European Centre for Environment and Human Health, Knowledge Spa, Royal Cornwall Hospitals NHS Trust, University of Exeter Medical School, Truro, UK.
Institute of Health Research (Primary Care), University of Exeter Medical School, Exeter, UK.
Heart. 2018 Sep;104(17):1394-1402. doi: 10.1136/heartjnl-2017-312832. Epub 2018 Apr 13.
To undertake a systematic review and meta-analysis to assess the impact of cardiac rehabilitation (CR) on physical activity (PA) levels of patients with heart disease and the methodological quality of these studies.
Databases (MEDLINE, EMBASE, CENTRAL, CINAHL, PsychINFO and SportDiscus) were searched without language restriction from inception to January 2017 for randomised controlled trials (RCTs) comparing CR to usual care control in adults with heart failure (HF) or coronary heart disease (CHD) and measuring PA subjectively or objectively. The direction of PA difference between CR and control was summarised using vote counting (ie, counting the positive, negative and non-significant results) and meta-analysis.
Forty RCTs, (6480 patients: 5825 CHD, 655 HF) were included with 26% (38/145) PA results showing a statistically significant improvement in PA levels with CR compared with control. This pattern of results appeared consistent regardless of type of CR intervention (comprehensive vs exercise-only) or PA measurement (objective vs subjective). Meta-analysis showed PA increases in the metrics of steps/day (1423, 95% CI 757.07 to 2089.43, p<0.0001) and proportion of patients categorised as physically active (relative risk 1.55, 95% CI 1.19 to 2.02, p=0.001). The included trials were at high risk of bias, and the quality of the PA assessment and reporting was relatively poor.
Overall, there is moderate evidence of an increase in PA with CR participation compared with control. High-quality trials are required, with robust PA measurement and data analysis methods, to assess if CR definitely leads to important improvements in PA.
系统评价和荟萃分析评估心脏康复（CR）对心脏病患者身体活动（PA）水平的影响，以及这些研究的方法学质量。
从建库开始到 2017 年 1 月，我们无语言限制地检索了 MEDLINE、EMBASE、CENTRAL、CINAHL、PsychINFO 和 SportDiscus 数据库，以寻找比较心力衰竭（HF）或冠心病（CHD）成人接受 CR 与常规护理对照，且主观或客观测量 PA 的随机对照试验（RCT）。使用投票计数（即，计数阳性、阴性和无显著性结果）和荟萃分析总结 CR 与对照组之间 PA 差异的方向。
共纳入 40 项 RCT（6480 例患者：5825 例 CHD，655 例 HF），其中 26%（38/145）的 PA 结果显示 CR 组的 PA 水平较对照组有统计学显著改善。无论 CR 干预类型（综合干预与仅运动干预）或 PA 测量方法（客观测量与主观测量）如何，结果模式似乎都是一致的。荟萃分析显示，在每日步数（1423，95%置信区间 757.07 至 2089.43，p<0.0001）和归类为身体活跃的患者比例（相对风险 1.55，95%置信区间 1.19 至 2.02，p=0.001）这两个 PA 测量指标中，PA 均有增加。纳入的试验存在较高的偏倚风险，PA 评估和报告的质量相对较差。
总体而言，与对照组相比，CR 参与后 PA 增加的证据为中等强度。需要高质量的试验，采用可靠的 PA 测量和数据分析方法，以评估 CR 是否确实能使 PA 有重要的改善。
