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.
This article has been cited by other articles:
 |
|
 |
|
  K. M. Nielsen, O. Faergeman, A. Foldspang, and M. L. Larsen Cardiac rehabilitation: health characteristics and socio-economic status among those who do not attend Eur J Public Health, July 9, 2008; (2008) ckn060v1. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Foster, J. P. Porcari, R. A. Battista, B. Udermann, G. Wright, and A. Lucia The Risk in Exercise Training American Journal of Lifestyle Medicine, July 1, 2008; 2(4): 279 - 284. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Soleimani, M. Salarifar, S. E Kasaian, S. Sadeghian, M. Nejatian, and A. Abbasi Effect of Completion of Cardiac Rehabilitation on Heart Rate Recovery Asian Cardiovasc Thorac Ann, June 1, 2008; 16(3): 202 - 207. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. K. Lahiri, P. J. Kannankeril, and J. J. Goldberger Assessment of autonomic function in cardiovascular disease: physiological basis and prognostic implications. J. Am. Coll. Cardiol., May 6, 2008; 51(18): 1725 - 1733. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. K. Wenger Current Status of Cardiac Rehabilitation J. Am. Coll. Cardiol., April 29, 2008; 51(17): 1619 - 1631. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C E. Pluss, M R. Karlsson, N. Wallen, E. Billing, and C. Held Effects of an expanded cardiac rehabilitation programme in patients treated for an acute myocardial infarction or a coronary artery by-pass graft operation Clinical Rehabilitation, April 1, 2008; 22(4): 306 - 318. [Abstract] [PDF]
|
|
|
|
 |
|
 C. Fiorina, E. Vizzardi, R. Lorusso, M. Maggio, G. De Cicco, S. Nodari, P. Faggiano, and L. Dei Cas The 6-min walking test early after cardiac surgery. Reference values and the effects of rehabilitation programme Eur. J. Cardiothorac. Surg., November 1, 2007; 32(5): 724 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. J. Schwartz and E. Vanoli From exercise training to sudden death prevention via adrenergic receptors Am J Physiol Heart Circ Physiol, November 1, 2007; 293(5): H2631 - H2633. [Full Text] [PDF]
|
|
|
|
 |
|
 J. A. Suaya, D. S. Shepard, S.-L. T. Normand, P. A. Ades, J. Prottas, and W. B. Stason Use of Cardiac Rehabilitation by Medicare Beneficiaries After Myocardial Infarction or Coronary Bypass Surgery Circulation, October 9, 2007; 116(15): 1653 - 1662. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Thomas, M. King, K. Lui, N. Oldridge, I. L. Pina, J. Spertus, R. O. Bonow, N.A. M. Estes III, D. C. Goff, K. L. Grady, et al. AACVPR/ACC/AHA 2007 Performance Measures on Cardiac Rehabilitation for Referral to and Delivery of Cardiac Rehabilitation/Secondary Prevention Services: Endorsed by the American College of Chest Physicians, American College of Sports Medicine, American Physical Therapy Association, Canadian Association of Cardiac Rehabilitation, European Association for Cardiovascular Prevention and Rehabilitation, Inter-American Heart Foundation, National Association of Clinical Nurse Specialists, Preventive Cardiovascular Nurses Association, and the Society of Thoracic Surgeons J. Am. Coll. Cardiol., October 2, 2007; 50(14): 1400 - 1433. [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Clark, P. D. MacIntyre, and J. Cruickshank A critical realist approach to understanding and evaluating heart health programmes Health (London) , October 1, 2007; 11(4): 513 - 539. [Abstract] [PDF]
|
|
|
|
|
|
J. L. Anderson, C. D. Adams, E. M. Antman, C. R. Bridges, R. M. Califf, D. E. Casey Jr, W. E. Chavey II, F. M. Fesmire, J. S. Hochman, T. N. Levin, et al. ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction) Developed in Collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine J. Am. Coll. Cardiol., August 14, 2007; 50(7): e1 - e157. [Full Text] [PDF]
|
|
|
|
|
|
R. Arena, J. Myers, M. A. Williams, M. Gulati, P. Kligfield, G. J. Balady, E. Collins, and G. Fletcher Assessment of Functional Capacity in Clinical and Research Settings: A Scientific Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention of the Council on Clinical Cardiology and the Council on Cardiovascular Nursing Circulation, July 17, 2007; 116(3): 329 - 343. [Full Text] [PDF]
