beland M, Lavoie KL, Briand S, White UK, Gemme C, Bacon SL. Aerobic exercise alleviates depressive symptoms in patients with a major non-communicable chronic disease: a systematic review and meta-analysis. British Journal of Sports Medicine 2020;54(5):272. - PubMed
Bettencourt 2005 {published data only}
    1. Bettencourt N, Dias C, Mateus P, Sampaio F, Santos L, Adao L, et al. Impact of cardiac rehabilitation on quality of life and depression after acute coronary syndrome [Impacto da reabilitacao cardiaca na qualidade-de-vida e sintomatologia depressiva apos sindroma coronaria aguda]. Revista Portuguesa de Cardiologia 2005;24(5):687-96. - PubMed
Bilinska 2010 {published data only}
    1. Bilinska M, Kosydar-Piechna M, Gasiorowska A, Mikulski T, Piotrowski W, Nazar K, et al. Influence of dynamic training on hemodynamic, neurohormonal responses to static exercise and on inflammatory markers in patients after coronary artery bypass grafting. Circulation Journal 2010;74:2598-604. - PubMed
Bilinska 2013 {published data only}
    1. Bilinska M, Kosydar-Piechna M, Mikulski T, Piotrowicz E, Gasiorowska A, Piotrowski W, et al. Influence of aerobic training on neurohormonal and hemodynamic responses to head-up tilt test and on autonomic nervous activity at rest and after exercise in patients after bypass surgery. Cardiology Journal 2013;20:17-24. - PubMed
Björntorp 1972 {published data only}
    1. Björntorp, Berchtold P, Grimby G, Lindholm B, Sanne H, Tibblin G, et al. Effects of physical training on glucose tolerance, plasma insulin and lipids and on body composition in men after myocardial infarction. Acta Medica Scandinavica 1972;192(1-6):439-43. - PubMed
Blokzijl 2018 {published data only}
    1. Blokzijl F, Dieperink W, Keus F, Reneman MF, Mariani MA, Van der Horst IC. Cardiac rehabilitation for patients having cardiac surgery: a systematic review. Journal of Cardiovascular Surgery 2018;59(6):817-29. - PubMed
Blumenthal 1997 {published data only}
    1. Blumenthal JA, Wei J, Babyak MA, Krantz DS, Frid DJ, Coleman RE, et al. Stress management and exercise training in cardiac patients with myocardial ischemia: effects on prognosis and evaluation of mechanisms. Archives of Internal Medicine 1997;157(19):2213-23. - PubMed
Bo 2015 {published data only}
    1. Bo E, Bergland A, Stranden E, Jorgensen JJ, Sandbaek G, Grotta OJ, et al. Effects of 12 weeks of supervised exercise after endovascular treatment: a randomized clinical trial. Physiotherapy Research International : The Journal for Researchers and Clinicians in Physical Therapy 2015;20(3):147-57. - PubMed
Borg 2017 {published data only}
    1. Borg S, Oberg B, Nilsson L, Sodelund A, Back M. The role of a behavioural medicine intervention in physiotherapy for the effects of rehabilitation outcomes in exercise-based cardiac rehabilitation (ECRA) - the study protocol of a randomised, controlled trial. BMC Cardiovascular Disorders 2017;17(1):134. - PMC - PubMed
Bourke 2010 {published data only}
    1. Bourke L, Tew GA, Milo M, Crossman DC, Saxton JM, Chico TJ. Study protocol: a randomised controlled trial investigating the effect of exercise training on peripheral blood gene expression in patients with stable angina. BMC Public Health 2010;10:620. - PMC - PubMed
Bricca 2020 {published data only}
    1. Bricca A, Harris LK, Saracutu M, Smith SM, Juhl CB, Skou ST. The benefits and harms of therapeutic exercise on physical and psychosocial outcomes in people with multimorbidity: protocol for a systematic review. Journal of Comorbidity 2020;10:1-7. - PMC - PubMed
Broers 2020 {published data only}
    1. Broers ER, Widdershoven J, Denollet J, Lodder P, Kop WJ, Wetzels M, et al. Personalized eHealth program for life-style change: results from the "Do Cardiac Health Advanced New Generated Ecosystem (Do CHANGE 2)" randomized controlled trial. Psychosomatic Medicine 2020;82(4):409-19. - PubMed
Bubnova 2014 {published data only}
    1. Bubnova MG, Aronov DM, Krasnitskii VB, Ioseliani DG, Novikova NK, Rodzinskaia EM. A home exercise training program after acute coronary syndrome and/or endovascular coronary intervention: efficiency and a patient motivation problem. Terapevticheskii Arkhiv 2014;86:23-32. - PubMed
