Exercise‐based cardiac rehabilitation for adults after heart valve surgery

Background Exercise‐based cardiac rehabilitation may benefit heart valve surgery patients. We conducted a systematic review to assess the evidence for the use of exercise‐based intervention programmes following heart valve surgery. Objectives To assess the benefits and harms of exercise‐based cardiac rehabilitation compared with no exercise training intervention, or treatment as usual, in adults following heart valve surgery. We considered programmes including exercise training with or without another intervention (such as a psycho‐educational component). Search methods We searched: the Cochrane Central Register of Controlled Trials (CENTRAL); the Database of s of Reviews of Effects (DARE); MEDLINE (Ovid); EMBASE (Ovid); CINAHL (EBSCO); PsycINFO (Ovid); LILACS (Bireme); and Conference Proceedings Citation Index‐S (CPCI‐S) on Web of Science (Thomson Reuters) on 23 March 2015. We handsearched Web of Science, bibliographies of systematic reviews and trial registers (ClinicalTrials.gov, Controlled‐trials.com, and The World Health Organization International Clinical Trials Registry Platform). Selection criteria We included randomised clinical trials that investigated exercise‐based interventions compared with no exercise intervention control. The trial participants comprised adults aged 18 years or older who had undergone heart valve surgery for heart valve disease (from any cause) and received either heart valve replacement, or heart valve repair. Data collection and analysis Two authors independently extracted data. We assessed the risk of systematic errors (‘bias’) by evaluation of bias risk domains. Clinical and statistical heterogeneity were assessed. Meta‐analyses were undertaken using both fixed‐effect and random‐effects models. We used the GRADE approach to assess the quality of evidence. We sought to assess the risk of random errors with trial sequential analysis. Main results We included two trials from 1987 and 2004 with a total 148 participants who have had heart valve surgery. Both trials had a high risk of bias. There was insufficient evidence at 3 to 6 months follow‐up to judge the effect of exercise‐based cardiac rehabilitation compared to no exercise on mortality (RR 4.46 (95% confidence interval (CI) 0.22 to 90.78); participants = 104; studies = 1; quality of evidence: very low) and on serious adverse events (RR 1.15 (95% CI 0.37 to 3.62); participants = 148; studies = 2; quality of evidence: very low). Included trials did not report on health