{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:19:03Z","timestamp":1789733943509,"version":"4.0.1"},"reference-count":65,"publisher":"BMJ","issue":"6","license":[{"start":{"date-parts":[[2020,6,5]],"date-time":"2020-06-05T00:00:00Z","timestamp":1591315200000},"content-version":"unspecified","delay-in-days":4,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,5,1]]},"published-print":{"date-parts":[[2020,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine the effect of contemporary exercise-based cardiac rehabilitation on generic and disease-specific health related quality of life for people with coronary artery disease.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Systematic review and meta-analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study eligibility criteria<\/jats:title>\n                    <jats:p>Randomised controlled trials testing exercise-based cardiac rehabilitation versus no exercise control that recruited after 31 December 1999. On 30 July 2019, we searched the Cochrane Central Register of Controlled Trials, MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCO) databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study appraisal and synthesis<\/jats:title>\n                    <jats:p>Studies were screened for inclusion by two independent reviewers. Risk of bias was assessed using the Cochrane risk of bias tool. Data were reported as pooled means (95% CI for between-group difference.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We identified 24 studies (n=4890). We performed meta-analyses for 15 short-term and 9 medium-term outcomes (36-Item Short Form Survey Instrument (SF-36), EuroQol-5D (EQ-5D) and MacNew, a cardiac-specific outcome). Six short-term and five medium-term SF-36 domains statistically favoured exercise-based cardiac rehabilitation. Only for two short-term SF-36 outcomes, \u2018physical function\u2019 (mean difference 12.0, 95% CI 4.4 to 19.6) and \u2018role physical\u2019 (mean difference 16.9, 95% CI 2.4 to 31.3), did the benefit appear to be clinically important. Meta-analyses of the short-term SF-36 physical and mental component scores, EQ-5D and MacNew and the medium-term SF-36 physical component score, did not show statistically significant benefits. Only two studies had a low risk of bias (n=463 participants).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and implications of key findings<\/jats:title>\n                    <jats:p>There is some evidence of a short-term benefit of contemporary exercise-based cardiac rehabilitation on quality of life for people with coronary artery disease. However, the contemporary data presented in this review are insufficient to support its routine use.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-036089","type":"journal-article","created":{"date-parts":[[2020,6,8]],"date-time":"2020-06-08T07:06:47Z","timestamp":1591600007000},"page":"e036089","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["Does contemporary exercise-based cardiac rehabilitation improve quality of life for people with coronary artery disease? A systematic review and meta-analysis"],"prefix":"10.1136","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8963-9107","authenticated-orcid":false,"given":"Gordon","family":"McGregor","sequence":"first","affiliation":[{"name":"University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK"},{"name":"Warwick Medical School, University of Warwick, Coventry, UK"},{"name":"Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Powell","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK"},{"name":"Centre for Sport, Exercise & Life Sciences, Coventry University, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kimani","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK"},{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Underwood","sequence":"additional","affiliation":[{"name":"University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK"},{"name":"Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,7]]},"reference":[{"key":"2025121509145571000_10.6.e036089.1","unstructured":"World Health Organisation . Global health estimates 2016: disease burden by cause, age, sex, by country and by region, 2000-2016. Geneva: World Health Organization, 2018."},{"key":"2025121509145571000_10.6.e036089.2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)12113-7"},{"key":"2025121509145571000_10.6.e036089.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2009.10.002"},{"key":"2025121509145571000_10.6.e036089.4","unstructured":"British Heart Foundation . Cardiovascular Disease Statistics - BHF UK Factsheet. London, England, 2018."