Exercise-based cardiac rehab reduces MI risk by more than one-quarter

Clinical takeaway: Refer eligible patients with coronary heart disease to exercise-based cardiac rehabilitation after a cardiac event or procedure. When in-person attendance is a barrier, consider home-based or digitally supported programs rather than forgoing rehabilitation.

Cardiac rehabilitation is widely recommended after myocardial infarction (MI) and coronary procedures, yet many eligible patients do not participate. Cochrane has updated its previous systematic review by incorporating 22 additional trials involving nearly 3,500 participants, strengthening the evidence for cardiac rehabilitation as a secondary-prevention intervention.

The updated review included 107 randomized trials and 26,886 people with coronary heart disease overall. Most participants had experienced an MI, undergone a coronary procedure, or had angina. Compared with no program, exercise-based cardiac rehabilitation reduced MI risk by 28% and all-cause hospital admissions by 35%.

Participants reported improvements in physical functioning, general health, vitality, social functioning, and mental well-being across several validated quality-of-life measures. Benefits also persisted over longer-term follow-up.

The update added 22 trials with nearly 3,500 participants, including studies of home-based and digitally supported rehabilitation. These newer approaches appeared to be as effective as traditional center-based programs, expanding options for patients facing transportation difficulties, work or caregiving responsibilities, and other barriers to attending in person.

Newer trials also included more participants from low- and middle-income countries and evaluated culturally familiar activities, including yoga in India and tai chi in China. The findings suggest that cardiac rehabilitation does not need to follow a single facility-based model. Flexible and culturally acceptable forms of supervised exercise may help broaden participation without sacrificing benefit.

The reported reductions are relative effects, so the absolute benefit for an individual patient will depend on baseline cardiovascular and hospitalization risk. Women represented only 17% of participants, leaving less certainty about whether the magnitude of benefit is similar across sexes.

“Many people lose confidence after a heart attack or cardiac procedure and worry that physical activity could be dangerous,” said lead author Grace Dibben, PhD, of the University of Glasgow. “Appropriately prescribed exercise is not only safe for most patients, but can play a vital role in recovery and long-term heart health.”

Source: Dibben G, et al. (2026 Sep 17) Cochrane Database Syst Rev. Exercise-based cardiac rehabilitation for coronary heart disease