Busch 2012 {published data only}
    1. Busch JC, Lillou D, Wittig G, Bartsch P, Willemsen D, Oldridge N, et al. Resistance and balance training improves functional capacity in very old participants attending cardiac rehabilitation after coronary bypass surgery. Journal of the American Geriatrics Society 2012;60:2270-6. Erratum in: Journal of the American Geriatrics Society 2013;61(3)479. - PubMed
Butler 2009 {published data only}
    1. Butler L, Furber S, Phongsavan P, Mark A, Bauman A. Effects of a pedometer-based intervention on physical activity levels after cardiac rehabilitation: a randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention 2009;29:105-14. - PubMed
Candelaria 2020 {published data only}
    1. Candelaria D, Randall S, Ladak L, Gallagher R. Health-related quality of life and exercise‑based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis. Quality of Life Research 2020;29:579-92. - PubMed
Carlsson 1997 {published data only}
    1. Carlsson R, Lindberg G, Westin L, Israelsson B. Influence of coronary nursing management follow up on lifestyle after acute myocardial infarction. Heart 1997;77(3):256-9. - PMC - PubMed
Chang 2010 {published data only}
    1. Chang R, Koo M, Kan C, Yu Z, Chu I, Hsu C, et al. Effects of Tai Chi rehabilitation on heart rate responses in patients with coronary artery disease. American Journal of Chinese Medicine 2010;38:461-72. - PubMed
Chatian 2014 {published data only}
    1. Chatian M, Tarchalski JL, Lisowski J, Poziomska-Piatkowska E. The influence of the outpatient cardiologic rehabilitation on the physical fitness at patients after a STEMI [Wpływ rehabilitacji ambulatoryjnej kardiologicznej na sprawności fizycznej na pacjentów po STEMI]. Polski Merkuriusz Lekarski 2014;36:88-91. - PubMed
Chen 2016 {published data only}
    1. Chen J, Lin T, Voon W, Lai W, Huang M, Sheu S, et al. Beneficial effects of home-based cardiac rehabilitation on metabolic profiles in coronary heart-disease patients. Kaohsiung Journal of Medical Sciences 2016;32(5):267-75. - PubMed
Chen 2017 {published data only}
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ChiCTR1800015823 {unpublished data only}
    1. ChiCTR1800015823. Effects of cardiac rehabilitation physical and breathing exercise on stage III rehabilitation in patients with stable coronary artery disease: a randomized controlled trial study. www.chictr.org.cn/hvshowproject.aspx?id=13015 (date registered 23 April 2018).
ChiCTR1800016209 {unpublished data only}
    1. ChiCTR1800016209. Effectiveness of different type of Baduanjin excercise on I and II phase cardiac rehabilitation for acute myocardial infarction: a randomized controlled trail (BECHAMI). www.chictr.org.cn/hvshowproject.aspx?id=19855 (date registered 5 June 2018).
ChiCTR1800016308 {unpublished data only}
    1. ChiCTR1800016308. Study on the effect of physical assessment and training on the prevention and rehabilitation of chronic diseases in middle and old age. www.chictr.org.cn/showproj.aspx?proj=27729 (date of registration 24 May 2018).
ChiCTR1800020411 {unpublished data only}
    1. ChiCTR1800020411. The effectiveness of eHealth cardiac rehabilitation on health outcomes of Chinese patients with coronary artery disease. www.chictr.org.cn/showprojen.aspx?proj=33906 (date of registration 28 December 2018).
ChiCTR‐IOR‐14005743 {unpublished data only}
    1. ChiCTR-IOR-14005743. The efficacy of Qigong Baduanjin Exercise on patients with coronary heart disease after PCI. www.who.int/trialsearch/Trial2.aspx?TrialID=ChiCTR-IOR-14005743 (date of registration 26 December 2014).
ChiCTR‐IOR‐17012684 {unpublished data only}
    1. ChiCTR-IOR-17012684. Exercise prescription of Taijiquan in rehabilitation of elderly patients with coronary heart disease. www.chictr.org.cn/showprojen.aspx?proj=21653 (date of registration 15 September 2017).
ChiCTR‐IOR‐17014149 {unpublished data only}
    1. ChiCTR-IOR-17014149. The effect of Baduanjin exercise on cardiac rehabilitation in patients with stable coronary artery disease: a randomized controlled trial. www.chictr.org.cn/com/25/showproj.aspx?proj=24131 (date of registration 26 December 2017).
