Rehabilitación cardíaca con ejercicios para pacientes adultos con angina estable
Appendices
Appendix 1. Search strategy
CENTRAL and DARE
#1 MeSH descriptor: [Angina Pectoris] this term only
#2 MeSH descriptor: [Angina, Unstable] this term only
#3 angina*
#4 stenocardia*
#5 angor pectoris
#6 #1 or #2 or #3 or #4 or #5
#7 MeSH descriptor: [Exercise Therapy] explode all trees
#8 MeSH descriptor: [Sports] this term only
#9 MeSH descriptor: [Physical Exertion] this term only
#10 rehabilitat*
#11 (physical* near/5 (fit* or train* or therap* or activit*))
#12 MeSH descriptor: [Exercise] explode all trees
#13 (train* near/5 (strength* or aerobic* or exercise*))
#14 ((exercise* or fitness) near/3 (treatment or intervent* or program*))
#15 MeSH descriptor: [Rehabilitation] explode all trees
#16 kinesiotherap*
#17 MeSH descriptor: [Physical Education and Training] this term only
#18 MeSH descriptor: [Patient Education as Topic] this term only
#19 (patient* near/5 educat*)
#20 ((lifestyle or life‐style) near/5 (interven* or program* or treatment*))
#21 MeSH descriptor: [Self Care] this term only
#22 (self near/5 (manag* or care or motivate*))
#23 MeSH descriptor: [Psychotherapy] explode all trees
#24 psychotherap*
#25 (psycholog* near/5 intervent*)
#26 MeSH descriptor: [Counseling] this term only
#27 (counselling or counseling)
#28 ((behavior* or behaviour*) near/5 (modify or modificat* or therap* or change))
#29 (psycho‐educat* or psychoeducat*)
#30 (motivat* near/5 (intervention or interv*))
#31 MeSH descriptor: [Health Education] this term only
#32 (health near/5 educat*)
#33 (psychosocial or psycho‐social)
#34 (cognitive near/2 behav*)
#35 #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24 or #25 or #26 or #27 or #28 or #29 or #30 or #31 or #32 or #33 or #34
#36 #6 and #35
MEDLINE
1 angina pectoris/ or angina, stable/
2 angina.tw.
3 stenocardia*.tw.
4 angor pectoris.tw.
5 1 or 2 or 3 or 4
6 exp Exercise Therapy/
7 Sports/
8 Physical Exertion/
9 rehabilitat*.tw.
10 (physical* adj5 (fit* or train* or therap* or activit*)).tw.
11 exp Exercise/
12 (train* adj5 (strength* or aerobic* or exercise*)).tw.
13 ((exercise* or fitness) adj3 (treatment or intervent* or program*)).tw.
14 exp Rehabilitation/
15 kinesiotherap*.tw.
16 "Physical Education and Training"/
17 Patient Education as Topic/
18 (patient* adj5 educat*).tw.
19 ((lifestyle or life‐style) adj5 (interven* or program* or treatment*)).tw.
20 Self Care/
21 (self adj5 (manag* or care or motivate*)).tw.
22 exp Psychotherapy/
23 psychotherap*.tw.
24 (psycholog* adj5 intervent*).tw.
25 Counseling/
26 (counselling or counseling).tw.
27 ((behavior* or behaviour*) adj5 (modify or modificat* or therap* or change)).tw.
28 (psycho‐educat* or psychoeducat*).tw.
29 (motivat* adj5 (intervention or interv*)).tw.
30 Health Education/
31 (health adj5 educat*).tw.
32 (psychosocial or psycho‐social).tw.
33 (cognitive adj2 behav*).tw.
34 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33
35 randomized controlled trial.pt.
36 controlled clinical trial.pt.
37 randomized.ab.
38 placebo.ab.
39 drug therapy.fs.
40 randomly.ab.
41 trial.ab.
42 groups.ab.
43 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42
44 exp animals/ not humans.sh.
45 43 not 44
46 5 and 34 and 45
Embase
1. angina pectoris/ or stable angina pectoris/
2. angina.tw.
3. stenocardia*.tw.
4. angor pectoris.tw.
5. 1 or 2 or 3 or 4
6. exp kinesiotherapy/
7. sport/
8. exp exercise/
9. rehabilitat*.tw.
10. (physical* adj5 (fit* or train* or therap* or activit*)).tw.
