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IHD – Improves energy, fitness and quality of life

Evidence summary (Updated 2022)
A large body of good quality randomised controlled data shows consistent improvements in cardiovascular fitness(1–10 ) and quality of life(4,11–14). These two factors combined will undoubtedly improve a patient’s self-reported energy(15). Cardiorespiratory fitness is also a strong predictor for mortality and heart failure in individuals with IHD.
Overall QoL improvements are seen in several studies across a number of interventions including HIIT(16), resistance and aerobic training(17), yoga(18) and Tai Chi(19). Long et al were unable to draw conclusions about the impact of exercise-based cardiac rehabilitation on HR-QoL (Health related quality of life score) but did find low quality evidence in 5 studies supporting improvements in exercise capacity (standardised mean difference (SMD) 0.45, 95% CI 0.20 to 0.70).(20) The recent Cochrane review showed the exercise-based CR improved HRQoL though the improvement was small and not always clinically meaningful.(21)
When assessing individual intervention types yoga compared to controls was found to significantly improve QoL (SMD, 0.07; 95%CI, 0.01-0.14).(18) Tai Chi was found to be superior to other low-intensity exercise interventions but not as effective as HIIT in improving VO2 max.(19) This was further confirmed in a SR and MA in which Tai Chi groups showed a large and significant improvement in aerobic endurance compared with both active and non-active control interventions (standard mean difference (SMD) 1.12; 95% confidence interval (CI): 0.58-1.66; p <0.001) and a significant improvement in QoL (SMD=0.73; 95%CI: 0.39 to 1.08, p<0.001).(22)

Combined resistance and aerobic training is effective at significantly improving cardiopulmonary exercise function(p<0.0001) however there was high heterogeneity across the 38 studies of 2465 participants (i2=81%).(17) Resistance training is more effective than aerobic training at increasing muscle strength and aerobic capacity.(17) And HIIT was found to be superior to moderate intensity continuous training in improving fitness in a systematic review of 953 participants(23) and in a number of other studies.(24,25) A further review looking at HIIT versus moderate continuous intensity exercise of 1272 participants showed fitness (VO2max, peak power and anaerobic threshold).(16) The improvements seen in HIIT training were found to be significant regardless of the frequency, duration, and type of HIIT training.(26)

A SR and MA of over 13000 participants considered the intensity of the aerobic exercise intervention and the affect on peak VO2 in patients with IHD, post myocardial infarction and revascularisation. While moderate, moderate to vigorous and vigorous intensity exercise all produced improvements in peak VO2 there was no clinically meaningful difference between intensities.(27)

Quality of evidence
B – Moderate quality

Strength of recommendation
1 – Strong


There is evidence to support improvements in this group of patients with cardiovascular disease in QoL, fitness and energy outcomes. However, a recent Cochrane review did not find all outcomes to be of a good quality of evidence.
When considering intervention type and intensity there is evidence supporting a wide range of activities at varying intensities


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