{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T04:14:15Z","timestamp":1789964055951,"version":"4.0.1"},"reference-count":64,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Open Heart"],"accepted":{"date-parts":[[2014,11,4]]},"published-print":{"date-parts":[[2015,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To update the Cochrane systematic review of exercise-based cardiac rehabilitation (CR) for heart failure.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A systematic review and meta-analysis of randomised controlled trials was undertaken. MEDLINE, EMBASE and the Cochrane Library were searched up to January 2013. Trials with 6 or more months of follow-up were included if they assessed the effects of exercise interventions alone or as a component of comprehensive CR programme compared with no exercise control.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>33 trials were included with 4740 participants predominantly with a reduced ejection fraction (&lt;40%) and New York Heart Association class II and III. Compared with controls, while there was no difference in pooled all-cause mortality between exercise CR with follow-up to 1\u2005year (risk ratio (RR) 0.93; 95% CI 0.69 to 1.27, p=0.67), there was a trend towards a reduction in trials with follow-up beyond 1\u2005year (RR 0.88; 0.75 to 1.02, 0.09). Exercise CR reduced the risk of overall (RR 0.75; 0.62 to 0.92, 0.005) and heart failure-specific hospitalisation (RR 0.61; 0.46 to 0.80, 0.0004) and resulted in a clinically important improvement in the Minnesota Living with Heart Failure questionnaire (mean difference: \u22125.8 points, \u22129.2 to \u22122.4, 0.0007). Univariate meta-regression analysis showed that these benefits were independent of the type and dose of exercise CR, and trial duration of follow- up, quality or publication date.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>This updated Cochrane review shows that improvements in hospitalisation and health-related quality of life with exercise-based CR appear to be consistent across patients regardless of CR programme characteristics and may reduce mortality in the longer term. An individual participant data meta-analysis is needed to provide confirmatory evidence of the importance of patient subgroup and programme level characteristics (eg, exercise dose) on outcome.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/openhrt-2014-000163","type":"journal-article","created":{"date-parts":[[2015,1,29]],"date-time":"2015-01-29T00:40:36Z","timestamp":1422492036000},"page":"e000163","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":221,"title":["Exercise-based rehabilitation for heart failure: systematic review and meta-analysis"],"prefix":"10.1136","volume":"2","author":[{"given":"Viral A","family":"Sagar","sequence":"first","affiliation":[{"name":"Maidstone & Tunbridge Wells NHS Trust, Maidstone, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward J","family":"Davies","sequence":"additional","affiliation":[{"name":"South West Cardiothoracic Centre, Derriford Hospital, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Briscoe","sequence":"additional","affiliation":[{"name":"Peninsula Technology Assessment Group (PenTAG), University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J S","family":"Coats","sequence":"additional","affiliation":[{"name":"University of East Anglia, Norwich, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasnain M","family":"Dalal","sequence":"additional","affiliation":[{"name":"Truro & Primary Care Research Group, Department of Research and Development, Knowledge Spa, Royal Cornwall Hospitals Trust, University of Exeter Medical School, Truro, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Lough","sequence":"additional","affiliation":[{"name":"The Hatter Institute, UCLH NHS Trust, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen","family":"Rees","sequence":"additional","affiliation":[{"name":"Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sally","family":"Singh","sequence":"additional","affiliation":[{"name":"Centre for Exercise and Rehabilitation Science, Glenfield Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod S","family":"Taylor","sequence":"additional","affiliation":[{"name":"Institute of Health Research, University of Exeter Medical School, Exeter, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2015,1,28]]},"reference":[{"key":"2025081711143106000_2.1.e000163.1","first-page":"125","article-title":"Recommendations for exercise training in chronic heart failure patients","volume":"22","author":"Working Group on Cardiac Rehabilitation & Exercice Physiology and Working Group on Heart Failure of the European Society of Cardiology","year":"2011","journal-title":"Eur Heart J"},{"key":"2025081711143106000_2.1.e000163.2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.0000441139.02102.80"},{"key":"2025081711143106000_2.1.e000163.