A September 2026 Cochrane review of 107 trials involving 26,886 patients reveals that exercise-based cardiac rehabilitation reduces heart attacks by 28% and hospitalizations by 35%. The update shows that digital and home-based programs are as effective as traditional center-based care, offering a solution to low uptake rates. Despite these clear benefits, participation remains low due to barriers like transportation and work, particularly affecting women and deprived communities.
Cardiac rehabilitation efficacy evidence
- ▪Participants in exercise-based cardiac rehabilitation programs reported improved physical functioning, general health, vitality, social functioning, and mental well-being across validated quality-of-life measures.
- ▪A September 2026 Cochrane review of 107 randomized controlled trials involving 26,886 people found exercise-based cardiac rehabilitation reduces heart attacks by 28% and all-cause hospital admissions by 35% compared to no program.
- ▪The September 2026 Cochrane review update added 22 new trials featuring just under 3,500 participants to the previous 2021 review, which had analyzed 85 trials with 23,430 people.
- ▪The September 2026 Cochrane review found that exercise-based cardiac rehabilitation was associated with a borderline significant reduction in the risk of short-term all-cause mortality.
Home-based digital rehabilitation programs
- ▪The September 2026 Cochrane review included trials testing traditional and cultural forms of exercise, such as yoga in India and tai chi in China, which may improve appeal for some populations.
- ▪The September 2026 Cochrane review suggests that newer home-based and digitally supported cardiac rehabilitation programs are as effective as traditional center-based services.
Patient access barriers
- ▪Patients face barriers to attending traditional hospital-based cardiac rehabilitation programs, including work commitments, transportation challenges, and caregiving responsibilities, which disproportionately affect women, older adults, and deprived communities.
- ▪Despite evidence-backed benefits, cardiac rehabilitation remains underused, with England having a 44.5% uptake and Wales having a 71.3% uptake for acute coronary syndrome patients according to the 2025 National Audit of Cardiac Rehabilitation report.
Study population diversity
- ▪The September 2026 Cochrane review update improved generalizability by enrolling more female participants and recruiting individuals from low- and middle-income countries.
- ▪Women made up only 17% of the 26,886 participants across the 107 trials analyzed in the September 2026 Cochrane review, representing a historical underrepresentation.
Long-term cardiovascular outcomes
- ▪The September 2026 Cochrane review authors noted that any incremental mortality benefit of exercise-based cardiac rehabilitation is likely to be small due to the survival advantages of contemporary medical treatments.
- ▪Studies extending over 36 months in the September 2026 Cochrane review showed that cardiac rehabilitation was associated with lower risks of cardiovascular mortality and fatal or non-fatal myocardial infarction.
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