Exercise-based cardiac rehabilitation reduces the risk of heart attack and hospital admission in people with coronary heart disease. An updated Cochrane review, co-authored by Radboudumc researchers, combined 107 randomized studies involving 26,886 patients worldwide.
Exercise-based cardiac rehabilitation reduces the risk of another heart attack and hospital admission in people with coronary heart disease. An updated Cochrane review, co-authored by researchers from Radboudumc, brings together 107 randomized studies involving 26,886 patients worldwide. The review was published in the Cochrane Database of Systematic Reviews.
Compared with no structured exercise program, participation in exercise-based cardiac rehabilitation was associated with 28% fewer heart attacks and 35% fewer hospital admissions. Participants also reported improvements in physical functioning, general health, vitality, social functioning, and mental well-being. The evidence also indicates that cardiac rehabilitation is cost-effective and may reduce mortality.
“Cardiac rehabilitation is already an established part of care, but many patients who are eligible still do not participate,” says Niels Stens, researcher at Radboudumc and co-author of the review. “Keeping the evidence up to date is important. It shows that the benefits remain highly relevant in contemporary cardiac care and across different healthcare settings.”
Combining all available evidence
A Cochrane review systematically combines the results of randomized controlled trials according to strict predefined methods. This makes it possible to assess the overall evidence across many individual studies rather than relying on the findings of a single trial.
The new publication is the fifth version of this long-running review and includes 22 additional randomized studies. The evidence is current through March 2026. The previous version is also an important evidence source for the recently published 2026 European Society of Cardiology guidelines on cardiac rehabilitation, which recommend cardiac rehabilitation after acute and chronic coronary syndromes to reduce cardiovascular mortality, heart attacks, and hospital admissions.
“The strength of a review like this is its scale,” says Dick Thijssen, researcher at Radboudumc and co-author. “By bringing together evidence from many randomized studies, we can estimate the effects much more robustly. The message is clear: exercise-based cardiac rehabilitation improves outcomes that really matter to patients.”
Reaching more patients
Despite these benefits, participation in cardiac rehabilitation remains relatively low in many countries. Traditional programs can be difficult to attend because of travel, work, or caring responsibilities.
The latest review includes more studies from low- and middle-income countries as well as newer home-based and digitally supported rehabilitation programs. This broadens the evidence beyond traditional rehabilitation delivered at specialized centers and could help make cardiac rehabilitation accessible to more patients.
Stens: “The newer studies show that cardiac rehabilitation does not necessarily have to follow one traditional model. Home-based and digitally supported approaches offer important opportunities to reach people who currently miss out.”
Radboudumc researchers Frederique de Vries, Niels Stens, and Dick Thijssen contributed to the review. The study was led by researchers from the University of Glasgow.
About the publication
Dibben G, de Vries FBG, Faulkner J, et al. (2026). Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database of Systematic Reviews, CD001800. DOI: 10.1002/14651858.CD001800.pub5.
