Coronary artery disease: exercise training reduces mortality

Clinical bottom line (level 1a)

  1. Patients with cardiovascular disease who undergo exercise training compared with usual care are less likely to die (NNT = 44 at weeks) , though not clearly less likely to have a myocardial infarction.
  2. A comprehensive cardiac rehabilitation programme reduces total cholesterol levels (by roughly 0.5 mmol/l), but does not clearly reduce mortality.
Jolliffe et al: Cochrane Library 2001; 4 : -
Expires March 2004

The study

Systematic review of all randomised controlled trials of
  • Patients: myocardial infarction, coronary revascularisation or coronary artery disease confirmed on angiography
  • Intervention: exercise training compared with usual care
  • Outcome: death, myocardial infarction, revascularisation
Articles found in all languages using Cardiovascular trials register at McMaster University, Central, Medline, Embase, CINAHL, AMED, BIDS ISI, SPORTDISCUS, to December 1998 (search terms: detailed in text ) and searching reference lists of retrieved articles, conference proceedings and contacting experts for advice.

Selection criteria: by 2 independent reviewers - disagreements were addressed by consensus or a third reviewer if required
Appraisal criteria: by 2 independent reviewers based on blinding, concealment of allocation, loss to follow-up. Authors were contacted for missing data.
Articles excluded if:
  • following heart transplant, heart valve surgery or heart failure


32 trials found involving 8440 patients followed for 8 weeks to 5 years

The evidence

Outcome Time to outcome CER OR
(95% CI)		 NNT
(95% CI)
death: exercise training only weeks 122/1285
(9.5%)		 0.74
(0.56 to 0.98) 		44
(25 to 580)
non-fatal myocardial infarction: exercise training only years 74/1045
(7.1%)		 0.96
(0.69 to 1.35) 		380
(NNT = 48 to infinity;
NNH = 44 to infinity)
death: comprehensive cardiac rehabilitation years 247/2535
(9.7%)		 0.87
(0.71 to 1.05) 		86
(NNT = 38 to infinity;
NNH = 230 to infinity)

  • fall in total cholesterol: comprehensive cardiac training: weighted mean difference: 0.57 mmol/l (95% CI: 0.31 to 0.83)

Comments

  1. Individual studies were often underpowered and quality was commonly poor.
  2. Comprehensive cardiac rehabilitation varied widely between studies ranging from offering tapes, counselling, daily gym to offering intensive dietary therapy.

Citation

  1. Jolliffe JA, Rees K, Taylor RS, et al: exercise-based rehabilitation for coronary heart disease. Cochrane Library 2001; 4 : -
Search Terms: from ACP Journal Club other articles noted
Contributor: Chris Ball, March 2002
Reviewer:

Clinical Question.
Patient coronary artery disease
Intervention or Exposure exercise training
Outcome death, myocardial infarction, cholesterol levels