Circulation, Vol 80, 234-244, Copyright © 1989 by American Heart Association
GT O'Connor, JE Buring, S Yusuf, SZ Goldhaber, EM Olmstead, RS Paffenbarger Jr and CH Hennekens
Of 22 randomized trials of rehabilitation with exercise after myocardial
infarction (MI), one trial had results that achieved conventional
statistical significance. To determine whether or not these studies, in the
aggregate, show a significant benefit of rehabilitation after myocardial
infarction, we performed an overview of all randomized trials, involving
4,554 patients; we evaluated total and cardiovascular mortality, sudden
death, and fatal and nonfatal reinfarction. For each endpoint, we
calculated an odds ratio (OR) and 95% confidence interval (95% CI) for the
trials combined. After an average of 3 years of follow-up, the ORs were
significantly lower in the rehabilitation than in the comparison group:
specifically, total mortality (OR = 0.80 [0.66, 0.96]), cardiovascular
mortality (OR = 0.78 [0.63, 0.96]), and fatal reinfarction (OR = 0.75
[0.59, 0.95]). The OR for sudden death was significantly lower in the
rehabilitation than in the comparison group at 1 year (OR = 0.63 [0.41,
0.97]). The data were compatible with a benefit at 2 (OR = 0.76 [0.54,
1.06]) and 3 years (OR = 0.92 [0.69, 1.23]), but these findings were not
statistically significant. For nonfatal reinfarction, there were no
significant differences between the two groups after 1 (OR = 1.09 [0.76,
1.57]), 2 (OR = 1.10 [0.82, 1.47]), or 3 years (OR = 1.09 [0.88, 1.34]) of
follow- up. The observed 20% reduction in overall mortality reflects a
decreased risk of cardiovascular mortality and fatal reinfarction
throughout at least 3 years and a reduction in sudden death during the 1st
year after infarction and possibly for 2-3 years. With respect to the
independent effects of the physical exercise component of cardiac
rehabilitation, the relatively small number of "exercise only" trials,
combined with the possibility that they may have had a formal or informal
nonexercise component precludes the possibility of reaching any definitive
conclusion. To do so would require a randomized trial of sufficient size to
distinguish between no effect and the most plausible effect based on the
results of this overview.
ARTICLES
An overview of randomized trials of rehabilitation with exercise after myocardial infarction
Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
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C. M Albert and J. N Ruskin Risk stratifiers for sudden cardiac death (SCD) in the community: primary prevention of SCD Cardiovasc Res, May 1, 2001; 50(2): 186 - 196. [Full Text] [PDF]
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F. Iellamo, J. M. Legramante, M. Massaro, G. Raimondi, and A. Galante Effects of a Residential Exercise Training on Baroreflex Sensitivity and Heart Rate Variability in Patients With Coronary Artery Disease : A Randomized, Controlled Study Circulation, November 21, 2000; 102(21): 2588 - 2592. [Abstract] [Full Text] [PDF]
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L. Steffen-Batey, M. Z. Nichaman, D. C. Goff Jr, R. F. Frankowski, C. L. Hanis, D. J. Ramsey, and D. R. Labarthe Change in Level of Physical Activity and Risk of All-Cause Mortality or Reinfarction : The Corpus Christi Heart Project Circulation, October 31, 2000; 102(18): 2204 - 2209. [Abstract] [Full Text] [PDF]
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J. L. Fleg, I. L. Pina, G. J. Balady, B. R. Chaitman, B. Fletcher, C. Lavie, M. C. Limacher, R. A. Stein, M. Williams, and T. Bazzarre Assessment of Functional Capacity in Clinical and Research Applications : An Advisory From the Committee on Exercise, Rehabilitation, and Prevention, Council on Clinical Cardiology, American Heart Association Circulation, September 26, 2000; 102(13): 1591 - 1597. [Full Text] [PDF]
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S. G. Wannamethee, A. G. Shaper, and M. Walker Physical Activity and Mortality in Older Men With Diagnosed Coronary Heart Disease Circulation, September 19, 2000; 102(12): 1358 - 1363. [Abstract] [Full Text] [PDF]
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M. Babyak, J. A. Blumenthal, S. Herman, P. Khatri, M. Doraiswamy, K. Moore, W. E. Craighead, T. T. Baldewicz, and K. R. Krishnan Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months Psychosom Med, September 1, 2000; 62(5): 633 - 638. [Abstract] [Full Text] [PDF]
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P. Abete, C. Calabrese, N. Ferrara, A. Cioppa, P. Pisanelli, F. Cacciatore, G. Longobardi, C. Napoli, and F. Rengo Exercise training restores ischemic preconditioning in the aging heart J. Am. Coll. Cardiol., August 1, 2000; 36(2): 643 - 650. [Abstract] [Full Text] [PDF]
