Efficacy and safety of exercise rehabilitation across the valve intervention pathway: A systematic review and meta-analysis

Background The benefits and safety of exercise-based rehabilitation across the valve intervention pathway remain uncertain. We assessed its effects on exercise capacity, cardiac function, postoperative recovery, and reported adverse events. Methods We searched eight English and Chinese databases for randomised controlled trials of rehabilitation initiated before, around, or after surgical or transcatheter valve intervention. Outcomes were 6-min walk distance (6MWD), peak oxygen uptake (peak VO 2 ), left ventricular ejection fraction (LVEF), postoperative length of stay, reported adverse events, and pulmonary complications. Principal analyses used random-effects models. We assessed outcome-specific risk of bias with RoB 2 and evidence certainty with GRADE, and performed subgroup interaction and sensitivity analyses. PROSPERO registration: CRD420261509016. Results Twenty-nine trials were included. Rehabilitation increased 6MWD (19 trials; mean difference [MD] 40.95 m, 95% CI 27.10 to 54.81), peak VO 2 [eight trials; standardised mean difference (SMD) 0.32, 0.07 to 0.57], and LVEF (14 trials; MD 4.41 percentage points, 2.26 to 6.56), and shortened postoperative hospital stay (16 trials; MD −1.77 days, −2.41 to −1.13). Reported adverse events were less frequent [14 estimable trials; risk ratio (RR) 0.53, 0.33 to 0.85], as were pulmonary complications (seven trials; RR 0.62, 0.50 to 0.77). Heterogeneity was substantial for 6MWD, LVEF, and hospital stay. Prediction intervals crossed the null for all outcomes except pulmonary complications. The peak VO 2 result was no longer statistically significant after excluding high-risk results. Evidence certainty was low for pulmonary complications and very low for the other outcomes. Conclusion Exercise-based rehabilitation may improve functional and postoperative outcomes around valve intervention, but the magnitude and applicability of benefits remain uncertain. Diverse event definitions prevent the pooled adverse-event result from establishing exercise-specific safety. Larger trials with standardised interventions, outcome assessment, and longer follow-up are needed.