Predictors of exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure: A meta-regression analysis

Abstract

Background

The aim of this study was to undertake a comprehensive assessment of the patient, intervention and trial-level factors that may predict exercise capacity following exercise-based rehabilitation in patients with coronary heart disease and heart failure.

Design

Meta-analysis and meta-regression analysis.

Methods

Randomized controlled trials of exercise-based rehabilitation were identified from three published systematic reviews. Exercise capacity was pooled across trials using random effects meta-analysis, and meta-regression used to examine the association between exercise capacity and a range of patient (e.g. age), intervention (e.g. exercise frequency) and trial (e.g. risk of bias) factors.

Results

55 trials (61 exercise-control comparisons, 7553 patients) were included. Following exercise-based rehabilitation compared to control, overall exercise capacity was on average 0.95 (95% CI: 0.76–1.41) standard deviation units higher, and in trials reporting maximum oxygen uptake (VO₂max) was 3.3 ml/kg.min⁻¹ (95% CI: 2.6–4.0) higher. There was evidence of a high level of statistical heterogeneity across trials (I² statistic > 50%). In multivariable meta-regression analysis, only exercise intervention intensity was found to be significantly associated with VO₂max (P = 0.04); those trials with the highest average exercise intensity had the largest mean post-rehabilitation VO₂max compared to control.

Conclusions

We found considerable heterogeneity across randomized controlled trials in the magnitude of improvement in exercise capacity following exercise-based rehabilitation compared to control among patients with coronary heart disease or heart failure. Whilst higher exercise intensities were associated with a greater level of post-rehabilitation exercise capacity, there was no strong evidence to support other intervention, patient or trial factors to be predictive.

Keywords

Exercise training cardiac rehabilitation heart failure coronary heart disease exercise capacity meta-analysis

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