Exercise-based cardiac rehabilitation and health-related quality of life in coronary artery disease: a systematic review and meta-analysis by exercise modality and disease status

Exercise-based cardiac rehabilitation may improve health-related quality of life (HR-QoL) in patients with coronary artery disease (CAD), but whether responses differ by exercise modality and baseline disease status remains uncertain. We searched four English- and Chinese-language databases through September 2025 for randomized controlled trials comparing exercise-based cardiac rehabilitation with usual care or non-exercise controls in adults with CAD. Hedges’ g was pooled using a multivariate three-level random-effects model. Subgroup analyses examined exercise modality and baseline disease status, and certainty of evidence was assessed using GRADE. Fifteen reports comprising 16 trial comparisons ( N = 1,353) were included. Exercise-based cardiac rehabilitation was associated with improved HR-QoL (Hedges’ g = 0.89, 95% CI 0.46 to 1.33; p < 0.001). Larger point estimates were observed for combined aerobic and resistance training and for patients in the post-ACS stable phase. However, these subgroup comparisons were indirect, and the certainty of evidence was low to very low. Exercise-based cardiac rehabilitation may improve HR-QoL in patients with CAD, although the certainty of evidence remains limited. Findings regarding exercise modality and disease status should be considered hypothesis-generating rather than evidence of definitive subgroup superiority. Open Science Framework, https://doi.org/10.17605/OSF.IO/RV5HP .