Exercise-based cardiac rehabilitation in heart transplant recipients.
Anderson L, Nguyen TT, et al.Cochrane Database of Systematic Reviews 2017; 4: CD012264.
Aims
To conduct a systematic review to determine the effectiveness and safety of exercise-based rehabilitation in heart transplant recipients.
Interventions
The Cochrane Central Register of Controlled Trials, Database of Abstracts of Reviews of Effects, Health Technology Assessment, MEDLINE, Embase, CINAHL Plus, and Web of Science Core Collection were searched on 27 June 2016. Two review authors independently screened titles and abstracts for parallel-group, cross-over or cluster design randomised controlled trials with exercise-based interventions either alone or where exercise training was a component of comprehensive cardiac rehabilitation programme which included adults aged ≥ 18 years who had received a heart transplant.
Participants
10 studies (25 publications) were included in the systematic review.
Outcomes
The primary outcomes measured were cardiovascular mortality, hospital admissions, and reported adverse events. Secondary measured outcomes included all-cause mortality, non cardiovascular mortality, return to work, exercise capacity, health-related quality of life, costs and adherence to the exercise programme.
Follow-up
Median: 12 weeks (Range: 8-52 weeks)
CET Conclusions
This Cochrane systematic review reviewed the effectiveness and safety of exercise-based rehabilitation in adult heart transplant recipients. The comprehensive search identified ten randomised controlled trials evaluating 300 patients. In addition to the Cochrane Risk of Bias tool, two reviewers also assessed two quality criteria, i.e. whether the study groups were balanced at baseline and if the groups received comparable care. The risk of bias assessment mostly showed a low or unclear risk of bias. Meta-analysis of nine studies comparing exercise with no exercise showed improved exercise capacity (VO2peak) for the exercise groups with the quality of the evidence being graded as moderate according to the GRADE criteria. Although there was limited data, exercise did not seem to improve short-term health-related quality of life with the quality of the evidence being graded as moderate. The authors point out the lack of long-term data and adequately powered, well-designed trials to demonstrate the effect of exercise on clinical and patient-related outcomes, and health care costs.
Quality notes
Quality assessment not appropriate
Trial registration
Not described