# Cardiac rehabilitation Intervention · id `cardio:cardiac-rehabilitation` · Cardiovascular Atlas · release `73130c34862e2d06` (public) > General information from published sources, not medical advice, and not reviewed by clinicians. Check the cited source before relying on anything here. The atlas's own text and curation may be reused under Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0, https://creativecommons.org/licenses/by-nc/4.0/): credit the atlas, and do not use it commercially. See the atlas About page. Text quoted from a source stays under that source's own terms, given as the source's reuse\_basis. The atlas's reuse terms do not cover it. The downloads list each quotation with its source in third\_party\_quotations. Also called: Exercise-based cardiac rehabilitation Browse, organ or system: Heart Browse, condition area: Coronary and vascular disease; Acute care and long-term living ## In plain language A medically supervised program for people with heart disease or after a heart event or heart procedure. MedlinePlus says a team of specialists builds a plan that includes exercise training, education on heart healthy living and counseling to reduce stress, with the aims of returning to an active life and lowering the chance of further heart problems. It is offered after a heart attack, angioplasty or bypass surgery for coronary heart disease, valve repair or replacement, heart or lung transplant, angina and heart failure. An updated Cochrane review of 85 trials in people with coronary heart disease found fewer heart attacks and fewer hospital admissions at 6 to 12 months compared with no exercise, likely little or no difference for some other outcomes, and uncertain effects for others. Many eligible people never take part (see the participation page). ## Technical summary Subtype rehabilitation. MeSH Cardiac Rehabilitation (D000072038) is an exact match. The evidence recorded here is the Cochrane review of exercise-based cardiac rehabilitation for coronary heart disease (85 trials, 23,430 participants; the review compared exercise training alone, or combined with psychosocial or educational interventions, with no exercise), split into four claims by GRADE certainty and follow-up, and the MedlinePlus description of who is offered it and what it includes. A joint scientific statement from rehabilitation and cardiology societies describes it as using patient education, health behavior modification and exercise training to improve secondary prevention outcomes, and as significantly underused in the United States. The Cochrane review covers coronary heart disease only. A heart failure trial of a supervised exercise training program is recorded separately; its registry record and abstract do not call that program cardiac rehabilitation, so this record does not link the trial to it. ## Claims, with the population each applies to ## Context: Adults with coronary heart disease in randomised trials of exercise-based cardiac rehabilitation (Cochrane review) Recipient: Adult; Population: Adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris or coronary artery disease, in trials that compared exercise-based cardiac rehabilitation with a no-exercise control. The 85 trials included predominantly post-MI and post-revascularisation patients.; Care setting: Randomised trials of exercise-based cardiac rehabilitation, with exercise training alone or combined with psychosocial or educational interventions. The abstract does not describe the settings of the individual trials.; Geography: Trials from many countries; the abstract says 21 of the 85 trials were done in low- and middle-income countries.; Life stage: Adults; the mean age across the included trials ranged from 47 to 77 years; Follow-up: The review split results into short-term (6 to 12 months), medium-term (more than 12 to 36 months) and long-term (more than 3 years) follow-up. The median longest follow-up was 12 months (range 6 months to 19 years). ### The Cochrane review is uncertain about the effect of exercise-based cardiac rehabilitation on cardiovascular hospitalisation at 6 to 12 months: the risk ratio was 0.80 (95% CI 0.41 to 1.59), with a wide interval that includes considerable benefit as well as harm, rated low certainty. The abstract also reports substantial heterogeneity across trials for cardiovascular hospitalisations (I2 = 53%). - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Low certainty (method: GRADE assessment by the review authors, stated in the Cochrane review abstract for the primary outcomes at 6 to 12 months) - Applies to: Recipient: Adult; Population: Adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris or coronary artery disease, in trials that compared exercise-based cardiac rehabilitation with a no-exercise control. The 85 trials included predominantly post-MI and post-revascularisation patients.; Care setting: Randomised trials of exercise-based cardiac