Exercise-based cardiac rehabilitation reduces hospital admissions by a third and heart attack risk by more than a quarter, as well as remaining beneficial in the long term, a new Cochrane review finds.
The evidence also suggests that newer home-based and digitally-supported cardiac rehabilitation programmes can be just as effective as traditional centre-based services.
Coronary heart disease is the single most common cause of death globally.
It can lead to chest pain, heart attacks or stroke.
Cardiac rehabilitation programmes are widely recommended following a cardiac event, with exercise recognized as a core component.
The researchers, led by the University of Glasgow in Britain, analysed 107 randomised controlled trials involving 26,886 people with coronary heart disease.
Most participants had experienced a heart attack, undergone heart procedures or experienced some sort of chest pain.
The overall results show that, compared with no programme, exercise-based cardiac rehabilitation reduces heart attacks by 28%, reduces all-cause hospital admissions by 35% and probably reduces deaths.
Participants also reported better physical functioning, general health, vitality, social functioning and mental well-being.
“Many people lose confidence after a heart attack or cardiac procedure, and worry that physical activity could be dangerous,” says study lead author and postdoctoral research associate Dr Grace Dibben.
“Appropriately-prescribed exercise is not only safe for most patients, but can play a vital role in recovery and long-term heart health.”
This new update included 22 new clinical trials, with the more recent studies having participants based in low- and middle-income countries (LMICs), and testing home-based and digital cardiac rehabilitation programmes.
“This review confirms that exercise is a great tool for improving the overall health of people with coronary heart disease,” says study senior author and professor of Population Health Research Dr Rod Taylor.
“By adding newer studies to this update, we’re able to see that digital programmes work as well as in-person programmes, which really changes the game here.
"These approaches may help us reach people who cannot attend traditional centre-based services.”
The newer studies conducted in LMICs also examined different types of exercise in different countries, e.g. yoga in India and tai chi in China.
The authors suggest that this not only improves the relevance of the evidence base, but also that some populations may find rehabilitation built around traditional and cultural forms of exercise more appealing than conventional, machine-based rehab.
Despite strong evidence supporting cardiac rehabilitation, uptake remains a challenge in many healthcare systems.
Various guidelines, including NICE (National Institute for Health and Care Excellence) in Britain, recognise cardiac rehabilitation as a key component following a cardiac event.
However, cardiac rehabilitation continues to be widely underused with generally low participation rates.
According to the British 2025 National Audit of Cardiac Rehabilitation (NACR) report, the uptake of cardiac rehabilitation for patients with acute coronary syndrome was 44.5% in England and 71.3% in Wales.
The study authors explain that many patients face barriers to attending traditional hospital-based programmes, including work commitments, transport challenges and caring responsibilities.
This can disproportionately impact groups like women, older adults and deprived communities the hardest.
“Exercise-based cardiac rehabilitation is an inexpensive and cost-effective intervention, but right now, it's underfunded and unprioritised,” explains Dr Dibben.
“We want this option to be available to everyone.
"This new research shows you don't even have to go into a rehab centre to benefit – you can participate from home and still see the benefits.”