11. (train* adj5 (strength* or aerobic* or exercise*)).tw.
12. ((exercise* or fitness) adj3 (treatment or intervent* or program*)).tw.
13. kinesiotherap*.tw.
14. exp rehabilitation/
15. physical education/
16. patient education/
17. (patient* adj5 educat*).tw.
18. ((lifestyle or life‐style) adj5 (interven* or program* or treatment*)).tw.
19. self care/
20. (self adj5 (manag* or care or motivate*)).tw.
21. exp psychotherapy/
22. psychotherap*.tw.
23. (psycholog* adj5 intervent*).tw.
24. counseling/
25. (counselling or counseling).tw.
26. ((behavior* or behaviour*) adj5 (modify or modificat* or therap* or change)).tw.
27. (psycho‐educat* or psychoeducat*).tw.
28. (motivat* adj5 (intervention or interv*)).tw.
29. health education/
30. (health adj5 educat*).tw.
31. (psychosocial or psycho‐social).tw.
32. (cognitive adj2 behav*).tw.
33. 6 or 7 or 8 or 9 or 10 or 11 or 12 or 13 or 14 or 15 or 16 or 17 or 18 or 19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32
34. random$.tw.
35. factorial$.tw.
36. crossover$.tw.
37. cross over$.tw.
38. cross‐over$.tw.
39. placebo$.tw.
40. (doubl$ adj blind$).tw.
41. (singl$ adj blind$).tw.
42. assign$.tw.
43. allocat$.tw.
44. volunteer$.tw.
45. crossover procedure/
46. double blind procedure/
47. randomized controlled trial/
48. single blind procedure/
49. 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46 or 47 or 48
50. (animal/ or nonhuman/) not human/
51. 49 not 50
52. 5 and 33 and 51
CINAHL
S46 S5 AND S33 AND S45
S45 S34 OR S35 OR S36 OR S37 OR S38 OR S39 OR S40 OR S41 OR S42 OR S43 OR S44
S44 TX allocat* random*
S43 (MH "Quantitative Studies")
S42 (MH "Placebos")
S41 TX placebo*
S40 TX random* allocat*
S39 (MH "Random Assignment")
S38 TX randomi* control* trial*
S37 TX ( (singl* n1 blind*) or (singl* n1 mask*) ) or TX ( (doubl* n1 blind*) or (doubl* n1 mask*) ) or TX ( (tripl* n1 blind*) or (tripl* n1 mask*) ) or TX ( (trebl* n1 blind*) or (trebl* n1 mask*) )
S36 TX clinic* n1 trial*
S35 PT Clinical trial
S34 (MH "Clinical Trials+")
S33 S6 OR S7 OR S8 OR S9 OR S10 OR S11 OR S12 OR S13 OR S14 OR S15 OR S16 OR S17 OR S18 OR S19 OR S20 OR S21 OR S22 OR S23 OR S24 OR S25 OR S26 OR S27 OR S28 OR S29 OR S30 OR S31 OR S32
S32 TX (cognitive n2 behav*)
S31 TX (psychosocial or psycho‐social)
S30 TX (health n5 educat*)
S29 (MH "Health Education")
S28 TX (motivat* n5 (intervention or interv*))
S27 TX (psycho‐educat* or psychoeducat*)
S26 TX ((behavior* or behaviour*) n5 (modify or modificat* or therap* or change))
S25 TX (counselling or counseling)
S24 (MH "Counseling")
S23 TX (psycholog* n5 intervent*)
S22 TX psychotherap*
S21 (MH "Psychotherapy+")
S20 TX (self n5 (manag* or care or motivate*))
S19 (MH "Self Care")
S18 TX ((lifestyle or life‐style) n5 (interven* or program* or treatment*))
S17 TX (patient* n5 educat*)
S16 (MH "Patient Education")
S15 (MH "Physical Education and Training")
S14 TX kinesiotherap*
S13 TX rehabilitat*
S12 (MH "Rehabilitation+")