rehabilitation, with exercise training alone or combined with psychosocial or educational interventions. The abstract does not describe the settings of the individual trials.; Geography: Trials from many countries; the abstract says 21 of the 85 trials were done in low- and middle-income countries.; Life stage: Adults; the mean age across the included trials ranged from 47 to 77 years; Follow-up: The review split results into short-term (6 to 12 months), medium-term (more than 12 to 36 months) and long-term (more than 3 years) follow-up. The median longest follow-up was 12 months (range 6 months to 19 years). - Limitations: Adults with coronary heart disease in trials of exercise-based cardiac rehabilitation (exercise training alone or with psychosocial or educational interventions) against a no-exercise control. The trials were predominantly post-MI and post-revascularisation patients, and women were under 15% of participants overall. Trial reporting was poor overall, although the abstract says reporting quality improved over the last decade. Only the PubMed abstract was read; the PMC copy is not in the open-access subset. This is a result the review itself calls uncertain, so it does not show that the programmes help or harm on this outcome. - Last checked: 2026-10-15 - Sources: 1. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 13, fragments 1 and 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Cardiovascular hospitalisation result and its certainty. 2. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 14, fragment 1. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Heterogeneity across trials for cardiovascular hospitalisations. 3. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 4. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Number of trials and people. 4. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, SELECTION CRITERIA, sentences 1 and 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Trial and population criteria. ### The Cochrane review also reports longer follow-up results. At medium-term follow-up (more than 12 to 36 months) there may be little to no difference in all-cause mortality (risk ratio 0.90, 95% CI 0.80 to 1.02; 15 trials), myocardial infarction (1.07, 0.91 to 1.27; 12 trials), percutaneous coronary intervention (0.96, 0.69 to 1.35; 6 trials), coronary artery bypass graft (0.97, 0.77 to 1.23; 9 trials) and all-cause hospitalisation (0.92, 0.82 to 1.03; 9 trials), but a large reduction in cardiovascular mortality was found (0.77, 0.63 to 0.93; 5 trials); the evidence is uncertain for cardiovascular hospitalisation (0.92, 0.76 to 1.12; 3 trials). At long-term follow-up (more than 3 years) there may be little to no difference in all-cause mortality (0.91, 0.75 to 1.10), while exercise-based cardiac rehabilitation may result in a large reduction in cardiovascular mortality (0.58, 0.43 to 0.78; 8 trials) and myocardial infarction (0.67, 0.50 to 0.90; 10 trials); the evidence is uncertain for coronary artery bypass graft (0.66, 0.34 to 1.27; 4 trials) and percutaneous coronary intervention (0.76, 0.48 to 1.20; 3 trials). Each value is a risk ratio with its 95% confidence interval. - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Certainty not assessed - Applies to: Recipient: Adult; Population: Adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris or coronary artery disease, in trials that compared exercise-based cardiac rehabilitation with a no-exercise control. The 85 trials included predominantly post-MI and post-revascularisation patients.; Care setting: Randomised trials of exercise-based cardiac rehabilitation, with exercise training alone or combined with psychosocial or educational interventions. The abstract does not describe the settings of the individual trials.; Geography: Trials from many countries; the abstract says 21 of the 85 trials were done in low- and middle-income countries.; Life stage: Adults; the mean age across the included trials ranged from 47 to 77 years; Follow-up: The review split results into short-term (6 to 12 months), medium-term (more than 12 to 36 months) and long-term (more than 3 years) follow-up. The median longest follow-up was 12 months (range 6 months to 19 years). - Limitations: Adults with coronary heart disease in trials of exercise-based cardiac rehabilitation (exercise training alone or with psychosocial or educational interventions) against a no-exercise control. The trials were predominantly post-MI and post-revascularisation patients, and women were under 15% of participants overall. Trial reporting was poor overall, although the abstract says reporting quality improved over the last decade. Only the PubMed abstract was read; the PMC copy is not in the open-access subset. The review used GRADE only for the primary outcomes at 6 to 12 months, so these medium- and long-term results carry no certainty rating in the abstract. The abstract gives the number of trials behind each result. - Last checked: 2026-10-15 - Sources: 1. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentences 15 and 16. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Medium-term results. 2. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentences 17 and 18. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Long-term results. 3. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, AUTHORS' CONCLUSIONS, sentence 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: The authors' summary of longer-term benefits. 4. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 4. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Number of trials and people. 5. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, SELECTION CRITERIA, sentences 1 and 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Trial and population criteria. ### An updated Cochrane review of 85 randomised trials, which together randomised 23,430 people with coronary heart disease, compared exercise-based cardiac rehabilitation with a no-exercise control. At short-term follow-up (6 to 12 months) it found a large reduction in myocardial infarction (risk ratio 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome 75, 95% CI 47 to 298), rated high certainty. It found little to no difference in coronary artery bypass graft (risk ratio 0.99, 95% CI 0.78 to 1.27; 20 trials), also rated high certainty. - Category: Effect - Evidence stage: Evidence synthesis - Certainty: High certainty (method: GRADE assessment by the review authors, stated in the Cochrane review abstract for the primary outcomes at 6 to 12 months) - Applies to: Recipient: Adult; Population: Adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris or coronary artery disease, in trials that compared exercise-based cardiac rehabilitation with a no-exercise control. The 85 trials included predominantly post-MI and post-revascularisation patients.; Care setting: Randomised trials of exercise-based cardiac rehabilitation, with exercise training alone or combined with psychosocial or educational interventions. The abstract does not describe the settings of the individual trials.; Geography: Trials from many countries; the abstract says 21 of the 85 trials were done in low- and middle-income countries.; Life stage: Adults; the mean age across the included trials ranged from 47 to 77 years; Follow-up: The review split results into short-term (6 to 12 months), medium-term (more than 12 to 36 months) and long-term (more than 3 years) follow-up. The median longest follow-up was 12 months (range 6 months to 19 years). - Limitations: Adults with coronary heart disease in trials of exercise-based cardiac rehabilitation (exercise training alone or with psychosocial or educational interventions) against a no-exercise control. The trials were predominantly post-MI and post-revascularisation patients, and women were under 15% of participants overall. Trial reporting was poor overall, although the abstract says reporting quality improved over the last decade. Only the PubMed abstract was read; the PMC copy is not in the open-access subset. The review gives GRADE ratings only for the primary outcomes at 6 to 12 months; moderate and low certainty outcomes are on separate claims. - Last checked: 2026-10-15 - Sources: 1. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 11, fragments 1 to 3. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Myocardial infarction result and its certainty. 2. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 12, fragment 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Coronary artery bypass graft result and its certainty. 3. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, AUTHORS' CONCLUSIONS, sentence 1. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: The authors' summary, including reduced risk of myocardial infarction. 4. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 4. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Number of trials and people. 5. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, SELECTION CRITERIA, sentences 1 and 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Trial and population criteria. ### At the same short-term follow-up (6 to 12 months), the Cochrane review reports with moderate certainty that exercise-based cardiac rehabilitation likely results in a slight reduction in all-cause mortality (risk ratio 0.87, 95% CI 0.73 to 1.04; 25 trials; the interval includes 1) and a large reduction in all-cause hospitalisation (risk ratio 0.58, 95% CI 0.43 to 0.77; 14 trials; number needed to treat for an additional beneficial outcome 12, 95% CI 9 to 21). It reports that exercise-based cardiac rehabilitation likely results in little to no difference in cardiovascular mortality (risk ratio 0.88, 95% CI 0.68 to 1.14; 15 trials) and in percutaneous coronary intervention (risk ratio 0.86, 95% CI 0.63 to 1.19; 13 trials). - Category: