Review Article

Impact of Cardiac Rehabilitation on Functional Capacity and Physical Activity after Coronary Revascularization: A Scientific Review

Table 1

Summary of reviewed studies.

S. No.Author/YearDesignPopulationInterventionOutcomeResults

1Anderson et al. 2016 [19]Systematic review and meta-analysisRCTs (n = 63) CHD inclusive of myocardial infarction (n = 36), CABG (n = 29) and PCI (n = 18)Duration ranged from 3 months to 3 years (maximum in 6–12-month range)HRQoL (20)Heterogenicity in data was seen
>50% improvement in the scores was seen in exercise-based rehabilitation

2Blanchard et al. 2010 [20]Pre-post-test designn = 280 MI: (n = 94), PCI: (n = 92) CABG: (n = 48) other: (n = 46)3-month home-based program1. Physical activity (Godin leisure time
questionnaire)
2. Body composition
Increase in PA was larger in males (r = −0.19), more in metabolic group (r = −0.16)

3Deskur-smielecka et al. 2011 [21]Controlled prospective cohortn = 74 post-PCI CR and ambulation: (n = 14) CR: (n = 30) control: (n = 20)1-year follow-up, 3-week in-patient, after 6 weeks the CR and ambulation were on a 3–4 times/week ambulatory programBody compositionBody composition and BP increased in controls significantly (, ) the BP in CR group compared to CR and ambulation also increased ()

4Dos santos et al. 2019 [22]RCTTotal: (n = 24) moderate to high intensity inspiratory muscle training (n = 12), resistance/combined training (n = 12)2 sessions/week for 12 weeks1. Exercise capacity
2. Respiratory muscle strength
3. Inspiratory muscle endurance
4. QoL
There was an overall increase in the oxygen uptake, 6MWT, maximal inspiratory pressure, and QoL

5De Melo ghisi et al. 2014 [23]Systematic review and meta-analysisn = 42 studies (26 studies analysed PA as primary outcome)Patient education and PA levelsPhysical activity levels and adherence to exercise after patient education in cardiac patientsPatient education was elementary in improving levels of PA, dietary habits, and smoking cessation

6Firouzabadi et al. 2014 [24]RCTn = 70 post-CABG control: (n = 35) intervention: (n = 35)24–32 sessions, 3 times/week, aerobic exercise on treadmill or cycle ergometer for intervention groupQoL (SF-36 QoL questionnaire)After 4 months there was a significant difference between the scores of both groups ()

7Ghashghaei et al. 2012 [25]RCTn = 32 post-CABG control: (n = 15) Rehab: (n = 17)Control-15–20 mins walking 2-3 times/week Rehab-60 mins aerobic training 60–85% HR max, 3 times/week1. Functional capacity (6MWT)
2. Ejection fraction
3. Blood pressure, heart rate, rate pressure product
A significant change in the outcomes ()

8Hodkinson et al. 2019 [26]Systematic review and meta-analysisn = 36 studies (accelerometers n = 20 and pedometers n = 16)Face to face consultation and accelerometer/pedometer interventionPA measured short term and medium term using accelerometers and pedometers (8-month follow-up)Small to medium improvements were observed in PA from complex accelerometers and pedometers interventions

9Jelinek et al. 2013 [27]Pre-post-test designn = 38 patients PCI (n = 22), CABG (n = 16)3 times/week for 6 weeks at 55–70% VO2 peak
Borg scale 11–13 consists of aerobic training and strength training
1. Functional capacity (6MWT)
2. Exercise capacity (VO2peak)
3. Heart rate variability
In both there was an increase in the VO2peak and 6MWD () for HRV changes were seen in CABG () but not in the PCI group

10Kim et al. 2012 [28]Pre-post designPower walking (PW) group (n = 16) and usual walking group (n = 18)The 2 groups have aerobic exercise training on treadmill for 50 minutes/session, 3 times/week for 6 weeks at 60–80% of Hr max. For PW group with upper limb activities. The UW group did the same while holding handle and no upper limb activitiesExercise capacity hemodynamic parameters lipid profileAfter the 6-week training, PW group showed better effect than the UW group on the exercise capacity and hemodynamic parameters

11Maddison et al. 2015 [29]RCTn = 171 mobile rehab: (n = 85) usual: (n = 86)Mobile rehab-30 mins for 5 days/week, automated texts and exercise videos usual-exercise in settings 3 days/weekVO2peak physical activity (IPAQ) HRQoLNo difference in VO2max between groups () but PA () and SF 36 general domain () showed significant difference for mobile group