|
|
|
|
|
|
L. Gao, W. Wang, D. Liu, and I. H. Zucker Exercise Training Normalizes Sympathetic Outflow by Central Antioxidant Mechanisms in Rabbits With Pacing-Induced Chronic Heart Failure Circulation, June 19, 2007; 115(24): 3095 - 3102. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. E. Boden, R. A. O'Rourke, K. K. Teo, P. M. Hartigan, D. J. Maron, W. J. Kostuk, M. Knudtson, M. Dada, P. Casperson, C. L. Harris, et al. Optimal Medical Therapy with or without PCI for Stable Coronary Disease N. Engl. J. Med., April 12, 2007; 356(15): 1503 - 1516. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Sarrafzadegan, K. Rabiei, S. Shirani, A. Kabir, N. Mohammadifard, and H. Roohafza Drop-out predictors in cardiac rehabilitation programmes and the impact of sex differences among coronary heart disease patients in an Iranian sample: a cohort study Clinical Rehabilitation, April 1, 2007; 21(4): 362 - 372. [Abstract] [PDF]
|
|
|
|
|
|
H. L. Lujan, S. L. Britton, L. G. Koch, and S. E. DiCarlo Reduced susceptibility to ventricular tachyarrhythmias in rats selectively bred for high aerobic capacity Am J Physiol Heart Circ Physiol, December 1, 2006; 291(6): H2933 - H2941. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Giallauria, R. Lucci, M. Pietrosante, G. Gargiulo, A. De Lorenzo, M. D'Agostino, G. Gerundo, P. Abete, F. Rengo, and C. Vigorito Exercise-based cardiac rehabilitation improves heart rate recovery in elderly patients after acute myocardial infarction. J. Gerontol. A Biol. Sci. Med. Sci., July 1, 2006; 61(7): 713 - 717. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. A. Ades, P. D. Savage, C. A. Brawner, C. E. Lyon, J. K. Ehrman, J. Y. Bunn, and S. J. Keteyian Aerobic Capacity in Patients Entering Cardiac Rehabilitation Circulation, June 13, 2006; 113(23): 2706 - 2712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. E. Billman, M. Kukielka, R. Kelley, M. Moustafa-Bayoumi, and R. A. Altschuld Endurance exercise training attenuates cardiac beta2-adrenoceptor responsiveness and prevents ventricular fibrillation in animals susceptible to sudden death Am J Physiol Heart Circ Physiol, June 1, 2006; 290(6): H2590 - H2599. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M.-W. Tsai, W.-C. Chie, T. B. Kuo, M.-F. Chen, J.-P. Liu, T. H.-H. Chen, and Y.-T. Wu Effects of Exercise Training on Heart Rate Variability After Coronary Angioplasty Physical Therapy, May 1, 2006; 86(5): 626 - 635. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kukielka, D. R. Seals, and G. E. Billman Cardiac vagal modulation of heart rate during prolonged submaximal exercise in animals with healed myocardial infarctions: effects of training Am J Physiol Heart Circ Physiol, April 1, 2006; 290(4): H1680 - H1685. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. E. Billman and M. Kukielka Effects of endurance exercise training on heart rate variability and susceptibility to sudden cardiac death: protection is not due to enhanced cardiac vagal regulation J Appl Physiol, March 1, 2006; 100(3): 896 - 906. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. M. Clark, L. Hartling, B. Vandermeer, and F. A. McAlister Meta-Analysis: Secondary Prevention Programs for Patients with Coronary Artery Disease Ann Intern Med, November 1, 2005; 143(9): 659 - 672. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Thompson Exercise Prescription and Proscription for Patients With Coronary Artery Disease Circulation, October 11, 2005; 112(15): 2354 - 2363. [Full Text] [PDF]
|
|
|
|
|
|
J.A. Iestra, D. Kromhout, Y.T. van der Schouw, D.E. Grobbee, H.C. Boshuizen, and W.A. van Staveren Effect Size Estimates of Lifestyle and Dietary Changes on All-Cause Mortality in Coronary Artery Disease Patients: A Systematic Review Circulation, August 9, 2005; 112(6): 924 - 934. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Kojda and R. Hambrecht Molecular mechanisms of vascular adaptations to exercise. Physical activity as an effective antioxidant therapy? Cardiovasc Res, August 1, 2005; 67(2): 187 - 197. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. S. Lett, J. Davidson, and J. A. Blumenthal Nonpharmacologic Treatments for Depression in Patients With Coronary Heart Disease Psychosom Med, May 1, 2005; 67(Supplement_1): S58 - S62. