Cochrane Review of 107 Trials Finds Cardiac Rehabilitation Cuts Admissions 35% and Heart Attacks 28%

The University of Glasgow-led meta-analysis pooled data from trials testing supervised exercise programs after heart attack, revascularization, or angina. Primary outcomes included all-cause mortality, cardiovascular mortality, myocardial infarction, and hospital admissions; secondary measures captured validated quality-of-life scores. Newer trials added home-based and digital delivery arms plus participants from India and China using yoga or tai chi, expanding generalizability beyond high-income center-based models. Women remained only 17% of enrollees, limiting sex-specific inferences. The review updates prior versions by incorporating 22 recent studies and 3,500 additional participants, confirming sustained benefits at longer follow-up.

Uptake data from the 2025 National Audit of Cardiac Rehabilitation reveal only 44.5% participation in England and 71.3% in Wales, underscoring persistent barriers of transport, work, and confidence. Home-based and digital formats performed equivalently to center programs on hard endpoints, suggesting scalable solutions for low- and middle-income settings where conventional infrastructure is absent. Cultural adaptation of exercise modalities may further improve adherence where machine-based rehabilitation feels alien.

Remaining questions center on optimal dose, long-term adherence beyond 12 months, and whether benefits persist in contemporary statin and SGLT2-inhibitor eras. Future trials must enroll representative female and elderly cohorts and test hybrid reimbursement models that tie payment to verified participation rather than referral alone.

This meta-analysis of randomized trials demonstrates clear reductions in admissions and recurrent events yet cannot establish causality for mortality or quantify cost-effectiveness across diverse health systems; adequately powered implementation RCTs with economic endpoints are now required.