Article

Exercise-based cardiovascular rehabilitation (CR) improves exercise
capacity (EC), lowers cardiovascular risk profile and increases physical
functioning in the short term. However, uptake of and adherence to a physically
active lifestyle in the long run remain problematic. Home-based (HB) exercise
programmes have been introduced in an attempt to enhance long-term adherence to
recommended levels of physical activity (PA). The current systematic review and
meta-analysis aimed to compare the longer-term effects of HB exercise programmes
with usual care (UC) or centre-based (CB) CR in patients referred for CR. Design
Systematic review and meta-analysis. Methods Non-randomised controlled trials
(RCTs) or randomised trials comparing the effects of HB exercise programmes with
UC or CB rehabilitation on EC and/or PA, with a follow-up period of >/=12 months
and performed in coronary artery disease patients, were searched in four
databases (PubMed, EMBASE, the Cumulative Index to Nursing and Allied Health
Literature (CINAHL) and the Cochrane Central Register of Controlled trials
(CENTRAL)) from their inception until September 7, 2016. Standardised mean
differences (SMDs) were calculated and pooled by means of random effects models.
Risk of bias, publication bias and heterogeneity among trials were also assessed.
Results Seven studies could be included in the meta-analysis on EC, but only two
studies could be included in the meta-analysis on PA (total number of 1440
patients). The results showed no significant differences in EC between HB
rehabilitation and UC (SMD 0.10, 95% confidence interval (CI) -0.13 to 0.33).
There was a small but significant difference in EC in favour of HB compared to CB
rehabilitation (SMD 0.25, 95% CI 0.02-0.48). No differences were found for PA
(SMD 0.37, 95% CI -0.18 to 0.92). Conclusions HB exercise is slightly more
effective than CB rehabilitation in terms of maintaining EC. The small number of
studies warrants the need for more RCTs evaluating the long-term effects of
different CR interventions on EC and PA behaviour, as this is the ultimate goal
of CR.

Langue : ANGLAIS