Scolaris Content Display Scolaris Content Display

Bewegungsorientierte kardiale Rehabilitation bei koronarer Herzkrankheit

Esta versión no es la más reciente

Contraer todo Desplegar todo

Abstract

Background

The burden of coronary heart disease (CHD) worldwide is one of great concern to patients and healthcare agencies alike. Exercise‐based cardiac rehabilitation aims to restore patients with heart disease to health.

Objectives

To determine the effectiveness of exercise‐based cardiac rehabilitation (exercise training alone or in combination with psychosocial or educational interventions) on mortality, morbidity and health‐related quality of life of patients with CHD.

Search methods

RCTs have been identified by searching CENTRAL, HTA, and DARE (using The Cochrane Library Issue 4, 2009), as well as MEDLINE (1950 to December 2009), EMBASE (1980 to December 2009), CINAHL (1982 to December 2009), and Science Citation Index Expanded (1900 to December 2009).

Selection criteria

Men and women of all ages who have had myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous transluminal coronary angioplasty (PTCA), or who have angina pectoris or coronary artery disease defined by angiography.

Data collection and analysis

Studies were selected and data extracted independently by two reviewers. Authors were contacted where possible to obtain missing information.

Main results

This systematic review has allowed analysis of 47 studies randomising 10,794 patients to exercise‐based cardiac rehabilitation or usual care. In medium to longer term (i.e. 12 or more months follow‐up) exercise‐based cardiac rehabilitation reduced overall and cardiovascular mortality [RR 0.87 (95% CI 0.75, 0.99) and 0.74 (95% CI 0.63, 0.87), respectively], and hospital admissions [RR 0.69 (95% CI 0.51, 0.93)] in the shorter term (< 12 months follow‐up) with no evidence of heterogeneity of effect across trials. Cardiac rehabilitation did not reduce the risk of total MI, CABG or PTCA. Given both the heterogeneity in outcome measures and methods of reporting findings, a meta‐analysis was not undertaken for health‐related quality of life. In seven out of 10 trials reporting health‐related quality of life using validated measures was there evidence of a significantly higher level of quality of life with exercise‐based cardiac rehabilitation than usual care.

Authors' conclusions

Exercise‐based cardiac rehabilitation is effective in reducing total and cardiovascular mortality (in medium to longer term studies) and hospital admissions (in shorter term studies) but not total MI or revascularisation (CABG or PTCA). Despite inclusion of more recent trials, the population studied in this review is still predominantly male, middle aged and low risk. Therefore, well‐designed, and adequately reported RCTs in groups of CHD patients more representative of usual clinical practice are still needed. These trials should include validated health‐related quality of life outcome measures, need to explicitly report clinical events including hospital admission, and assess costs and cost‐effectiveness.

PICO

Population
Intervention
Comparison
Outcome

El uso y la enseñanza del modelo PICO están muy extendidos en el ámbito de la atención sanitaria basada en la evidencia para formular preguntas y estrategias de búsqueda y para caracterizar estudios o metanálisis clínicos. PICO son las siglas en inglés de cuatro posibles componentes de una pregunta de investigación: paciente, población o problema; intervención; comparación; desenlace (outcome).

Para saber más sobre el uso del modelo PICO, puede consultar el Manual Cochrane.

Laienverständliche Zusammenfassung

Regelmäßige Bewegung oder Bewegung mit Schulungen und psychologischer Unterstützung kann die Wahrscheinlichkeit vermindern, an einer Herzerkrankung zu sterben.

Die koronare Herzkrankheit (KHK) ist eine der häufigsten Formen von Herzerkrankungen. Sie schädigt das Herz, indem der Blutfluss um das Herz herum eingeschränkt oder blockiert wird. Dies kann zu einem Engegefühl in der Brust (Angina) oder einem Herzinfarkt führen. Die bewegungsorientierte kardiale Rehabilitation hat zum Ziel, die Gesundheit bei Menschen mit KHK durch regelmäßige Bewegung allein oder durch eine Kombination aus Bewegung mit Schulung und psychologischer Unterstützung wiederaufzubauen. Die Ergebnisse dieses Reviews deuten darauf hin, dass eine bewegungsorientierte Rehabilitation die Wahrscheinlichkeit vermindert, an einer Herzerkrankung zu sterben. Es gibt mittelgradige Evidenz für eine Verbesserung der Lebensqualität bei den Teilnehmern dieser Studien, welche vorrangig männlicher Patienten im mittleren Alter waren. Zusätzliche Forschungsarbeiten sind nötig, um die Auswirkungen der bewegungsorientierten Rehabilitation auf die gesamte Gesundheit in verschiedenen Patientengruppen zu untersuchen.