Jolliffe J A, Rees K, Taylor R S, Thompson D, Oldridge N, Ebrahim S
Research and Development Support Unit, Noy Scott House, Haldon View terrace, Exeter, Devon, UK, EX2 5EQ.
Cochrane Database Syst Rev. 2001(1):CD001800. doi: 10.1002/14651858.CD001800.
The burden of cardiovascular disease world-wide is one of great concern to patients and health care agencies alike. Cardiac rehabilitation aims to restore patients with heart disease to health through exercise only based rehabilitation or comprehensive cardiac rehabilitation.
To determine the effectiveness of exercise only or exercise as part of a comprehensive cardiac rehabilitation programme on the mortality, morbidity, health-related quality of life (HRQoL) and modifiable cardiac risk factors of patients with coronary heart disease.
Electronic databases were searched for randomised controlled trials, using standardised trial filters, from the earliest date available to December 31st 1998.
Men and women of all ages, in hospital or community settings, who have had myocardial infarction, coronary artery bypass graft or percutaneous transluminal coronary angioplasty, or who have angina pectoris or coronary artery disease defined by angiography.
Studies were selected independently by two reviewers, and data extracted independently. Authors were contacted where possible to obtain missing information.
This systematic review has allowed analysis of an increased number of patients from approximately 4500 in earlier meta-analyses to 8440 (7683 contributing to the total mortality outcome). The pooled effect estimate for total mortality for the exercise only intervention shows a 27% reduction in all cause mortality (random effects model OR 0.73 (0.54, 0.98)). Comprehensive cardiac rehabilitation reduced all cause mortality, but to a lesser degree (OR 0.87 (0.71, 1.05)). Total cardiac mortality was reduced by 31% (random effects model OR 0.69 (0.51, 0.94)) and 26% (random effects model OR 0.74 (0.57, 0.96)) in the exercise only and comprehensive cardiac rehabilitation groups respectively. Neither intervention had any effect on the occurrence of non-fatal myocardial infarction. There was a significant net reduction in total cholesterol (pooled WMD random effects model -0.57 mmol/l (-0.83, -0.31)) and LDL (pooled WMD random effects model -0.51 mmol/l (-0.82, -0.19) in the comprehensive cardiac rehabilitation group.
REVIEWER'S CONCLUSIONS: Exercise-based cardiac rehabilitation is effective in reducing cardiac deaths. It is not clear from this review whether exercise only or a comprehensive cardiac rehabilitation intervention is more beneficial. The population studied in this review is still predominantly male, middle aged and low risk. Identification of the ethnic origin of the participants was seldom reported. It is possible that patients who would have benefited most from the intervention were excluded from the trials on the grounds of age, sex or co-morbidity.
心血管疾病在全球范围内的负担是患者和医疗保健机构共同极为关注的问题。心脏康复旨在通过仅基于运动的康复或综合心脏康复使心脏病患者恢复健康。
确定仅运动或作为综合心脏康复计划一部分的运动对冠心病患者的死亡率、发病率、健康相关生活质量（HRQoL）以及可改变的心脏危险因素的有效性。
使用标准化试验筛选器，从最早可获取日期至1998年12月31日，检索电子数据库中的随机对照试验。
所有年龄的男性和女性，无论在医院还是社区环境中，曾发生过心肌梗死、冠状动脉搭桥术或经皮腔内冠状动脉成形术，或患有经血管造影定义的心绞痛或冠状动脉疾病。
由两名评审员独立选择研究，并独立提取数据。尽可能与作者联系以获取缺失信息。
该系统评价使得能够分析的患者数量有所增加，从早期荟萃分析中的约4500例增加到8440例（7683例对总死亡率结果有贡献）。仅运动干预的总死亡率合并效应估计显示全因死亡率降低27%（随机效应模型OR 0.73（0.54，0.98））。综合心脏康复降低了全因死亡率，但程度较小（OR 0.87（0.71，1.05））。仅运动组和综合心脏康复组的心脏总死亡率分别降低了31%（随机效应模型OR 0.69（0.51，0.94））和26%（随机效应模型OR 0.74（0.57，0.96））。两种干预对非致命性心肌梗死的发生均无影响。综合心脏康复组的总胆固醇（合并加权均数差随机效应模型 -0.57 mmol/l（-0.83，-0.31））和低密度脂蛋白（合并加权均数差随机效应模型 -0.51 mmol/l（-0.82，-0.19））有显著净降低。
基于运动的心脏康复在降低心脏死亡方面有效。从本评价尚不清楚仅运动还是综合心脏康复干预更有益。本评价中研究的人群仍主要为中年男性且风险较低。很少报告参与者的种族来源。有可能因年龄、性别或合并症而将最能从干预中获益的患者排除在试验之外。
