What question did this study set out to answer?

The aim was to explore if improvements in health-related quality of life mediate the effect of exercise-based cardiac rehabilitation on hospitalisation risk.

July 18, 2026European Journal of EpidemiologyOpen Access

Exercise-based cardiac rehab cuts 2-year all-cause hospitalization risk ~39%, mediated by improved quality of life.

Q: What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: coronary heart disease (n=3959). Intervention: Exercise-based cardiac rehabilitation (ExCR) vs. Usual care. Primary outcome: 2-year all-cause hospitalisation risk (HR 0.61, 95% CI 0.43-0.87).

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Why the study?

Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this mediated by improvements in health-related quality of life?

Population

3,959 people with coronary heart disease (pooled individual participant data from 5 RCTs published since 2010)

Comparison

Exercise-based cardiac rehabilitation (ExCR) vs Usual care

Design

Meta-analysis, Randomized to ExCR or usual care in the original trials

Follow-up

1 and 2 years

Key result

Exercise-based cardiac rehabilitation significantly reduced 2-year all-cause hospitalization risk (HR 0.61; 95% CI 0.43-0.87), an effect mediated by improvements in health-related quality of life.

Authors

IKI A De Koning AHA E Hiensch LBLaurien M. Buffart

Discussion

Member takes

Overview

HRQoL improvements mediate ExCR's effect on CHD hospitalizations; extends mechanistic understanding from pooled RCTs.

Key Points

The aim was to explore if improvements in health-related quality of life mediate the effect of exercise-based cardiac rehabilitation on hospitalisation risk.
Pooled individual participant data from five randomized controlled trials published since 2010
Participants were randomized to exercise-based cardiac rehabilitation or usual care
A one-stage meta-analysis assessed mediation effects on all-cause and cardiovascular disease-related hospitalisation risk
No significant reduction in 1-year hospitalisation risk; however, 2-year all-cause hospitalisation risk was reduced (HR 0.72, 95% CI: 0.45, 1.14)
CVD-related hospitalisation risk was significantly reduced at 2 years (HR 0.58, 95% CI: 0.33, 1.03)
Improvements in HRQoL mediated 2-year reductions in hospitalisation risk, with physical and mental dimensions significantly contributing.

Study Design

Type

Meta-Analysis (n=3,959)

Randomization

randomized

Multicenter

Yes

Structured PICO

Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this mediated by improvements in health-related quality of life?

Population

3,959 participants with coronary heart disease from five randomized controlled trials published since 2010, followed for up to 2 years.

Intervention

Exercise-based cardiac rehabilitation (ExCR)

Comparator

Usual care

Outcome

All-cause and cardiovascular disease (CVD)-related hospitalisation risk at 1- and 2-year follow-up, and mediation by health-related quality of life (HRQoL)hard clinical

Main Result

Hazard Ratio: 0.61 (95% CI 0.43–0.87)

Improvements in physical and mental health-related quality of life significantly mediate the reduction in hospitalizations seen with exercise-based cardiac rehabilitation in patients with coronary heart disease.

Cite This Study

Koning et al. (2026) conducted a meta-analysis in coronary heart disease (n=3,959). Exercise-based cardiac rehabilitation (ExCR) vs. Usual care was evaluated on 2-year all-cause hospitalisation risk (HR 0.61, 95% CI 0.43-0.87). Exercise-based cardiac rehabilitation significantly reduced 2-year all-cause hospitalization risk (HR 0.61; 95% CI 0.43-0.87), an effect mediated by improvements in health-related quality of life.

synapsesocial.com/papers/6a5b195c18557b26c203af99 https://doi.org/10.1007/s10654-026-01432-z

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July 18, 2026European Journal of EpidemiologyOpen Access

Exercise-based cardiac rehab cuts 2-year all-cause hospitalization risk ~39%, mediated by improved quality of life.

View Full Paper

Ask AI

Bookmark

Why the study?

Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this mediated by improvements in health-related quality of life?

Population

3,959 people with coronary heart disease (pooled individual participant data from 5 RCTs published since 2010)

Comparison

Exercise-based cardiac rehabilitation (ExCR) vs Usual care

Design

Meta-analysis, Randomized to ExCR or usual care in the original trials

Follow-up

1 and 2 years

Key result

Exercise-based cardiac rehabilitation significantly reduced 2-year all-cause hospitalization risk (HR 0.61; 95% CI 0.43-0.87), an effect mediated by improvements in health-related quality of life.

Authors

IKI A De Koning AHA E Hiensch LBLaurien M. Buffart

Discussion

Member takes

Overview

HRQoL improvements mediate ExCR's effect on CHD hospitalizations; extends mechanistic understanding from pooled RCTs.

Key Points

The aim was to explore if improvements in health-related quality of life mediate the effect of exercise-based cardiac rehabilitation on hospitalisation risk.
Pooled individual participant data from five randomized controlled trials published since 2010
Participants were randomized to exercise-based cardiac rehabilitation or usual care
A one-stage meta-analysis assessed mediation effects on all-cause and cardiovascular disease-related hospitalisation risk
No significant reduction in 1-year hospitalisation risk; however, 2-year all-cause hospitalisation risk was reduced (HR 0.72, 95% CI: 0.45, 1.14)
CVD-related hospitalisation risk was significantly reduced at 2 years (HR 0.58, 95% CI: 0.33, 1.03)
Improvements in HRQoL mediated 2-year reductions in hospitalisation risk, with physical and mental dimensions significantly contributing.

Study Design

Type

Meta-Analysis (n=3,959)

Randomization

randomized

Multicenter

Yes

Structured PICO

Does exercise-based cardiac rehabilitation reduce hospitalization risk in people with coronary heart disease, and is this mediated by improvements in health-related quality of life?

Population

3,959 participants with coronary heart disease from five randomized controlled trials published since 2010, followed for up to 2 years.

Intervention

Exercise-based cardiac rehabilitation (ExCR)

Comparator

Usual care

Outcome

All-cause and cardiovascular disease (CVD)-related hospitalisation risk at 1- and 2-year follow-up, and mediation by health-related quality of life (HRQoL)hard clinical

Main Result

Hazard Ratio: 0.61 (95% CI 0.43–0.87)

Cite This Study

synapsesocial.com/papers/6a5b195c18557b26c203af99 https://doi.org/10.1007/s10654-026-01432-z

Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

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