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Mimura, F. Yuasa, R. Yuyama, A. Kawamura, M. Iwasaki, T. Sugiura, and T. Iwasaka The Effect of Residential Exercise Training on Baroreflex Control of Heart Rate and Sympathetic Nerve Activity in Patients With Acute Myocardial Infarction Chest, April 1, 2005; 127(4): 1108 - 1115. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. L. Collins, A. M. Loka, and S. E. DiCarlo Daily exercise-induced cardioprotection is associated with changes in calcium regulatory proteins in hypertensive rats Am J Physiol Heart Circ Physiol, February 1, 2005; 288(2): H532 - H540. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. S. Leon, B. A. Franklin, F. Costa, G. J. Balady, K. A. Berra, K. J. Stewart, P. D. Thompson, M. A. Williams, and M. S. Lauer Cardiac Rehabilitation and Secondary Prevention of Coronary Heart Disease: An American Heart Association Scientific Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in Collaboration With the American Association of Cardiovascular and Pulmonary Rehabilitation Circulation, January 25, 2005; 111(3): 369 - 376. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A F Cooper, G Jackson, J Weinman, and R Horne A qualitative study investigating patients' beliefs about cardiac rehabilitation Clinical Rehabilitation, January 1, 2005; 19(1): 87 - 96. [Abstract] [PDF]
|
|
|
|
|
|
N. Lauer, T. Suvorava, U. Ruther, R. Jacob, W. Meyer, D. G. Harrison, and G. Kojda Critical involvement of hydrogen peroxide in exercise-induced up-regulation of endothelial NO synthase Cardiovasc Res, January 1, 2005; 65(1): 254 - 262. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. Wolk, C. N. Bairey Merz, and P. D. Thompson President's page: The promise of prevention: So, why aren't all cardiologists "preventive"? J. Am. Coll. Cardiol., November 16, 2004; 44(10): 2082 - 2084. [Full Text] [PDF]
|
|
|
|
|
|
W. Hassan and M. E. Fawzy Exercise Training Improves Overall Physical Fitness and Quality of Life in Older Women With Coronary Artery Disease: Just Keep on Moving? Chest, October 1, 2004; 126(4): 1009 - 1010. [Full Text] [PDF]
|
|
|
|
|
|
T. Suvorava, N. Lauer, and G. Kojda Physical inactivity causes endothelial dysfunction in healthy young mice J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1320 - 1327. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Witt, S. J. Jacobsen, S. A. Weston, J. M. Killian, R. A. Meverden, T. G. Allison, G. S. Reeder, and V.e. L. Roger Cardiac rehabilitation after myocardial infarction in the community J. Am. Coll. Cardiol., September 1, 2004; 44(5): 988 - 996. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Napoli, S. Williams-Ignarro, F. de Nigris, L. O. Lerman, L. Rossi, C. Guarino, G. Mansueto, F. Di Tuoro, O. Pignalosa, G. De Rosa, et al. Long-term combined beneficial effects of physical training and metabolic treatment on atherosclerosis in hypercholesterolemic mice PNAS, June 8, 2004; 101(23): 8797 - 8802. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. A. Lear, A. Ignaszewski, W. Linden, A. Brozic, M. Kiess, J. J. Spinelli, P. Haydn Pritchard, and J. J. Frohlich The Extensive Lifestyle Management Intervention (ELMI) following cardiac rehabilitation trial Eur. Heart J., November 1, 2003; 24(21): 1920 - 1927. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. D. Thompson, D. Buchner, I. L. Pina, G. J. Balady, M. A. Williams, B. H. Marcus, K. Berra, S. N. Blair, F. Costa, B. Franklin, et al. Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) Arterioscler. Thromb. Vasc. Biol., August 1, 2003; 23(8): e42 - 49. [Full Text] [PDF]
|
|
|
|
|
|
P. D. Thompson Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease Arterioscler. Thromb. Vasc. Biol., August 1, 2003; 23(8): 1319 - 1321. [Full Text] [PDF]
|
|
|
|
|
|
P. Giannuzzi, H. Saner, H. Bjornstad, P. Fioretti, M. Mendes, A. Cohen-Solal, L. Dugmore, R. Hambrecht, I. Hellemans, H. McGee, et al. Secondary Prevention Through Cardiac Rehabilitation: Position Paper of the Working Group on Cardiac Rehabilitation and Exercise Physiology of the European Society of Cardiology Eur. Heart J., July 1, 2003; 24(13): 1273 - 1278. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. D. Thompson, D. Buchner, I. L. Pina, G. J. Balady, M. A. Williams, B. H. Marcus, K. Berra, S. N. Blair, F. Costa, B. Franklin, et al. Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) Circulation, June 24, 2003; 107(24): 3109 - 3116. [Full Text] [PDF]
