Home-based exercise programmes were slightly more effective than centre-based rehabilitation for maintaining exercise capacity in coronary artery disease patients (SMD 0.25; 95% CI 0.02-0.48).
Meta-Analysis (n=1,440)
Do home-based exercise programmes improve long-term exercise capacity and physical activity compared to usual care or centre-based rehabilitation in patients with coronary artery disease?
Home-based exercise programs are slightly more effective than center-based rehabilitation for maintaining long-term exercise capacity in patients with coronary artery disease.
Effect estimate: SMD 0.25 (95% CI 0.02-0.48)
Background Exercise-based cardiovascular rehabilitation (CR) improves exercise capacity (EC), lowers cardiovascular risk profile and increases physical functioning in the short term. However, uptake of and adherence to a physically active lifestyle in the long run remain problematic. Home-based (HB) exercise programmes have been introduced in an attempt to enhance long-term adherence to recommended levels of physical activity (PA). The current systematic review and meta-analysis aimed to compare the longer-term effects of HB exercise programmes with usual care (UC) or centre-based (CB) CR in patients referred for CR. Design Systematic review and meta-analysis. Methods Non-randomised controlled trials (RCTs) or randomised trials comparing the effects of HB exercise programmes with UC or CB rehabilitation on EC and/or PA, with a follow-up period of ≥12 months and performed in coronary artery disease patients, were searched in four databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the Cochrane Central Register of Controlled trials (CENTRAL)) from their inception until September 7, 2016. Standardised mean differences (SMDs) were calculated and pooled by means of random effects models. Risk of bias, publication bias and heterogeneity among trials were also assessed. Results Seven studies could be included in the meta-analysis on EC, but only two studies could be included in the meta-analysis on PA (total number of 1440 patients). The results showed no significant differences in EC between HB rehabilitation and UC (SMD 0.10, 95% confidence interval (CI) -0.13 to 0.33). There was a small but significant difference in EC in favour of HB compared to CB rehabilitation (SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA (SMD 0.37, 95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more effective than CB rehabilitation in terms of maintaining EC. The small number of studies warrants the need for more RCTs evaluating the long-term effects of different CR interventions on EC and PA behaviour, as this is the ultimate goal of CR.
Claes et al. (Thu,) conducted a meta-analysis in Coronary artery disease (n=1,440). Home-based exercise programmes vs. Usual care or centre-based rehabilitation was evaluated on Exercise capacity (home-based vs centre-based rehabilitation) (SMD 0.25, 95% CI 0.02-0.48). Home-based exercise programmes were slightly more effective than centre-based rehabilitation for maintaining exercise capacity in coronary artery disease patients (SMD 0.25; 95% CI 0.02-0.48).