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(11)61314-7"},{"key":"2025081711143106000_2.1.e000163.4","unstructured":"National Institute for H, Care E. Chronic Heart Failure. Management of Chronic Heart Failure in Adults in Primary and Secondary Care. NICE Clinical Guideline CG108. 2010. http:\/\/guidance.nice.org.uk\/nicemedia\/live\/13099\/50514\/50514.pdf (accessed 3 Jan 2014)."},{"key":"2025081711143106000_2.1.e000163.5","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfp103"},{"key":"2025081711143106000_2.1.e000163.6","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfq121"},{"key":"2025081711143106000_2.1.e000163.7","doi-asserted-by":"crossref","unstructured":"Davies EJ , Moxham T , Rees K , et al . Exercise based rehabilitation for heart failure. Cochrane Database Syst Rev 2010;(4):CD003331. doi:10.1002\/14651858.CD003331.pub3","DOI":"10.1002\/14651858.CD003331.pub3"},{"key":"2025081711143106000_2.1.e000163.8","doi-asserted-by":"crossref","first-page":"e147","DOI":"10.1016\/j.jacc.2013.05.019","article-title":"2013 ACCF\/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines","volume":"15","author":"Yancy","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2025081711143106000_2.1.e000163.9","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfs105"},{"key":"2025081711143106000_2.1.e000163.10","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b2535"},{"key":"2025081711143106000_2.1.e000163.11","unstructured":"Higgins JPT , Green S, eds . Cochrane Handbook for Systematic Reviews of Interventions 5.1.0 [updated March 2011]. 2011. http:\/\/www.cochrane.org\/training\/cochrane-handbook"},{"key":"2025081711143106000_2.1.e000163.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7109.629"},{"key":"2025081711143106000_2.1.e000163.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2004.10.004"},{"key":"2025081711143106000_2.1.e000163.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcnurse.2008.04.005"},{"key":"2025081711143106000_2.1.e000163.15","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e3282f10e87"},{"key":"2025081711143106000_2.1.e000163.16","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.99.9.1173"},{"key":"2025081711143106000_2.1.e000163.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9149(01)01434-5"},{"key":"2025081711143106000_2.1.e000163.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.06.036"},{"key":"2025081711143106000_2.1.e000163.19","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1590\/S1807-59322008000400005","article-title":"Physical exercise improves the functional capacity and quality of life in patients with heart failure","volume":"63","author":"Bocalini","year":"2008","journal-title":"Clinics (Sao Paulo)"},{"key":"2025081711143106000_2.1.e000163.20","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1016\/j.ahj.2005.06.010","article-title":"A randomized clinical trial of hospital-based, comprehensive cardiac rehabilitation versus usual care for patients with congestive heart failure, ischemic heart disease, or high risk of ischemic heart disease (the DANREHAB trial)\u2014design, intervention, and population","volume":"150","author":"Zwisler","year":"2005","journal-title":"Am Heart J"},{"key":"2025081711143106000_2.1.e000163.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.12.033"},{"key":"2025081711143106000_2.1.e000163.22","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e328334ea56"},{"key":"2025081711143106000_2.1.e000163.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2007.07.019"},{"key":"2025081711143106000_2.1.e000163.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.10.025"},{"key":"2025081711143106000_2.1.e000163.25","doi-asserted-by":"crossref","first-page":"28","DOI":"10.3810\/psm.2010.04.1759","article-title":"Is exercise adherence associated with clinical outcomes in patients with advanced heart failure?","volume":"38","author":"Evangelista","year":"2010","journal-title":"Phys Sportsmed"},{"key":"2025081711143106000_2.1.e000163.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2010.01.013"},{"key":"2025081711143106000_2.1.e000163.27","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.0000081780.38477.FA"},{"key":"2025081711143106000_2.1.e000163.28","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(03)00848-9"},{"key":"2025081711143106000_2.1.e000163.29","doi-asserted-by":"publisher","DOI":"10.1016\/S1071-9164(99)90002-7"},{"key":"2025081711143106000_2.1.e000163.30","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)00568-B"},{"key":"2025081711143106000_2.1.e000163.31","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.98.24.2709"},{"key":"2025081711143106000_2.1.e000163.32","doi-asserted-by":"publisher","DOI":"10.1001\/jama.283.23.3095"},{"key":"2025081711143106000_2.1.e000163.33","doi-asserted-by":"crossref","first-page":"1451","DOI":"10.1001\/jama.2009.457","article-title":"Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial","volume":"153","author":"Flynn","year":"2009","journal-title":"JAMA"},{"key":"2025081711143106000_2.1.e000163.