},{"key":"2025121509145571000_10.6.e036089.5","unstructured":"NICE . Secondary prevention after a myocardial infarction. NICE quality standard [QS99]., 2015. Available: https:\/\/www.nice.org.uk\/guidance\/qs99"},{"key":"2025121509145571000_10.6.e036089.6","unstructured":"NICE . Cardiac rehabilitation after myocardial infarction, 2018. Available: https:\/\/pathways.nice.org.uk\/pathways\/myocardial-infarction-rehabilitation-and-preventing-further-cardiovascular-disease\/cardiac-rehabilitation-after-myocardial-infarction"},{"key":"2025121509145571000_10.6.e036089.7","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehw106"},{"key":"2025121509145571000_10.6.e036089.8","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0838.2010.01133.x"},{"key":"2025121509145571000_10.6.e036089.9","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","author":"Anderson","year":"2016","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121509145571000_10.6.e036089.10","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","author":"Heran","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121509145571000_10.6.e036089.11","doi-asserted-by":"crossref","first-page":"514","DOI":"10.3390\/jcm7120514","article-title":"Comparative effectiveness of the core components of cardiac rehabilitation on mortality and morbidity: a systematic review and network meta-analysis","volume":"7","author":"Kabboul","year":"2018","journal-title":"J Clin Med"},{"key":"2025121509145571000_10.6.e036089.12","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1007\/s11606-018-4636-y","article-title":"Efficacy of different types of Exercise-Based cardiac rehabilitation on coronary heart disease: a network meta-analysis","volume":"33","author":"Xia","year":"2018","journal-title":"J Gen Intern Med"},{"key":"2025121509145571000_10.6.e036089.13","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-019656"},{"key":"2025121509145571000_10.6.e036089.14","doi-asserted-by":"publisher","DOI":"10.1016\/0277-9536(95)00112-K"},{"key":"2025121509145571000_10.6.e036089.15","doi-asserted-by":"crossref","first-page":"353","DOI":"10.2147\/PROM.S156279","article-title":"The importance of patient-reported outcomes in clinical trials and strategies for future optimization","volume":"9","author":"Mercieca-Bebber","year":"2018","journal-title":"Patient Relat Outcome Meas"},{"key":"2025121509145571000_10.6.e036089.16","first-page":"352","article-title":"The effect of cardiac rehabilitation on health-related quality of life in patients with coronary artery disease: a meta-analysis","volume":"35","author":"Francis","year":"2019","journal-title":"Can J Cardiol"},{"key":"2025121509145571000_10.6.e036089.17","first-page":"CD012786","article-title":"Exercise-based cardiac rehabilitation for adults with stable angina","volume":"2","author":"Long","year":"2018","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121509145571000_10.6.e036089.18","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.hrtlng.2018.09.011","article-title":"Effect of exercise-based cardiac rehabilitation on anxiety and depression in patients with myocardial infarction: a systematic review and meta-analysis","volume":"48","author":"Zheng","year":"2019","journal-title":"Heart Lung"},{"key":"2025121509145571000_10.6.e036089.19","doi-asserted-by":"crossref","first-page":"38","DOI":"10.1177\/1474515118783157","article-title":"Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies","volume":"18","author":"Resurrecci\u00f3n","year":"2019","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025121509145571000_10.6.e036089.20","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s11136-019-02338-y","article-title":"Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis","volume":"29","author":"Candelaria","year":"2020","journal-title":"Qual Life Res"},{"key":"2025121509145571000_10.6.e036089.21","doi-asserted-by":"publisher","DOI":"10.1016\/S0021-9150(98)90209-X"},{"key":"2025121509145571000_10.6.e036089.22","doi-asserted-by":"crossref","unstructured":"Schwarzer G . Meta: an R package for meta-analysis, 2007: 40\u20135.","DOI":"10.32614\/CRAN.package.meta"},{"key":"2025121509145571000_10.6.e036089.23","unstructured":"Team RC . R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing, 2018. https:\/\/www.R-project.org\/."