A Systematic Review of Clinical Practice Guidelines for Physical Activity in Patients with Coronary Heart Disease.

OBJECTIVE: This study aimed to appraise clinical practice guidelines relevant to physical activity in patients with coronary heart disease (CHD) and summarize consensus and discrepant recommendations. METHODS: The websites of organizations that develop guidelines, including those of cardiovascular and medical sports associations, were searched in addition to 9 literature databases from January 2014 to November 2024. The included guidelines were published in English or Chinese, labeled as a recommendation guideline, position paper, practice parameter, or consensus statement; and addressed physical activity for patients with coronary heart disease. Two authors independently extracted recommendations. Three reviewers independently assessed guideline quality using the AGREE II instrument. RESULTS: A total of 32 guidelines were included, with the Scottish Intercollegiate Guidelines Network and the American Heart Association deemed to have the highest methodological quality. A total of 26 consensus recommendations were identified, including general recommendations, principles for early in-hospital rehabilitation, and the FITT-VP principles for outpatient rehabilitation exercise prescriptions, of which 4 were classified as having moderate consensus and 22 as having low consensus. CONCLUSION: The guidelines have developed consensus recommendations for routine physical activity in patients with coronary heart disease. However, inconsistencies in exercise prescriptions indicate a need to develop core FITT standards that are applicable across various clinical settings and can be flexibly adapted to individual needs. Furthermore, international collaboration and standardization efforts should be pursued to enhance the applicability of evidence-based guidelines, and implementation frameworks should be introduced to bridge the gap between clinical practice and guideline recommendations.