Immediate medical care for a heart attack or blocked coronary arteries can prevent death and decrease damage to the heart, but it is only the first step to getting well. Choices patients make after immediate medical care and procedures play an important role in survival and prevention of future heart trouble. A cardiac rehabilitation program assists people with recent a heart attack or heart procedure through initial recovery and guides people through steps to healthier lifestyles. Rehabilitation programs can vary but generally include education about risk factors and signs of heart attack or heart disease, psychological support, nutrition guidance, and an exercise program. Unfortunately, not all patients are referred to or choose to participate in a cardiac rehabilitation program.
Analysts from the Cochrane Database examined the benefits of exercise-based rehabilitation compared to usual care (standard medication and physician follow-up). The review, published in Cochrane Database, found that exercise-based cardiac rehabilitation was associated with lower risk of death and decreased need for further medical intervention.
About the Study
The systematic review included 47 randomized trials that compared rates of death or illness after exercise-based rehabilitation compared to usual care (medical care but no exercise program or advice). There was 10,794 patients that had a recent heart attack or heart procedure (revascularization-angioplasty).
In trials that followed patients for 6-12 months, exercise-based rehabilitation was associated with:
- Trend for decreased risk of death in 19 trials with 6,000 patients
- 31% fewer hospital admissions in four trials with 463 patients
- No significant difference in death from heart attack, rate of heart attacks, or further heart procedures (bypass grafts or angioplasty)
In trials that followed patients for 12 months or longer, exercise-based rehabilitation was associated with:
- 13% lower risk of death from any cause in 16 trials with 5,790 patients
- 26% lower risk death from heart-related reasons in 12 trials with 4,757 patients
- No significant difference in rates of heart attacks, hospital admissions, or further heart procedures (bypass grafts or angioplasty)
In 10 trials assessing quality of life, seven trials found that quality of life was significantly improved in one or more categories in patients that participated in exercise-based rehabilitation.
How Does This Affect You?
A systematic review looks for similar trials and combines the results in a large data pool. The larger group of data may improve the reliability of results. However, the quality of the systematic review is only as good as the trials that make it up. In this case, several of the individual trials did not adequately keep the information about which patient was in which group a secret. Knowing which patients are in which group can affect the results so quality studies keep this information hidden. Also, in 12 trials, a large number of people (21%-48%) did not finish the study. Although higher dropout rates can be common in rehabilitation programs, it can reduce the reliability of overall results.
Regular physical activity is associated with improved heart health even for people who have heart problems. It not only conditions the body and deceases stress on the heart but may also decrease mental stress and depression, which is common in patients after heart events. Understandably, people with recent heart procedures or heart attack may be anxious at the idea of a new exercise program. A rehabilitation program with exercise may help decrease fears since it generally includes some type of heart monitoring during the first few sessions. The program gradually moves towards nonmonitored activity to encourage independent exercise, which hopefully continues after rehabilitation is complete. Not every patient that attends a rehabilitation program will adopt every recommended healthy habit but hopefully it may remove some obstacles and alleviates anxieties for some. If you have had a heart attack or heart procedure, talk to your cardiologist about steps to help you regain health. If cardiac rehabilitation is recommended, it is important to participate.
- Reviewer: Brian P. Randall, MD
- Review Date: 09/2011 -