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Original research article
Exercise-based cardiac rehabilitation for stable angina: systematic review and meta-analysis
  1. Linda Long1,
  2. Lindsey Anderson2,
  3. jingzhou He3,
  4. Manish Gandhi3,
  5. Alice Dewhirst4,
  6. Charlene Bridges5 and
  7. Rod Taylor1
  1. 1Institute of Health Research, University of Exeter Medical School, Exeter, UK
  2. 2Department of Innovation, Impact & Business, University of Exeter, Exeter, UK
  3. 3Department of Cardiology, Royal Devon & Exeter NHS Foundation Trust Hospital, Exeter, UK
  4. 4University of Exeter Medical School, Exeter, UK
  5. 5Farr Institute of Health Informatics Research, University College London, London, UK
  1. Correspondence to Dr Linda Long, Institute of Health Research, University of Exeter Medical School, Exeter EX1 2LU, Devon, UK; L.Long{at}


Objective A systematic review was undertaken to assess the effects of exercise-based cardiac rehabilitation (CR) for patients with stable angina.

Methods Databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase and CINAHL) were searched up to October 2017, without language restriction. Randomised trials comparing CR programmes with no exercise control in adults with stable angina were included. Where possible, study outcomes were pooled using meta-analysis. Grading of Recommendations Assessment, Development and Evaluation was used to assess the quality of evidence. The protocol was published on the Cochrane Database of Systematic Reviews.

Results Seven studies (581 patients), with a median of 12-month follow-up, were included. The effect of exercise-based CR on all-cause mortality (risk ratio (RR) 1.01, 95 % CI: 0.18 to 5.67), acute myocardial infarction (RR 0.33, 95% CI: 0.07 to 1.63) and cardiovascular-related hospital admissions (RR 0.14, 95% CI: 0.02 to 1.1) relative to control were uncertain. We found low-quality evidence that exercise-based CR results in a moderate improvement in exercise capacity (standard mean difference 0.45, 95% CI: 0.20 to 0.70). There was limited and very low-quality evidence for the effect of exercise-based CR on health-related quality of life (HRQoL), adverse events and costs. No data were identified on cost-effectiveness or return to work.

Conclusions Exercise-based CR may improve the short-term exercise capacity of patients with stable angina pectoris. Well-designed randomised controlled trials are needed to definitely determine the impact of CR on outcomes including mortality, morbidity, HRQoL, and costs in the population of patients with stable angina receiving contemporary medical therapy.

  • stable angina
  • cardiac rehabilitation
  • exercise
  • systematic review

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  • Contributors LL contributed to writing the protocol, undertook the ‘Risk of bias’ assessment, conducted the GRADE analysis and led the writing of the final review manuscript. LA led writing of the protocol, undertook study selection and data extraction and contributed to writing the final review manuscript. AD contributed to writing the protocol and manuscript, undertook study selection, data extraction and ‘Risk of bias’ assessment, and approved the final review manuscript. JH provided clinical expertise, assisted in writing the protocol, undertook study selection, data extraction and ‘Risk of bias’ assessment. MMG contributed to writing the protocol and provided clinical expertise. RST led the statistical analysis, conducted the GRADE analysis, edited the review and contributed to writing the final review manuscript. All authors approved the final review.

  • Funding Internal sources: University of Exeter Medical School. External sources: The Cochrane Heart Group US Satellite is supported by intramural support from the Northwestern University Feinberg School of Medicine and the Northwestern University Clinical and Translational Science (NUCATS) Institute (UL1TR000150), USA. This project was supported by the National Institute for Health Research, via Cochrane Incentive funding to the Heart Group. The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the Systematic Reviews Programme, NIHR, NHS or the Department of Health, UK.

  • Competing interests LA is an author on a number of other Cochrane reviews on cardiac rehabilitation (CR). RST is an author on a number of other Cochrane reviews on CR and is currently the co-chief investigator on the programme of research with the overarching aims of developing and evaluating a home-based CR intervention for people with heart failure and their carers (NIHR PGfAR RP-PG-0611-12004).

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available in a public, open access repository. All data relevant to the study are included in the article or uploaded as supplementary information.