Exercise-based cardiac rehabilitation offers lasting heart health benefits

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 programs can be just as effective as traditional center-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 programs are widely recommended following a cardiac event, with exercise recognized as a core component. 

Effective and inexpensive intervention 

The researchers, led by the University of Glasgow, analyzed 107 randomized 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. Women were underrepresented, making up only 17% of participants despite being included in most studies. 

The overall results show that, compared with no program, 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 wellbeing. These benefits were seen across several validated quality-of-life measures. 

Our review shows that exercise-based cardiac rehabilitation can reduce the risk of heart attack and hospital admission while helping people return to healthier, more active lives."

Dr. Grace Dibben, lead author, University of Glasgow

"Many people lose confidence after a heart attack or cardiac procedure and worry that physical activity could be dangerous," Dr Dibben adds. "Appropriately prescribed exercise is not only safe for most patients, but can play a vital role in recovery and long-term heart health." 

Growing evidence for modern rehabilitation models

This new update included 22 new trials featuring just under 3,500 participants, incorporating more recent data into the final results. The more recent studies included participants based in low- and middle-income countries (LMICs) and tested home-based and digital cardiac rehabilitation programs. 

"This review confirms that exercise is a great tool for improving the overall health of people with coronary heart disease," says Professor Rod Taylor, senior author from the University of Glasgow. "By adding newer studies to this update, we're able to see that digital programs work as well as in-person programmes, which really changes the game here. These approaches may help us reach people who cannot attend traditional center-based services." 

Several studies in this update were conducted in LMICs, examining different types of exercise in different countries; for example, yoga in India and tai chi in China. The authors suggest this not only improves the relevance of the evidence base, but that some populations may find rehabilitation built around traditional and cultural forms of exercise more appealing than conventional, machine-based rehab. 

Low uptake despite evidence-backed benefits 

Despite strong evidence supporting cardiac rehabilitation, uptake remains a challenge in many healthcare systems. Various guidelines, including NICE in the UK, recognize 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 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 authors explain that many patients face barriers to attending traditional hospital-based programs, 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 unprioritized," 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 center to benefit – you can participate from home and still see the benefits."