Exercise-based cardiac rehabilitation after myocardial revascularization: a systematic review and meta-analysis

Background: The present study aimed to analyze the effects of exercise-based cardiac rehabilitation (CR) on physical performance after myocardial revascularization. In addition, we compared the type and duration of exercise-based CR protocols to determine which ones produced the best performance improvements. Methods: This systematic review and meta-analysis was conducted and reported in accordance with PRISMA statement. A systematic search of PubMed, Web of Science, SPORTDiscus and ProQuest, was performed in July 2020. Studies that met the following criteria were included: (i) participants submitted to myocardial revascularization (i.e., coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI)), (ii) participants submitted to exercise-based CR, and (iii) participants submitted to protocols for assessing physical performance before and after the exercise-based CR. Results: Thirteen and eleven studies evaluating the effects of exercise-based CR after myocardial revascularization were included in the systematic review and meta-analysis, respectively. Exercise-based CR increased physical performance after myocardial revascularization (mean effect size (ES) 0.75; 95% confidence interval (CI) 0.62, 0.88), particularly when aerobic (ES 0.85; 95% CI 0.68, 1.01) and combined training (ES 1.04; 95% CI 0.70, 1.38) lasting 8-12 weeks (ES 1.20; 95% CI 0.87, 1.53) was prescribed. Conclusions: The present systematic review and meta-analysis indicates that exercise-based CR increases physical performance after myocardial revascularization. The prescription of physical training for these patients should emphasize aerobic and combined training lasting at least 8-12 weeks, which is more effective in improving physical performance. Impact: Our findings demonstrate the effectiveness of physical training in improving physical performance after myocardial revascularization.