The Effect of Exercise-Based Cardiac Rehabilitation on Objectively Measured Physical Activity and Sedentary Behavior: A Systematic Review and Meta-analysis.

Abstract

<b>Objective:</b> Adequate physical activity following cardiac rehabilitation (CR) is required to reduce secondary cardiovascular disease risk. The aim of this review and meta-analysis was to determine the effect of exercise-based CR on objectively measured physical activity (PA) and sedentary behavior (SB) comparing pre- to postintervention, pre- to postchange compared to a control group, and in a longer term follow-up. <b>Methods:</b> Five databases were searched (PubMed, MEDLINE [OVID], Scopus, SPORTDiscus, and CINAHL) from inception to January 2019. Two reviewers screened and selected 15 studies involving 1434 participants. Data were synthesized descriptively and by meta-analyses. <b>Results:</b> CR resulted in an improvement in activity behaviors compared with preintervention levels (standardized mean difference [SMD] 0.50, 95% CI 0.25-0.55, <i>P</i> < .0001). CR resulted in a greater improvement in activity behaviors in the intervention compared with the control group (SMD 0.25, 95% CI 0.02-0.49, <i>P</i> = .04). Increased PA was maintained (SMD 0.32, 95% CI 0.22-0.41, <i>P</i> < .0001). Eight out of 15 studies showed an improvement in PA outcomes while 7 reported that objectively measured PA did not change immediately following the intervention compared to preintervention levels and/or compared with the control group. Of the 7 studies that reported changes in SB, 4 observed a reduction following CR while 3 reported no change. <b>Conclusion:</b> Participation in exercise-based CR programs is effective in improving PA and SB. However, our descriptive synthesis indicates that only half the studies were successful in improving activity behaviors following exercise-based CR. Standard guidelines for the assessment of activity behaviors following CR would be valuable in understanding of the effects of CR on long-term activity participation.