S11 TX ((exercise* or fitness) n3 (treatment or intervent* or program*))
S10 TX (train* n5 (strength* or aerobic* or exercise*))
S9 TX (physical* n5 (fit* or train* or therap* or activit*))
S8 (MH "Exercise+")
S7 (MH "Sports")
S6 (MH "Therapeutic Exercise+")
S5 S1 OR S2 OR S3 OR S4
S4 TX angor pectoris
S3 TX stenocardia*
S2 TX angina
S1 (MH "Angina Pectoris") OR (MH "Angina, Unstable")
CPCI‐S
#47 AND #46 AND #4
# 47 TS=(random* or blind* or allocat* or assign* or trial* or placebo* or crossover* or cross‐over*)
# 46 #45 OR #44 OR #43 OR #42 OR #41 OR #40 OR #39 OR #38 OR #37 OR #36 OR #35 OR #34 OR #33 OR #32 OR #31 OR #30 OR #29 OR #28 OR #27 OR #26 OR #25 OR #24 OR #23 OR #22 OR #21 OR #20 OR #19 OR #18 OR #17 OR #16 OR #15 OR #14 OR #13 OR #12 OR #11 OR #10 OR #9 OR #8 OR #7 OR #6 OR #5
# 45 TS=(cognitive NEAR/2 behav*)
# 44 TS=(psychosocial or psycho‐social)
# 43 TS=(health NEAR/5 educat*)
# 42 TS=(motivat* NEAR/5 interv*)
# 41 TS=(psycho‐educat* or psychoeducat*)
# 40 TS=(behaviour* NEAR/5 change)
# 39 TS=(behaviour* NEAR/5 therap*)
# 38 TS=(behaviour* NEAR/5 modificat*)
# 37 TS=(behaviour* NEAR/5 modify)
# 36 TS=(behavior* NEAR/5 change)
# 35 TS=(behavior* NEAR/5 therap*)
# 34 TS=(behavior* NEAR/5 modificat*)
# 33 TS=(behavior* NEAR/5 modify)
# 32 TS=(counselling or counseling)
# 31 TS=(psycholog* NEAR/5 intervent*)
# 30 TS=psychotherap*
# 29 TS=(self NEAR/5 motivate*)
# 28 TS=(self NEAR/5 care)
# 27 TS=(self NEAR/5 manag*)
# 26 TS=(life‐style NEAR/5 treatment*)
# 25 TS=(life‐style NEAR/5 program*)
# 24 TS=(life‐style NEAR/5 interven*)
# 23 TS=(lifestyle NEAR/5 treatment*)
# 22 TS=(lifestyle NEAR/5 program*)
# 21 TS=(lifestyle NEAR/5 interven*)
# 20 TS=(patient* NEAR/5 educat*)
# 19 TS=kinesiotherap*
# 18 TS=(fitness NEAR/3 program*)
# 17 TS=(fitness NEAR/3 intervent*)
# 16 TS=(fitness NEAR/3 treatment)
# 15 TS=(exercise* NEAR/3 program*)
# 14 TS=(exercise* NEAR/3 intervent*)
# 13 TS=(exercise* NEAR/3 treatment)
# 12 TS=(train* NEAR/5 exercise*)
# 11 TS=(train* NEAR/5 aerobic*)
# 10 TS=(train* NEAR/5 strength*)
# 9 TS=(physical* NEAR/5 activit*)
# 8 TS=(physical* NEAR/5 therap*)
# 7 TS=(physical* NEAR/5 train* )
# 6 TS=(physical* NEAR/5 fit*)
# 5 TS=rehabilitat*
# 4 #3 OR #2 OR #1
# 3 TS=angor pectoris
# 2 TS=stenocardia*
# 1 TS=angina
WHO's ICTRP
"Cardiac rehabilitation"
rehabilitation AND "angina"
exercise AND "angina"
Clinicaltrials.gov
"Cardiac rehabilitation"
rehabilitation AND angina
exercise AND angina
PRISMA flow diagram of trial selection
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Comparison 1 Exercise versus no exercise for stable angina, Outcome 1 All‐cause mortality.
Comparison 1 Exercise versus no exercise for stable angina, Outcome 2 Acute myocardial infarction (AMI).
Comparison 1 Exercise versus no exercise for stable angina, Outcome 3 Revascularisation procedure (CABG or PCI).
Comparison 1 Exercise versus no exercise for stable angina, Outcome 4 Exercise capacity.