Effect - Evidence stage: Evidence synthesis - Certainty: Moderate certainty (method: GRADE assessment by the review authors, stated in the Cochrane review abstract for the primary outcomes at 6 to 12 months) - Applies to: Recipient: Adult; Population: Adult men and women who have had a myocardial infarction (MI), coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI), or who have angina pectoris or coronary artery disease, in trials that compared exercise-based cardiac rehabilitation with a no-exercise control. The 85 trials included predominantly post-MI and post-revascularisation patients.; Care setting: Randomised trials of exercise-based cardiac rehabilitation, with exercise training alone or combined with psychosocial or educational interventions. The abstract does not describe the settings of the individual trials.; Geography: Trials from many countries; the abstract says 21 of the 85 trials were done in low- and middle-income countries.; Life stage: Adults; the mean age across the included trials ranged from 47 to 77 years; Follow-up: The review split results into short-term (6 to 12 months), medium-term (more than 12 to 36 months) and long-term (more than 3 years) follow-up. The median longest follow-up was 12 months (range 6 months to 19 years). - Limitations: Adults with coronary heart disease in trials of exercise-based cardiac rehabilitation (exercise training alone or with psychosocial or educational interventions) against a no-exercise control. The trials were predominantly post-MI and post-revascularisation patients, and women were under 15% of participants overall. Trial reporting was poor overall, although the abstract says reporting quality improved over the last decade. Only the PubMed abstract was read; the PMC copy is not in the open-access subset. The abstract notes small study bias for all-cause hospitalisation. The all-cause mortality result is reported as a likely slight reduction, but its confidence interval includes no effect. - Last checked: 2026-10-15 - Sources: 1. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 11, fragments 1, 4 and 5. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: All-cause mortality and all-cause hospitalisation results and their certainty. 2. Supports: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 12, fragments 1 to 3. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Cardiovascular mortality and percutaneous coronary intervention results and their certainty. 3. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 14, fragment 1. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Small study bias for all-cause hospitalisation. 4. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, DATA COLLECTION AND ANALYSIS, sentence 4. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Number of trials and people. 5. Background: Exercise-based cardiac rehabilitation for coronary heart disease (Publication, edition PubMed record (abstract and bibliographic data) from NCBI E-utilities. The full text and the version of record were not fetched.) Locator: Abstract, SELECTION CRITERIA, sentences 1 and 2. Retrieved 2026-10-15T13:48:11Z. Source state: Current. Snapshot hash: c88744581358fff0e64fe1548ede864d301df2dc54ea65eb2ade91911c46ecb8. How it applies: Trial and population criteria. ## Connected pages - Cochrane review, adults with coronary heart disease: fewer heart attacks at 6 to 12 months (high certainty); other results on the claims page: Coronary artery disease (`cardio:coronary-artery-disease`) [a claim, not a settled fact; see claim `cardio:claim-cochrane-cr-mi-cabg-short-term` and its context] - MedlinePlus lists heart failure among the conditions for which cardiac rehabilitation is offered: Heart failure (`cardio:heart-failure`) - Filed under this front: Rehabilitation and living well (`cardio:front-rehabilitation-and-living-well`) - MedlinePlus lists a heart attack among the events after which it is offered: Heart attack (myocardial infarction) (`cardio:myocardial-infarction`) - MedlinePlus lists angioplasty among the procedures after which it is offered: Percutaneous coronary intervention (stents) (`cardio:pci`) - MedlinePlus lists heart valve repair or replacement among the procedures after which it is offered: Heart valve disease (`cardio:heart-valve-disease`) - Related to: MedlinePlus (`core:medlineplus`) - Related to: Low participation in cardiac rehabilitation among eligible patients (`cardio:bottleneck-low-cardiac-rehab-participation`) - Related to: After a heart attack: from the emergency to recovery (`cardio:reading-path-after-heart-attack`) - Related to: Living with a new heart-failure diagnosis (`cardio:reading-path-heart-failure`) - Related to: Living well with heart disease (`cardio:reading-path-living-well`) ## Provenance Content hash: 19d6272019aa96a56f5b290ed1a4a6df7637618831324ee02ba4b4ab834c815c Last substantive edit: 2026-10-15 Evidence last checked: 2026-10-15