ChiCTR‐IPR‐17011445 {unpublished data only}
    1. ChiCTR-IPR-17011445. The effects of I stage cardiac rehabilitation on cardiopulmonary function in patients undergoing open heart surgery: a randomized controlled study. www.chictr.org.cn/showproj.aspx?proj=19355 (date of registration 20 May 2017).
Chokshi 2018 {published data only}
    1. Chokshi N, Adusumalli S, Small D, Morris A, Feingold J, Ha Y, et al. Effect of loss-framed financial incentives and personalized goal-setting on physical activity among ischemic heart disease patients using wearable devices: the active reward randomized clinical trial. Journal of General Internal Medicine 2018;33:176. - PMC - PubMed
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    1. Chow CK, Redfern J, Thiagalingam A, Jan S, Whittaker R, Hackett M, et al. Design and rationale of the tobacco, exercise and diet messages (TEXT ME) trial of a text message-based intervention for ongoing prevention of cardiovascular disease in people with coronary disease: a randomised controlled trial protocol. BMJ Open 2012;2:e000606. - PMC - PubMed
Christa 2019 {published data only}
    1. Christa E, Srivastava P, Chandran DS, Jaryal AK, Yadav RK, Roy A, et al. Effect of yoga-based cardiac rehabilitation on heart rate variability: randomized controlled trial in patients post-MI. International Journal of Yoga Therapy 2019;29(1):43-50. - PubMed
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Claes 2020 {published data only}
    1. Claes J, Cornelissen V, McDermott C, Moyna N, Pattyn N, Cornelis N, et al. Feasibility, acceptability, and clinical effectiveness of a technology-enabled cardiac rehabilitation platform (Physical Activity Toward Health-I): randomized controlled trial. Journal of Medical Internet Research 2020;22(2):19. - PMC - PubMed
Clark 2017 {published data only}
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Conboy 2020 {published data only}
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    1. Cugusi L, Prosperini L, Mura G. Exergaming for quality of life in persons living with chronic diseases: a systematic review and meta-analysis. PM & R : the Journal of Injury, Function, and Rehabilitation 2020 Sept 10 [Epub ahead of print]. [DOI: 10.1002/pmrj.12444] - DOI - PubMed
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    1. da Costa Torres D, Da Silva PR, Lima Reis HJ, Paisani DM, Chiavegato LD. Effectiveness of an early mobilization program on functional capacity after coronary artery bypass surgery: randomized controlled trial. European Respiratory Journal 2016;48(S60):PA4419. - PMC - PubMed
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Dalçóquio 2020 {published data only}
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Davoodvand 2009 {published data only}
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De Bakker 2020 {published data only}
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Deng 2020 {published data only}
    1. Deng BY, Shou XL, Ren AH, Liu XW, Wang QN, Wang BZ, et al. Effect of aerobic training on exercise capacity and quality of life in patients older than 75 years with acute coronary syndrome undergoing percutaneous coronary intervention. Physiotherapy Theory and Practice 2020 Sept 29 [Epub ahead of print]. [DOI: 10.1080/09593985.2020.1825580] - DOI - PubMed
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DRKS00007569 {unpublished data only}
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Engelen 2020 {published data only}
    1. Engelen MM, Van Dulmen S, Puijk-Hekman S, Vermeulen H, Nijhuis-van der Sanden MW, Bredie SJ, et al. Evaluation of a web-based self-management program for patients with cardiovascular disease: explorative randomized controlled trial. Journal of Medical Internet Research 2020;22(7):14. - PMC - PubMed
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Franssen 2020 {published data only}
    1. Franssen WM, Franssen GH, Spaas J, Solmi F, Eijnde BO. Can consumer wearable activity tracker-based interventions improve physical activity and cardiometabolic health in patients with chronic diseases? A systematic review and meta-analysis of randomised controlled trials. International Journal of Behavioral Nutrition and Physical Activity 2020;17(1):20. - PMC - PubMed
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Gao 2020 {published data only}
    1. Gao L, Maddison R, Rawstorn J, Ball K, Oldenburg B, Chow C, et al. Economic evaluation protocol for a multicentre randomised controlled trial to compare Smartphone Cardiac Rehabilitation, Assisted self-Management (SCRAM) versus usual care cardiac rehabilitation among people with coronary heart disease. BMJ Open 2020;10(8):8. - PMC - PubMed
Garcia‐Bravo 2020 {published data only}
    1. Garcia-Bravo S, Cano-de-la-Cuerda R, Dominguez-Paniagua J, Campuzano-Ruiz R, Barrenada-Copete E, Lopez-Navas MJ, et al. Effects of virtual reality on cardiac rehabilitation programs for ischemic heart disease: a randomized pilot clinical trial. International Journal of Environmental Research and Public Health 2020;17(22):17. - PMC - PubMed
Gerlach 2020 {published data only}
    1. Gerlach S, Mermier C, Kravitz L, Degnan J, Dalleck L, Zuhl M. Comparison of treadmill and cycle ergometer exercise during cardiac rehabilitation: a meta-analysis. Archives of Physical Medicine and Rehabilitation 2020;101(4):690-9. - PubMed
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Giallauria 2012 {published data only}
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Giallauria 2013 {published data only}
    1. Giallauria F, Acampa W, Ricci F, Vitelli A, Torella G, Lucci R, et al. Exercise training early after acute myocardial infarction reduces stress-induced hypoperfusion and improves left ventricular function. European Journal of Nuclear Medicine & Molecular Imaging 2013;40:315-24. - PubMed
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IRCT20130211012439N3 {unpublished data only}
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IRCT2014061418075N2 {unpublished data only}
    1. IRCT2014061418075N2. The effect of a cardiac rehabilitation program on quality of life in acute coronary syndrome ‎patients. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2014061418075N2 (date of registration 15 July 2014).