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W. Nieuwland, M. A. Berkhuysen, D. J. van Veldhuisen, J. Brugemann, M. L. J. Landsman, E. van Sonderen, K. I. Lie, H. J. G. M. Crijns, and P. Rispens Differential effects of high-frequency versus low-frequency exercise training in rehabilitation of patients with coronary artery disease J. Am. Coll. Cardiol., July 1, 2000; 36(1): 202 - 207. [Abstract] [Full Text] [PDF]
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T. Y. Goraya, S. J. Jacobsen, P. A. Pellikka, T. D. Miller, A. Khan, S. A. Weston, B. J. Gersh, and V. L. Roger Prognostic Value of Treadmill Exercise Testing in Elderly Persons Ann Intern Med, June 6, 2000; 132(11): 862 - 870. [Abstract] [Full Text] [PDF]
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C. N. Bairey Merz, M. Paul-Labrador, and P. Vongvanich Time to Reevaluate Risk Stratification Guidelines for Medically Supervised Exercise Training in Patients With Coronary Artery Disease JAMA, March 15, 2000; 283(11): 1476 - 1478. [Full Text] [PDF]
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R.P. Steeds and K.S. Channer Depression: the sleeping giant Eur. Heart J., March 2, 2000; 21(6): 427 - 429. [PDF]
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C. J. Lavie and R. V. Milani Benefits of Cardiac Rehabilitation and Exercise Training Chest, January 1, 2000; 117(1): 5 - 7. [Full Text] [PDF]
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P Kay, J Kittelson, and R A H Stewart Relation between duration and intensity of first exercise and "warm up" in ischaemic heart disease Heart, January 1, 2000; 83(1): 17 - 21. [Abstract] [Full Text] [PDF]
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A. Stahle, R. Nordlander, and L. Bergfeldt Aerobic group training improves exercise capacity and heart rate variability in elderly patients with a recent coronary event. A randomized controlled study Eur. Heart J., November 2, 1999; 20(22): 1638 - 1646. [Abstract] [PDF]
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J. Dorn, J. Naughton, D. Imamura, and M. Trevisan Results of a Multicenter Randomized Clinical Trial of Exercise and Long-Term Survival in Myocardial Infarction Patients : The National Exercise and Heart Disease Project (NEHDP) Circulation, October 26, 1999; 100(17): 1764 - 1769. [Abstract] [Full Text] [PDF]
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P. A. Ades, A. Maloney, P. Savage, and R. L. Carhart Jr Determinants of Physical Functioning in Coronary Patients: Response to Cardiac Rehabilitation Arch Intern Med, October 25, 1999; 159(19): 2357 - 2360. [Abstract] [Full Text] [PDF]
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G. Morocutti, D. Tuniz, and P.M. Fioretti Comprehensive cardiac rehabilitation: an issue to be readdressed Eur. Heart J., October 2, 1999; 20(20): 1448 - 1450. [PDF]
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K. A. Eagle, R. A. Guyton, R. Davidoff, G. A. Ewy, J. Fonger, T. J. Gardner, J. P. Gott, H. C. Herrmann, R. A. Marlow, W. C. Nugent, et al. ACC/AHA guidelines for coronary artery bypass graft surgery: A report of the American College of Cardiology/ American Heart Association task force on Practice Guidelines (Committee to revise the 1991 Guidelines for Coronary Artery Bypass Graft Surgery) J. Am. Coll. Cardiol., October 1, 1999; 34(4): 1262 - 1347. [Full Text] [PDF]
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M R Melville, C Packham, N Brown, C Weston, and D Gray Cardiac rehabilitation: socially deprived patients are less likely to attend but patients ineligible for thrombolysis are less likely to be invited Heart, September 1, 1999; 82(3): 373 - 377. [Abstract] [Full Text] [PDF]
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A Cooper, G Lloyd, J Weinman, and G Jackson Why patients do not attend cardiac rehabilitation: role of intentions and illness beliefs Heart, August 1, 1999; 82(2): 234 - 236. [Abstract] [Full Text] [PDF]
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R. J. Gibbons, K. Chatterjee, J. Daley, J. S. Douglas, S. D. Fihn, J. M. Gardin, M. A. Grunwald, D. Levy, B. W. Lytle, R. A. O'Rourke, et al. ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients With Chronic Stable Angina) J. Am. Coll. Cardiol., June 1, 1999; 33(7): 2092 - 2197. [Full Text] [PDF]
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D.E.H. Flanagan, P. Cox, D. Paine, J. Davies, and M. Armitage Secondary prevention of coronary heart disease in primary care: a healthy heart initiative QJM, May 1, 1999; 92(5): 245 - 250. [Abstract] [Full Text] [PDF]
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L D Dugmore, R J Tipson, M H Phillips, E J Flint, N H Stentiford, M F Bone, and W A Littler Changes in cardiorespiratory fitness, psychological wellbeing, quality of life, and vocational status following a 12 month cardiac exercise rehabilitation programme Heart, April 1, 1999; 81(4): 359 - 366. [Abstract] [Full Text]
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R E Ferner and H. J N Bethell Secondary prevention in coronary heart disease BMJ, December 5, 1998; 317(7172): 1592 - 1592. [Full Text]
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