Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library.  Cochrane Reviews cover a very wide range of interventions for people with heart disease. One of these looks at exercise-based rehabilitation for patients with heart failure and it was updated for the fourth time in March 2024. Two of the authors, Rod Taylor and Cal Molloy from the University of Glasgow in the UK, discuss the latest findings in this podcast.

Rod: Hello Cal. As Mike mentioned, our review investigates the effectiveness of exercise-based cardiac rehabilitation for adults with heart failure so let’s begin with an explanation of this type of rehabilitation. What is it and who is it for?

Cal: Hi Rod. Cardiac rehabilitation aims to help people recover from heart problems. The programmes can involve exercise training and may also provide education on lifestyle and risk factor management, plus counselling and psychological support. We were interested in programmes which used exercise, regardless of whether or not they included other forms of support. Turning to the condition, heart failure is when your heart can't pump blood around your body as well as it should. Globally, heart failure causes a serious disease burden, has low survival rates, and high prevalence.

Rod: Thanks Cal. Why is it important to review the effects of exercise-based cardiac rehabilitation for adults with heart failure?

Cal: We know that people with heart failure have increased risk of hospital admission and death, and experience symptoms such as fatigue and shortness of breath. This makes everyday activities difficult, and it can affect people's quality of life. Studies have shown that exercise-based rehabilitation is a safe and effective therapy, but it’s important to have an up-to-date synthesis of the body of evidence, and to see if the data continue to support exercise-based cardiac rehabilitation as a safe therapy. We were also interested in potential differences between rehabilitation methods, particularly those conducted at home, in-centre, or as a hybrid of both settings. This is especially important now because, since the COVID-19 pandemic, there has been a drive to increase the management options for those who are able and would prefer to perform their rehab at home rather than following the traditional centre-based approach.

Rod: So, how was the updated review conducted and what literature was found?

Cal: We searched for studies that compared a group undertaking an exercise‐based cardiac rehabilitation intervention against a group who did not undertake such exercise. The participants had to be over 18 and have heart failure. We compared and summarised the results of relevant studies and rated our confidence in the evidence based on factors such as study methods and size. After checking the titles and abstracts for more than 4500 articles, we found 16 new studies. Overall, the review now includes 60 studies that had recruited about 8700 people with heart failure. About 40% of the people came from two large studies, and all studies lasted six months or longer, allowing us to look into the effects of the intervention in a long disease course. 

Rod: And what do these studies tell us?

Cal: Across the 60 studies, we understand that participation in exercise‐based cardiac rehabilitation likely reduces the risk of hospital admissions from any cause, and due to heart failure, for at least 12 months. These rehabilitation interventions also likely improve health‐related quality of life but probably make little to no difference to the risk of death from any cause.

Rod: You mentioned a comparison of different methods of rehabilitation earlier: is there a difference in effectiveness across these? For example, based on where the rehabilitation took place, such as at home, in a centre, or as a hybrid of both?

Cal: We found that the effects appear to be consistent whether the exercise‐based cardiac rehabilitation is delivered in a hospital or medical centre, home‐based, or a mixture of both. This is regardless of the amount of exercise, whether the programme also includes other components such as education or counselling, or whether the training was just aerobic or was aerobic plus resistance training.

Rod: Overall, what is the take-home message about exercise-based rehabilitation for adults with heart failure?

Cal: I’d say: for adults with heart failure, participating in exercise‐based cardiac rehabilitation likely reduces the risk of hospital admissions from any cause, and heart failure‐related hospital admissions, and likely results in important improvements in health‐related quality of life.

Rod: Thanks Cal. If people want to read the full review, where could they find it?

Cal: Great question Rod! It’s available online as part of the Cochrane Library. If they go to www dot Cochrane Library dot com, and type “exercise based cardiac rehabilitation” in the search box, it should be top of the list.