Exercise-based cardiac rehabilitation for patients undergoing coronary artery operation: a systematic review and meta-analysis based on current randomized controlled trials
Year: 2026
Type: review
Abstract: Dear Editor, Coronary heart disease (CHD) is one of the main causes of the disease burden around the world[1–3]. Both the incidence and death rates of cardiovascular disease have considerably increased during the last several decades. For individuals with CHD, percutaneous coronary interventions (PCIs) and coronary artery graft bypass remain the gold standard of therapy. As a comprehensive strategy, exercise-based cardiac rehabilitation integrates exercise training, physical activity promotion, health education, psychological support, as well as cardiovascular risk management to address the distinct requirements of cardiac patients. The American College of Cardiology and the American Heart Association have classified this rehabilitation as a Class I indication for patients with acute coronary syndrome, patients undergoing coronary artery bypass graft surgery or PCI, as its benefits are supported by strong evidence. A recent meta-analysis and systematic review by Shi et al[4] assessed the effectiveness of exercise-based cardiac rehabilitation for individuals having coronary artery surgery. There were 4106 participants in 25 RCTs. According to the current meta-analysis, exercise-based cardiac rehabilitation dramatically enhanced the quality of life for patients following coronary artery surgery and did not increase mortality rates or the incidence of surgical reintervention. Exercise training has been demonstrated to directly improve coronary vascular and cardiac system function, encompassing coagulation factors, myocardial oxygen consumption, endothelial function, coronary collateral vessel growth, autonomic nervous system tone, as well as inflammatory markers. Exercise-based cardiac rehabilitation focuses on exercise training and includes treatments for health education, risk assessment and management, lifestyle modifications, and psychological assessment and management. For secondary prevention, guidelines advise these individuals to be active and engage in moderate-intensity physical exercise. Exercise-based cardiac rehabilitation can assist in lowering cardiac load by decreasing classic cardiovascular risk factors, including high blood cholesterol levels and abdominal obesity. By increasing fibrinolysis, inhibiting the generation of pro-inflammatory cytokines, and stimulating the synthesis of anti-inflammatory mediators and antioxidants, it also aids in the prevention of thrombogenesis. Exercise can also lead to improved endothelial function through improved nitric oxide production in endothelial cells. Exercise training may also increase heart rate variability and improve autonomic nervous system adaptability. Nevertheless, the current analysis included a number of shortcomings. First, subgroup analysis based on other factors, including age, economic status, and smoking history, was not done since patient-level data was not available. According to this result, the suitable population may not be well-identified for practice, and this limitation may increase the risk of bias. Second, the impact of the period between surgery and the beginning of cardiac rehabilitation was not assessed by the authors. The optimal starting time of exercise-based cardiac rehabilitation programs was not covered by any of the included research. Therefore, we cannot identify the optimal timing for postoperative patients to initiate exercise-based cardiac rehabilitation. Finally, the follow-up period was relatively short, making it impossible to assess the long-term effects of cardiac rehabilitation on postoperative patients. This study was conducted in compliance with the Transparency in the Reporting of Artificial Intelligence – the TITAN guideline[5].
Source: International Journal of Surgery
Authors: Yingxin Zhao, Zhizun Wang, Yuxia Gao
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7124283448