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JPRN‐UMIN000010031 {unpublished data only}
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    1. Maldonado-Martin S, Jayo-Montoya JA, Matajira-Chia T, Villar-Zabala B, Goiriena JJ, Aispuru GR. Effects of combined high-intensity aerobic interval training program and Mediterranean diet recommendations after myocardial infarction (INTERFARCT Project): study protocol for a randomized controlled trial. Trials 2018;19(1):156. - PMC - PubMed
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Manresa‐Rocamora 2020 {published data only}
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    1. Mao S, Zhang XX, Chen MG, Wang CY, Chen QB, Guo LH, et al. Beneficial effects of baduanjin exercise on left ventricular remodelling in patients after acute myocardial infarction: an exploratory clinical trial and proteomic analysis. Cardiovascular Drugs and Therapy 2021;35:21-32. - PubMed
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McGregor 2020 {published data only}
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Mezey 2008 {published data only}
    1. Mezey B, Kullmann L, Smith K, Sarolta B, Sandori K, Belicza E, et al. Outpatient cardiac rehabilitation: initial experience in the first Hungarian multicenter study. Orvosi Hetilap 2008;149(8):353-9. - PubMed
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    1. Moholdt T, Aamot IL, Granoien I, Gjerde L, Myklebust G, Walderhaug L, et al. Aerobic interval training increases peak oxygen uptake more than usual care exercise training in myocardial infarction patients: a randomized controlled study. Clinical Rehabilitation 2012;26:33-44. - PubMed
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    1. Meehan G, Koshy A, Kunniardy P, Murphy A, Farouque O, Yudi M. A systematic review and meta-analysis of randomized controlled trials assessing smartphone based cardiac rehabilitation in patients with coronary heart diseae. Journal of the American College of Cardiology 2020;75:2004.
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NCT02219815 {unpublished data only}
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NCT02235753 {unpublished data only}
    1. NCT02235753. High-intensity exercise after acute cardiac event (HITCARE). clinicaltrials.gov/NCT02235753 (first posted 10 September 2014).
NCT02584192 {unpublished data only}
    1. NCT02584192. Efficacy of early home-based cardiac rehabilitation program for patients after acute myocardial infarction. clinicaltrials.gov/ct2/show/NCT02584192 (first posted 22 October 2015).
NCT02778165 {unpublished data only}
    1. NCT02778165. My Cardiac Recovery (MyCaRe): a pilot RCT. clinicaltrials.gov/ct2/show/NCT02778165 (first posted 19 May 2016).
NCT03415841 {unpublished data only}
    1. NCT03415841. Kardia - a smartphone-based care model for outpatient cardiac rehabilitation. clinicaltrials.gov/ct2/show/NCT03415841 (first posted 30 January 2018).
NCT03704025 {unpublished data only}
    1. NCT03704025. Home-based exercise training in cardiac patients. clinicaltrials.gov/ct2/show/NCT03704025 (first posted 12 October 2018).
NCT04271566 {unpublished data only}
    1. NCT04271566. Drug utilisation and lifestyle intervention study in patients attending cardiac outpatient clinic. clinicaltrials.gov/show/NCT04271566 (first posted 17 February 2020).
NCT04294940 {unpublished data only}
    1. NCT04294940. Impact of a digital solution (CardiCare™) on cardiorespiratory fitness improvement in patients discharged from a phase 2 cardiac rehabilitation following an acute coronary syndrome. clinicaltrials.gov/show/NCT04294940 (first posted 4 March 2020).