},{"key":"2025121509145571000_10.6.e036089.24","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2012-001820"},{"key":"2025121509145571000_10.6.e036089.25","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2340\/16501977-2499","article-title":"Early physical and psycho-educational rehabilitation in patients with coronary artery bypass grafting: a randomized controlled trial","volume":"51","author":"H\u00f8jskov","year":"2019","journal-title":"J Rehabil Med"},{"key":"2025121509145571000_10.6.e036089.26","doi-asserted-by":"publisher","DOI":"10.18637\/jss.v036.i11"},{"key":"2025121509145571000_10.6.e036089.27","doi-asserted-by":"publisher","DOI":"10.1177\/2047487314535076"},{"key":"2025121509145571000_10.6.e036089.28","first-page":"ED000142","article-title":"Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for systematic reviews of interventions","volume":"10","author":"Cumpston","year":"2019","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121509145571000_10.6.e036089.29","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(01)01236-0"},{"key":"2025121509145571000_10.6.e036089.30","first-page":"687","article-title":"Impact of cardiac rehabilitation on quality of life and depression after acute coronary syndrome","volume":"24","author":"Bettencourt","year":"2005","journal-title":"Rev Port Cardiol"},{"key":"2025121509145571000_10.6.e036089.31","doi-asserted-by":"crossref","first-page":"450","DOI":"10.5694\/j.1326-5377.2005.tb07121.x","article-title":"Cost\u2010effectiveness of rehabilitation after an acute coronary event: a randomised controlled trial","volume":"183","author":"Briffa","year":"2005","journal-title":"Med J Aust"},{"key":"2025121509145571000_10.6.e036089.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2011.09.020"},{"key":"2025121509145571000_10.6.e036089.33","first-page":"152","article-title":"Randomized controlled evaluation shows the effectiveness of a home-based cardiac rehabilitation program","volume":"33","author":"Mutwalli","year":"2012","journal-title":"Saudi Med J"},{"key":"2025121509145571000_10.6.e036089.34","doi-asserted-by":"publisher","DOI":"10.1080\/14038190510010287"},{"key":"2025121509145571000_10.6.e036089.35","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2011.05.005"},{"key":"2025121509145571000_10.6.e036089.36","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2011-300302"},{"key":"2025121509145571000_10.6.e036089.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2004.05.010"},{"key":"2025121509145571000_10.6.e036089.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.12.033"},{"key":"2025121509145571000_10.6.e036089.39","doi-asserted-by":"publisher","DOI":"10.1177\/1741826711422988"},{"key":"2025121509145571000_10.6.e036089.40","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1159\/000339224","article-title":"Cardiac rehabilitation to improve physical functioning in refractory angina: a pilot study","volume":"122","author":"Asbury","year":"2012","journal-title":"Cardiology"},{"key":"2025121509145571000_10.6.e036089.41","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/j.kjms.2014.08.004","article-title":"Benefits of exercise training and the correlation between aerobic capacity and functional outcomes and quality of life in elderly patients with coronary artery disease","volume":"30","author":"Chen","year":"2014","journal-title":"Kaohsiung J Med Sci"},{"key":"2025121509145571000_10.6.e036089.42","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.3340"},{"key":"2025121509145571000_10.6.e036089.43","first-page":"260","article-title":"Effect of physical activity on the life quality of coronary artery bypass graft patients","volume":"7","author":"Firouzabadi","year":"2014","journal-title":"J Med Life"},{"key":"2025121509145571000_10.6.e036089.44","doi-asserted-by":"crossref","first-page":"1395","DOI":"10.1111\/sms.12738","article-title":"Economic evaluation of exercise-based cardiac rehabilitation in patients with a recent acute coronary syndrome","volume":"27","author":"Hautala","year":"2017","journal-title":"Scand J Med Sci Sports"},{"key":"2025121509145571000_10.6.e036089.45","doi-asserted-by":"publisher","DOI":"10.1177\/1474515115594524"},{"key":"2025121509145571000_10.6.e036089.46","first-page":"308","article-title":"Early exercise-based rehabilitation improves health-related quality of life and functional capacity after acute myocardial infarction: a randomized controlled trial","volume":"31","author":"Peixoto","year":"2015","journal-title":"Can J Cardiol"},{"key":"2025121509145571000_10.6.e036089.47","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1177\/1474515116648801","article-title":"The efficacy of a supervised exercise training programme on readmission rates in patients with myocardial ischemia: results from a randomised controlled