12Maddison et al. 2019 [30]Randomised controlled non-inferiority trialn = 162 REMOTE-CR: (n = 82) control: (n = 80)REMOTE-CR: Bespoke telerehabilitation: 30–60 mins > 5 days/week at 40–65% HRRVO2max lipid profile Anthropometry physical activity HRQOL exercise related motivation Blood pressureREMOTE-CR is cost effective alternative to centre-based CR.
PA {(sedentary: week 24: −61.5 (117.8 to −5.3)}, HRQoL {−0.94(−4.96 to 3.08)}

13Moholdt et al. 2009 [31]RCTAfter CABG aerobic interval training (AIT): (n = 33) moderate continuous training (MCT) (n = 36)5 days/week for 4 weeks AIT-Aerobic exercise 4 mins of 4 intervals at 90% HR max MCT-70% HR max for 46 mins. After 4 weeks, home-based for both1. VO2 peak (exercise capacity)
2. MacNew questionnaire for quality of life
At 4 weeks in VO2max AIT and MCT were effective ( for both) at 6 months AIT better than MCT ()

14Oerkild et al. 2010 [32]RCTn = 75 CHD (MI, CABG, PCI) home-based (HB): (n = 36) centre-based (CB): (n = 39)HB-30 mins/day, 6 days/week, Borg scale 11–13 CB-60 mins twice a week after 3 months both home-based. Follow-up-3,6 and 12 months1. 6MWT
2. VO2max
3. Body composition
Both group interventions were found to be equally effective in improving the outcomes ()

15Peterson et al. 2012 [33]RCTAfter PCI-2 groups physical education (PE): (n = 118) physical affirmation (PA): (n = 124)12 months duration. PA-physical activity promotion by self-affirmation and positive affect induction. PE-PA education and goal bookPaffenbarger physical activity and exercise IndexPA group 1.7 times more effective to reach goal than PE ()

16Reid et al. 2012 [34]RCTTotal- (n = 141) Motivational counselling (MC): (n = 69) usual care (UC): (n = 72)12 months more than 30 mins PA moderate to vigorous ≥5 days/week MC-9 motivational sessions by therapist, telephonic follow-up7-day physical recall questionnaireIt was seen that PA increased more over MC than UC group ()

17Scalvini et al. 2013 [35]Quasi experimental study2 groups: Hospital based (n = 100) home-based rehabilitation (n = 100)4-week home-based tele-monitoring of vital, exercise program, hospital-supervised exercises. 100 min/day for both1. Echocardiogram
2. Functional capacity (6MWT)
Equally significant results for the outcomes () both equally effective

18Thomas et al. 2019 [36]Scientific statement from AACVPR/AHA/ACCn = 23 studies (RCT) included with home-based CRThe studies included exercise and physical activity based studies.
Behavioural strategies were used
HRQoL exercise capacity physical activityThey concluded that HBCR can help in the delivery of CR services to maximum population

19Yang et al. 2017 [37]Systematic review and meta-analysis6 RCTs n = 682 participants3–6 months, total 30–60 mins/day frequency 2-4 times/day1. Maximum exercise time
2. Exercise tolerance
3. Angina
4. ST segment decline
It was found that there was a significant improvement in all outcomes ()

20Yates et al. 2017Descriptive comparative design with secondary analysis of two studiesTwo groups: (CABG and HF) n = 62PA examined objectively (ActiHeart accelerometer) and subjectively (PA interview)Percentage of patients meeting the PA guidelines of ≥150 minutes per week33% of the CABG patients met the criteria of ≥150 minutes/week of PA No patients with HF were able to fulfil the criteria

21Yu et al. 2004 [38]RCTn = 269 acute MI: (n = 193), PCI: (n = 76)Cardiac rehabilitation and preventive programs (CRPP)-8-week exercise and educational knowledge with aerobic exercise at 65–85% of HRR. Conventional therapy-no exercise, only educational talk about importance of physical activityQoL-
1. SF-36 QoL questionnaire
2. Symptom questionnaire
3. Time trade-off questionnaire
SF-36: 6 of 8 sections improved till phase 2 significant changes seen in physical role and functioning

MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass graft; HF, heart failure; CHD, coronary heart disease; HRQoL, heath related quality of life; QoL, quality of life, 6MWT, 6 minute walk test; 6MWD, 6 minute walk distance; CR, cardiac rehabilitation; HRV, heart rate variability; HRR, heart rate reserve; BP, blood pressure; PA, physical activity; SF36, Short Form 36; IPAQ, International Physical Activity Questionnaire; RCT, randomised controlled trial; AACVPR, American Association of Cardiovascular and Pulmonary Rehabilitation; AHA, American Heart Association; ACC, American College of Cardiology.