Health-related quality of life and exercise-based cardiac rehabilitation in contemporary acute coronary syndrome patients: a systematic review and meta-analysis

  • Dion CandelariaEmail author
  • Sue Randall
  • Laila Ladak
  • Robyn Gallagher



To review the literature on health-related quality of life (HRQoL) outcomes for exercise-based cardiac rehabilitation (EBCR) in contemporary acute coronary syndrome (ACS) patients.


Electronic databases (CENTRAL, MEDLINE, Embase, and CINAHL) were searched from January 2000 to March 2019 for randomised controlled trials (RCTs) comparing EBCR to a no-exercise control in ACS patients recruited after year 2000, follow-up of at least 6 months, and HRQoL as outcome. Potential papers were independently screened by two reviewers. Risks of bias were assessed using the Cochrane Tool. Data analyses were performed using RevMan v5.3, random effects model.


Fourteen RCTs (1739 participants) were included, with eight studies suitable for meta-analyses. EBCR resulted in statistically significant and clinically important improvements in physical performance (mean difference [MD] 7.09, 95% CI 0.08, 14.11) and general health (MD 5.08, 95% CI 1.03, 9.13) (SF-36) at 6 months, and in physical functioning (MD 9.82, 95% CI 1.46, 18.19) at 12 months. Statistically significant and sustained improvements were also found in social and physical functioning. Meta-analysis of two studies using the MacNew Heart Disease HRQoL instrument did not show any significant benefits. Of the six studies unsuitable for meta-analyses, five reported significant changes in overall HRQoL, general physical activity levels and functional capacity, or quality-adjusted life-years (QALYs).


In an era where adherence to clinical practice guidelines has improved survival, EBCR still achieves clinically meaningful improvements in physical performance, general health, and physical functioning in the short and long term in contemporary ACS patients.


Health-related quality of life Quality of life Exercise Cardiac rehabilitation Acute coronary syndrome Systematic review Meta-analysis 



We would like to acknowledge the valuable assistance of Judith Fethney, our resident statistician, in providing guidance on our statistical methods.

Compliance with ethical standards

Conflict of interest

The authors declare no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

Ethical approval was not required for conducting this review.

Informed consent

Informed consent was not required for conducting this review.

Supplementary material

11136_2019_2338_MOESM1_ESM.docx (99 kb)
Supplementary material 1 (DOCX 98 kb)


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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and HealthThe University of SydneyCamperdownAustralia
  2. 2.Charles Perkins CentreThe University of SydneyCamperdownAustralia
  3. 3.Aga Khan University HospitalThe Aga Khan UniversityKarachiPakistan

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