Comparison 1 Exercise versus no exercise for stable angina, Outcome 5 Cardiovascular‐related hospital admissions.
| Exercise‐based cardiac rehabilitation (CR) compared to usual care for patients with stable angina | ||||||
| Patient or population: adults with stable angina | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | № of participants | Quality of the evidence | Comments | |
| Risk with usual care | Risk with exercise‐based cardiac rehabilitation | |||||
| All‐cause mortality Follow‐up: 12 months | Study population | RR 1.01 | 195 | ⊕⊝⊝⊝ | We are uncertain about the effect of exercise‐based CR on all‐cause mortality compared to usual care. | |
| 20 per 1,000 | 21 per 1,000 | |||||
| Acute myocardial infarction (AMI) Follow‐up: 12 months | Study population | RR 0.33 | 254 | ⊕⊝⊝⊝ | We are uncertain about the effect of exercise‐based CR on AMI compared to usual care. | |
| 39 per 1,000 | 13 per 1,000 | |||||
| Exercise capacity (assessed using a variety of outcomes including VO2 max and duration of exercise) Follow‐up: range 6 to 12 months | The mean exercise capacity in the intervention groups was 0.45 standard deviations higher | 267 | ⊕⊕⊝⊝ | Using Cohen's rule of thumb a SMD of 0.2 represents a small effect, 0.5 a moderate effect and 0.8 a large effect between groups (Cohen 1988). Exercise‐based CR may slightly improve exercise capacity compared to usual care. | ||
| Cardiovascular‐related hospital admissions Follow‐up: 12 months | Study population | RR 0.14 (0.02 to 1.1) | 101 | ⊕⊝⊝⊝ | We are uncertain about the effect of exercise‐based CR on cardiovascular‐related hospital admissions compared to usual care. | |
| 140 per 1000 | 20 per 1000 (2 to 154) | |||||
| Health‐related quality of life (assessed with: Seattle Angina Questionnaire and The MacNew Questionnaire) | One study showed improvement in emotional score at 6‐week follow up, and benefits in angina frequency and social HRQL score at 6 months follow‐up. | Not estimable | 94 (1 RCT) | ⊕⊝⊝⊝ | We are uncertain about the effect of exercise‐based CR on quality of life compared to usual care. | |
| Return to work | No studies were found that looked at return to work. | |||||
| Adverse events (e.g. skeletomuscular injury) Follow‐up: 12 months | Only one study looked at adverse events and reported that there were no adverse events during the exercise‐based CR. | Not estimable | 101 (1 RCT) | ⊕⊝⊝⊝ | We are uncertain about the effect of exercise‐based CR on adverse events compared to usual care. | |
| *The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Some concerns with random sequence generation, allocation concealment, blinding of outcome assessment and selective reporting; bias likely, therefore quality of evidence downgraded by one level 2 Some concern with applicability to review question as participants in all studies were limited to middle‐aged men, therefore quality of evidence downgraded by one level 3 Imprecise due to small number of participants (less than 300) and confidence intervals including potential for important harm or benefit as 95% CI crosses RR of 0.75 and 1.25, therefore quality of evidence downgraded by two levels 4 Some concerns with random sequence generation, allocation concealment, blinding of outcome assessment, selective reporting and unbalanced groups at baseline; bias likely, therefore quality of evidence downgraded by one level 5 Some concern with random sequence generation, allocation concealment, blinding of outcome assessment, high loss to follow‐up, selective reporting and unbalanced groups at baseline; serious bias likely, therefore quality of evidence downgraded by two levels 6 Imprecise due to small number of participants (less than 300) therefore quality of evidence downgraded by one level 7 Some concerns with random sequence generation, allocation concealment and selective reporting; bias likely, therefore quality of evidence downgraded by one level 8 Some concerns with blinding of outcome assessment, selective reporting and groups not receiving comparable care; bias likely, therefore quality of evidence downgraded by one level 9 Imprecise due to very small number of participants therefore quality of evidence downgraded by two levels | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 All‐cause mortality Show forest plot | 3 | 195 | Risk Ratio (M‐H, Fixed, 95% CI) | 1.01 [0.18, 5.67] |
| 2 Acute myocardial infarction (AMI) Show forest plot | 3 | 254 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.33 [0.07, 1.63] |
| 3 Revascularisation procedure (CABG or PCI) Show forest plot | 3 | 256 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.27 [0.11, 0.64] |
| 4 Exercise capacity Show forest plot | 5 | 267 | Std. Mean Difference (IV, Fixed, 95% CI) | 0.45 [0.20, 0.70] |
| 5 Cardiovascular‐related hospital admissions Show forest plot | 1 | 101 | Risk Ratio (M‐H, Fixed, 95% CI) | 0.14 [0.02, 1.10] |