|
|
|
|
|
|
N. Marchionni, F. Fattirolli, S. Fumagalli, N. Oldridge, F. Del Lungo, L. Morosi, C. Burgisser, and G. Masotti Improved Exercise Tolerance and Quality of Life With Cardiac Rehabilitation of Older Patients After Myocardial Infarction: Results of a Randomized, Controlled Trial Circulation, May 6, 2003; 107(17): 2201 - 2206. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
The Task Force on the Management of Acute Myocardi, F. Van de Werf, D. Ardissino, A. Betriu, D. V. Cokkinos, E. Falk, K. A.A. Fox, D. Julian, M. Lengyel, F.-J. Neumann, et al. Management of acute myocardial infarction in patients presenting with ST-segment elevation Eur. Heart J., January 1, 2003; 24(1): 28 - 66. [Full Text] [PDF]
|
|
|
|
 |
|
 B. C. Bock, R. E. Carmona-Barros, J. L. Esler, and P. L. Tilkemeier Program Participation and Physical Activity Maintenance After Cardiac Rehabilitation Behav Modif, January 1, 2003; 27(1): 37 - 53. [Abstract] [PDF]
|
|
|
|
|
|
P. A. Ades, T. E. Kottke, N. Houston Miller, J. C. McGrath, N. B. Record, and S. S. Record Task Force #3--getting results: who, where, and how? J. Am. Coll. Cardiol., August 21, 2002; 40(4): 615 - 630. [Full Text] [PDF]
|
|
|
|
|
|
M. T. La Rovere, C. Bersano, M. Gnemmi, G. Specchia, and P. J. Schwartz Exercise-Induced Increase in Baroreflex Sensitivity Predicts Improved Prognosis After Myocardial Infarction Circulation, August 20, 2002; 106(8): 945 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D J Wright, S G Williams, R Riley, P Marshall, and L B Tan Is early, low level, short term exercise cardiac rehabilitation following coronary bypass surgery beneficial? A randomised controlled trial Heart, July 1, 2002; 88(1): 83 - 84. [Full Text] [PDF]
|
|
|
|
|
|
A F Cooper, G Jackson, J Weinman, and R Horne Factors associated with cardiac rehabilitation attendance: a systematic review of the literature Clinical Rehabilitation, May 1, 2002; 16(5): 541 - 552. [Abstract] [PDF]
|
|
|
|
|
|
C. Mannheimer, P. Camici, M.R. Chester, A. Collins, M. DeJongste, T. Eliasson, F. Follath, I. Hellemans, J. Herlitz, T. Luscher, et al. The problem of chronic refractory angina. Report from the ESC Joint Study Group on the Treatment of Refractory Angina Eur. Heart J., March 1, 2002; 23(5): 355 - 370. [Full Text] [PDF]
|
|
|
|
|
|
G. E. Billman Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention J Appl Physiol, February 1, 2002; 92(2): 446 - 454. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. A McAlister, F. M E Lawson, K. K Teo, and P. W Armstrong Randomised trials of secondary prevention programmes in coronary heart disease: systematic review BMJ, October 27, 2001; 323(7319): 957 - 962. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Denollet and D. L. Brutsaert Reducing Emotional Distress Improves Prognosis in Coronary Heart Disease: 9-Year Mortality in a Clinical Trial of Rehabilitation Circulation, October 23, 2001; 104(17): 2018 - 2023. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 B. W. J. H. Penninx, S. P. Messier, W. J. Rejeski, J. D. Williamson, M. DiBari, C. Cavazzini, W. B. Applegate, and M. Pahor Physical Exercise and the Prevention of Disability in Activities of Daily Living in Older Persons With Osteoarthritis Arch Intern Med, October 22, 2001; 161(19): 2309 - 2316. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. D. Fihn, S. V. Williams, J. Daley, and R. J. Gibbons Guidelines for the Management of Patients with Chronic Stable Angina: Treatment Ann Intern Med, October 16, 2001; 135(8_Part_1): 616 - 632. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. F. Fletcher, G. J. Balady, E. A. Amsterdam, B. Chaitman, R. Eckel, J. Fleg, V. F. Froelicher, A. S. Leon, I. L. Pina, R. Rodney, et al. Exercise Standards for Testing and Training: A Statement for Healthcare Professionals From the American Heart Association Circulation, October 2, 2001; 104(14): 1694 - 1740. [Full Text] [PDF]
|
|