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.08.958"},{"key":"2025081711143106000_2.1.e000163.35","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.454"},{"key":"2025081711143106000_2.1.e000163.36","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.8720"},{"key":"2025081711143106000_2.1.e000163.37","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCOUTCOMES.109.907287"},{"key":"2025081711143106000_2.1.e000163.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2012.05.059"},{"key":"2025081711143106000_2.1.e000163.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2006.11.007"},{"key":"2025081711143106000_2.1.e000163.40","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfn029"},{"key":"2025081711143106000_2.1.e000163.41","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2005.05.002"},{"key":"2025081711143106000_2.1.e000163.42","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-124-12-199606150-00004"},{"key":"2025081711143106000_2.1.e000163.43","doi-asserted-by":"publisher","DOI":"10.1097\/HJR.0b013e3280114f12"},{"key":"2025081711143106000_2.1.e000163.44","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2004.10.021"},{"key":"2025081711143106000_2.1.e000163.45","doi-asserted-by":"publisher","DOI":"10.1080\/11026480310015549"},{"key":"2025081711143106000_2.1.e000163.46","doi-asserted-by":"publisher","DOI":"10.1067\/mhj.2002.123310"},{"key":"2025081711143106000_2.1.e000163.47","doi-asserted-by":"publisher","DOI":"10.1177\/0269215507079097"},{"key":"2025081711143106000_2.1.e000163.48","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-8703(00)90234-5"},{"key":"2025081711143106000_2.1.e000163.49","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2008.06.046"},{"key":"2025081711143106000_2.1.e000163.50","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1097\/01823246-201223040-00004","article-title":"Effects of exercise training versus attention on plasma b-type natriuretic peptide, 6-minute walk test and quality of life in individuals with heart failure","volume":"23","author":"Norman","year":"2012","journal-title":"Cardiopulm Phys Ther J"},{"key":"2025081711143106000_2.1.e000163.51","doi-asserted-by":"publisher","DOI":"10.1016\/j.hrtlng.2010.04.008"},{"key":"2025081711143106000_2.1.e000163.52","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.12.050"},{"key":"2025081711143106000_2.1.e000163.53","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejcnurse.2007.08.002"},{"key":"2025081711143106000_2.1.e000163.54","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2009.09.478"},{"key":"2025081711143106000_2.1.e000163.55","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-5273(00)00383-1"},{"key":"2025081711143106000_2.1.e000163.56","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2005.01.031"},{"key":"2025081711143106000_2.1.e000163.57","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.111.963132"},{"key":"2025081711143106000_2.1.e000163.58","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.150"},{"key":"2025081711143106000_2.1.e000163.59","doi-asserted-by":"crossref","unstructured":"McAllister F , Ezekowitz J , Wiebe N , et al . 106 Cardiac resynchronization therapy for congestive heart failure. AHRQ Evidence Report Summaries 2004:1\u20138.","DOI":"10.1016\/j.hrthm.2004.03.065"},{"key":"2025081711143106000_2.1.e000163.60","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejheart.2006.02.013"},{"key":"2025081711143106000_2.1.e000163.61","doi-asserted-by":"publisher","DOI":"10.1016\/S0004-9514(08)70041-2"},{"key":"2025081711143106000_2.1.e000163.62","doi-asserted-by":"crossref","unstructured":"Boutron I , Moher D , Altman DG , et al .; for the CONSORT group. Extending the CONSORT Statement to randomized trials of nonpharmacologic treatment: explanation and elaboration. Ann Intern Med 2008:295\u2013309. doi:10.7326\/0003-4819-148-4-200802190-00008","DOI":"10.7326\/0003-4819-148-4-200802190-00008"},{"key":"2025081711143106000_2.1.e000163.63","doi-asserted-by":"publisher","DOI":"10.1093\/eurjhf\/hfr139"},{"key":"2025081711143106000_2.1.e000163.64","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2014.04.203"}],"container-title":["Open Heart"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/openhrt-2014-000163","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,17]],"date-time":"2025-08-17T18:14:40Z","timestamp":1755454480000},"score":1,"resource":{"primary":{"URL":"https:\/\/openheart.bmj.com\/lookup\/doi\/10.1136\/openhrt-2014-000163"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,1]]},"references-count":64,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2015,1,28]]},"published-print":{"date-parts":[[2015,1]]}},"alternative-id":["10.1136\/openhrt-2014-000163"],"URL":"https:\/\/doi.org\/10.1136\/openhrt-2014-000163","relation":{},"ISSN":["2053-3624"],"issn-type":[{"value":"2053-3624","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,1]]}}}