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Open Heart. 2015 Jan 28;2(1):e000163. doi: 10.1136/openhrt-2014-000163. eCollection 2015.

Exercise-based rehabilitation for heart failure: systematic review and meta-analysis.

Author information

Maidstone & Tunbridge Wells NHS Trust , Maidstone , UK.
South West Cardiothoracic Centre, Derriford Hospital , Plymouth , UK.
Peninsula Technology Assessment Group (PenTAG) , University of Exeter Medical School , Exeter , UK.
University of East Anglia , Norwich , UK.
Truro & Primary Care Research Group, Department of Research and Development, Knowledge Spa , Royal Cornwall Hospitals Trust, University of Exeter Medical School , Truro , UK.
The Hatter Institute, UCLH NHS Trust , London , UK.
Division of Health Sciences , Warwick Medical School, University of Warwick , Coventry , UK.
Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust , Leicester , UK.
Institute of Health Research, University of Exeter Medical School , Exeter , UK.



To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.


A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control.


33 trials were included with 4740 participants predominantly with a reduced ejection fraction (<40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1 year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1 year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: -5.8 points, -9.2 to -2.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date.


This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.



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