What is the effect of aerobic exercise intensity on cardiorespiratory fitness in those undergoing cardiac rehabilitation? A systematic review with meta-analysis.

Abstract

Assess the role of exercise intensity on changes in cardiorespiratory fitness (CRF) in patients with cardiac conditions attending exercise-based cardiac rehabilitation. Systematic review with meta-analysis. MEDLINE, Embase, CINAHL, SPORTDiscus, PsycINFO and Web of Science. Studies assessing change in CRF (reported as peak oxygen uptake; V̇O_2peak) in patients post myocardial infarction and revascularisation, following exercise-based cardiac rehabilitation. Studies establishing V̇O_2peak via symptom-limited exercise test with ventilatory gas analysis and reported intensity of exercise during rehabilitation were included. Studies with mean ejection fraction <40% were excluded. 128 studies including 13 220 patients were included. Interventions were classified as moderate, moderate-to-vigorous or vigorous intensity based on published recommendations. Moderate and moderate-to-vigorous-intensity interventions were associated with a moderate increase in <i>relative</i> V̇O_2peak (standardised mean difference±95% CI=0.94±0.30 and 0.93±0.17, respectively), and vigorous-intensity exercise with a large increase (1.10±0.25). Moderate and vigorous-intensity interventions were associated with moderate improvements in <i>absolute</i>V̇O_2peak (0.63±0.34 and 0.93±0.20, respectively), whereas moderate-to-vigorous-intensity interventions elicited a large effect (1.27±0.75). Large heterogeneity among studies was observed for all analyses. Subgroup analyses yielded statistically significant, but inconsistent, improvements in CRF. Engagement in exercise-based cardiac rehabilitation was associated with significant improvements in both absolute and relative V̇O_2peak. Although exercise of vigorous intensity produced the greatest pooled effect for change in relative V̇O_2peak, differences in pooled effects between intensities could not be considered clinically meaningful. Prospero CRD42016035638.