Effect of exercise intensity and volume on mortality and hospitalization in patients with coronary artery disease: a systematic review and pairwise and exploratory network meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: MICT: RR 0.66 for both overall and cardiovascular hospitalization; VICT: RR 0.35 for cardiovascular hospitalization

• Primary Outcome: Overall hospitalization and cardiovascular hospitalization

• Nnt Or Sensitivity: SUCRA rankings: MICT 70.6% (overall hospitalization), 80.1% (cardiovascular hospitalization); VICT 94.1% (cardiovascular hospitalization)

• Confidence Interval: MICT overall hospitalization: 0.47-0.95; MICT cardiovascular hospitalization: 0.44-0.99; VICT cardiovascular hospitalization: 0.14-0.92

Clinical Application

Moderate-intensity continuous training is feasible in most cardiac rehabilitation programs; vigorous-intensity requires careful patient selection and monitoring Aligns with RACGP guidelines for cardiac rehabilitation; Medicare rebates available for structured cardiac rehabilitation programs; supports current Heart Foundation exercise recommendations Adults with established coronary artery disease suitable for exercise training

Abstract

AIMS: To ascertain the impact of varying exercise intensities and volumes on clinical outcomes of patients with coronary artery disease (CAD) via a systematic review and meta-analysis. METHODS AND RESULTS: This study included randomized controlled trials to evaluate the effects of different intensity levels and volumes of exercise training and control interventions on clinical outcomes in patients with CAD. Data from eight databases were screened, extracted, and assessed for quality by two independent reviewers. Included studies were categorized into subgroups based on exercise intensity and volume. A random-effects model was used to conduct a meta-analysis of different outcomes. To further explore the combined effects, an exploratory network meta-analysis was performed, combining exercise intensity and exercise volume. Exercise training reduces the risk of cardiovascular mortality, overall hospitalization and cardiovascular hospitalization. In subgroup analyses, both moderate-intensity and continuous training significantly reduce the risk of overall hospitalization. Furthermore, the network meta-analysis shows that moderate-intensity continuous training (MICT) significantly lowers the risk of overall hospitalization [(risk ratio (RR) = 0.66, 95% confidence interval (CI): 0.47-0.95), surface under the cumulative ranking curve (SUCRA) = 70.6%] and cardiovascular hospitalization (RR = 0.66, 95% CI: 0.44-0.99, SUCRA = 80.1%) compared with usual care. In contrast to usual care, vigorous-intensity continuous training (VICT) lowers the risk of cardiovascular hospitalization (RR = 0.35, 95% CI: 0.14-0.92, SUCRA = 94.1%). CONCLUSION: MICT significantly reduces the risk of overall hospitalization and cardiovascular hospitalization. Although the evidence is limited, VICT appears to reduce the risk of cardiovascular hospitalization. Consequently, it may become an effective exercise-based intervention for preventing such events. REGISTRATION: PROSPERO: CRD42024519198.

References

1. 1.Dong, J., Zhang, L., Xu, J., Yang, C., Cheng, Y., Jiang, X., Xing, J., Wang, C., & Zheng, M. (2026). Effect of exercise intensity and volume on mortality and hospitalization in patients with coronary artery disease: a systematic review and pairwise and exploratory network meta-analysis. European Journal of Cardiovascular Nursing. https://doi.org/10.1093/eurjcn/zvaf233