trial","volume":"16","author":"Santaularia","year":"2017","journal-title":"Eur J Cardiovasc Nurs"},{"key":"2025121509145571000_10.6.e036089.48","first-page":"134","article-title":"Efficacy of cardiac rehabilitation after percutaneous coronary intervention","volume":"9","author":"Hassan","year":"2016","journal-title":"Int J Pharmtech Res"},{"key":"2025121509145571000_10.6.e036089.49","doi-asserted-by":"crossref","first-page":"196","DOI":"10.5539\/gjhs.v8n4p196","article-title":"Comparison between effects of home based cardiac rehabilitation programs versus usual care on the patients' health related quality of life after coronary artery bypass graft","volume":"8","author":"Salavati","year":"2015","journal-title":"Glob J Health Sci"},{"key":"2025121509145571000_10.6.e036089.50","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1080\/17483107.2017.1297858","article-title":"Virtual reality exercise on a home-based phase III cardiac rehabilitation program, effect on executive function, quality of life and depression, anxiety and stress: a randomized controlled trial","volume":"13","author":"Vieira","year":"2018","journal-title":"Disabil Rehabil Assist Technol"},{"key":"2025121509145571000_10.6.e036089.51","doi-asserted-by":"crossref","DOI":"10.2196\/12052","article-title":"Evaluation of a web-based intervention for multiple health behavior changes in patients with coronary heart disease in home-based rehabilitation: pilot randomized controlled trial","volume":"20","author":"Duan","year":"2018","journal-title":"J Med Internet Res"},{"key":"2025121509145571000_10.6.e036089.52","first-page":"34-38","article-title":"Home-based interactive e-health educational intervention for middle-aged adults to improve total exercise, adherence rate, exercise efficacy, and outcome: a randomised controlled trial","volume":"24","author":"Wong","year":"2018","journal-title":"Hong Kong Med J"},{"key":"2025121509145571000_10.6.e036089.53","doi-asserted-by":"publisher","DOI":"10.1253\/circj.67.73"},{"key":"2025121509145571000_10.6.e036089.54","unstructured":"SF-36.org . FAQ: is there one summary score that is a combined score for the various subscales in the SF-36\u00ae so that a single score could be used for each patient? Available: http:\/\/www.webcitation.org\/6cfeefPkf [Accessed 01 Oct 2019]."},{"key":"2025121509145571000_10.6.e036089.55","doi-asserted-by":"crossref","first-page":"205031211667172","DOI":"10.1177\/2050312116671725","article-title":"Sf-36 total score as a single measure of health-related quality of life: scoping review","volume":"4","author":"Lins","year":"2016","journal-title":"SAGE Open Med"},{"key":"2025121509145571000_10.6.e036089.56","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.hlc.2018.07.010","article-title":"Making sense of the unfavourable systematic review of exercise-based cardiac rehabilitation in the modern era: how should we proceed?","volume":"28","author":"Abell","year":"2019","journal-title":"Heart Lung Circ"},{"key":"2025121509145571000_10.6.e036089.57","doi-asserted-by":"publisher","DOI":"10.1177\/1740774513504151"},{"key":"2025121509145571000_10.6.e036089.58","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1989.03430070055030"},{"key":"2025121509145571000_10.6.e036089.59","doi-asserted-by":"publisher","DOI":"10.3109\/07853890109002089"},{"key":"2025121509145571000_10.6.e036089.60","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-004-0705-2"},{"key":"2025121509145571000_10.6.e036089.61","doi-asserted-by":"publisher","DOI":"10.1186\/1477-7525-11-211"},{"key":"2025121509145571000_10.6.e036089.62","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2003.10.039"},{"key":"2025121509145571000_10.6.e036089.63","doi-asserted-by":"publisher","DOI":"10.1023\/A:1015005109731"},{"key":"2025121509145571000_10.6.e036089.64","doi-asserted-by":"publisher","DOI":"10.1007\/s00059-003-2388-9"},{"key":"2025121509145571000_10.6.e036089.65","doi-asserted-by":"publisher","DOI":"10.1097\/00008483-200201000-00003"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-036089","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,15]],"date-time":"2025-12-15T17:15:07Z","timestamp":1765818907000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-036089"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6]]},"references-count":65,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2020,6,7]]},"published-print":{"date-parts":[[2020,6]]}},"alternative-id":["10.1136\/bmjopen-2019-036089"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-036089","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6]]}}}