Article Text

Download PDFPDF

Exercise-based rehabilitation for heart failure: systematic review and meta-analysis
  1. Viral A Sagar1,
  2. Edward J Davies2,
  3. Simon Briscoe3,
  4. Andrew J S Coats4,
  5. Hasnain M Dalal5,
  6. Fiona Lough6,
  7. Karen Rees7,
  8. Sally Singh8 and
  9. Rod S Taylor9
  1. 1Maidstone & Tunbridge Wells NHS Trust, Maidstone, UK
  2. 2South West Cardiothoracic Centre, Derriford Hospital, Plymouth, UK
  3. 3Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK
  4. 4University of East Anglia, Norwich, UK
  5. 5Truro & Primary Care Research Group, Department of Research and Development, Knowledge Spa, Royal Cornwall Hospitals Trust, University of Exeter Medical School, Truro, UK
  6. 6The Hatter Institute, UCLH NHS Trust, London, UK
  7. 7Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  8. 8Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  9. 9Institute of Health Research, University of Exeter Medical School, Exeter, UK
  1. Correspondence to Professor Rod S Taylor; r.taylor{at}


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

Methods 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.

Results 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.

Conclusions 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.


This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See:

View Full Text

Statistics from

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    Files in this Data Supplement:

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.