NCT04313777 {unpublished data only}
    1. NCT04313777. Virtual reality therapy in cardiology. clinicaltrials.gov/show/NCT04313777 (first posted 18 March 2020).
NCT04330560 {unpublished data only}
    1. NCT04330560. Electronic Activity Tracking System (EATs). clinicaltrials.gov/show/NCT04330560 (first posted 1 April 2020).
NCT04407624 {unpublished data only}
    1. NCT04407624. Effects of intermittent exercise training programs in patients with myocardial infarction. clinicaltrials.gov/show/NCT04407624 (first posted 29 May 2020).
NCT04409210 {unpublished data only}
    1. NCT04409210. Cardio-cerebrovascular co-prevention and co-management based on Internet+. clinicaltrials.gov/show/NCT04409210 (first posted 1 June 2020).
NCT04441086 {unpublished data only}
    1. NCT04441086. Emotion regulation intervention to sustain physical activity in rural-dwelling women and men after myocardial infarction. clinicaltrials.gov/show/NCT04441086 (first posted 22 June 2020).
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    1. Ngaage D, Mitchell N, Dean A, Hirst C, Akowuah E, Doherty P, et al. Feasibility study of early outpatient review and early cardiac rehabilitation after cardiac surgery: mixed-methods research design - a study protocol. BMJ Open 2019;9(12):8. - PMC - PubMed
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Passaglia 2020 {published data only}
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    1. Peschel T, Sixt S, Beitz F, Sonnabend M, Muth G, Thiele H, et al. High, but not moderate frequency and duration of exercise training induces downregulation of the expression of inflammatory and atherogenic adhesion molecules. European Journal of Cardiovascular Prevention and Rehabilitation 2007;14(3):476-82. - PubMed
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    1. Piestrzeniewicz K, Navarro-Kuczborska N, Bolinska H, Jegier A, Maciejewski M. The impact of comprehensive cardiac rehabilitation in young patients after acute myocardial infarction treated with primary coronary intervention on the clinical outcome and leading again a "normal" life [Korzystne efekty kompleksowej rehabilitacji kardiologicznej u osob do 55 roku zycia, po zawale miesnia sercowego, leczonych za pomoca pierwotnej angioplastyki]. Polskie Archiwum Medycyny Wewnetrznej 2004;111(3):309-17. - PubMed
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    1. Pluss CE, Billing E, Held C, Henriksson P, Kiessling A, Karlsson MR, et al. Long-term effects of an expanded cardiac rehabilitation programme after myocardial infarction or coronary artery bypass surgery: a five-year follow-up of a randomized controlled study. Clinical Rehabilitation 2011;25:79-87. - PubMed
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Rakhshan 2019 {published data only}
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    1. Sadeghi M, Garakyaraghi M, Khosravi M, Taghavi M, Sarrafzadegan N, Roohafza H. The impacts of cardiac rehabilitation program on echocardiographic parameters in coronary artery disease patients with left ventricular dysfunction. Cardiology Research and Practice 2013;2013. - PMC - PubMed
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Salzwedel 2020 {published data only}
    1. Salzwedel A, Jensen K, Rauch B, Doherty P, Metzendorf MI, Hackbusch M, et al. Effectiveness of comprehensive cardiac rehabilitation in coronary artery disease patients treated according to contemporary evidence based medicine: update of the Cardiac Rehabilitation Outcome Study (CROS-II). European Journal of Preventive Cardiology 2020;27(16):1756-74. - PMC - PubMed
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    1. Sangster J, Furber S, Allman-Farinelli M, Phongsavan P, Redfern J, Haas M, et al. Effectiveness of a pedometer-based telephone coaching program on weight and physical activity for people referred to a cardiac rehabilitation program. A randomized controlled trial. Journal of Cardiopulmonary Rehabilitation and Prevention 2015;35(2):124-9. - PubMed
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References to studies awaiting assessment

Aronov 2006 {published data only}
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References to ongoing studies

ACTRN12616001204437 {unpublished data only}
    1. ACTRN12616001204437. Tai Chi for stress and cardiovascular function. www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=369625 (date registered 31 August 2016).
CTRI/2017/07/008951 {unpublished data only}
    1. CTRI/2017/07/008951. Efficacy of YOGA in Indian patients with coronary artery disease. www.ctri.nic.in/Clinicaltrials/pdf_generate.php?trialid=16214&EncHid=&mo... (registered on 3 July 2017).
CTRI/2017/10/009981 {unpublished data only}
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CTRI/2019/06/019948 {unpublished data only}
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NCT03102346 {unpublished data only}
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NCT03905187 {published data only}
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NCT03978130 {published data only}
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NCT04425057 {unpublished data only}
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NCT04511182 {unpublished data only}
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