Myocardial infarction: structured exercise during rehabilitation reduces mortality.

Clinical bottom line (level 1a)

  1. Patients with a myocardial infarction who undergo a structured exercise program during rehabilitation compared with performing usual daily activities are less likely to die (NNT = 44 at 3 years) . There is no clear effect on recurrent non-fatal MI.
O'Connor et al: Circulation 1989; 80 (2): 234-244
Expires March 2003

The study

Systematic review of all randomised controlled trials of
  • Patients: myocardial infarction
  • Intervention: rehabilitation after exercise compared with usual activities of daily living
  • Outcome: death, myocardial infarction



Articles found in using 'computer-aided search', (search terms: not given ) and and searching abstracts from meeting, contacting principal investigators of major studies.

Selection criteria: see above
Appraisal criteria: not given
Articles excluded if:

  • if no objective or reproducible entry criteria
  • not randomised
  • no structured physical exercise program


22 studies found involving 4554 patients
Studies were combined using a random-effect model. No significant heterogeneity was found.

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
death 3 years 270/2088
(12.8%)		 0.80
(0.66 to 0.96) 		44
(25 to 220)
non-fatal myocardial infarction 3 years /
(%)		 1.09
(0.88 to 1.34)

Comments

  1. Only published trials were included.

Citation

  1. O'Connor GT, Buring JE, Yusuf S, et al: An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation 1989; 80 (2): 234-244
Search Terms: ?
Contributor: Chris Ball and Clare Wotton, February 2000
Reviewer:

Clinical Question.
Patient myocardial infarction
Intervention or Exposure structure exercise during rehabilitation
Comparison usual daily activities
Outcome death, myocardial infarction