Exercise Parameters and Outcome Measures Used in Cardiac Rehabilitation Programs Following Median Sternotomy in the Elderly: A Systematic Review and Meta-Analysis

Objective: The aim of this systematic review was to identify exercise parameters and outcome measures used in cardiac rehabilitation programs following median sternotomy, in the elderly cardiac population. Data Sources: Five (5) electronic databases were searched for relevant studies published in English after 1997. Study Selection: The screening process was completed by two independent researchers, with a third independent reviewer for overall agreement. Studies were selected if they included only cardiac patients aged ≥65 years who had undergone valve surgery and/or coronary artery bypass grafting via median sternotomy, and who had undertaken a postoperative cardiac rehabilitation exercise intervention assessing physical function and/or cognitive recovery as outcomes. Data Extraction: Two researchers independently completed the data extraction and quality assessment. Quality was assessed using a modified Downs and Black tool. Data Synthesis: In total, 11 articles were included for appraisal with respect to the quality of the study. Only two randomised controlled trials were suitable for meta-analysis. A higher volume of exercise was shown to have a positive effect on functional recovery, assessed using the 6-minute walk test (6MWT) (mean difference = 26.97 m; 95% confidence interval [CI], 6.96–46.97; p = 0.008; I² = 0%). No significant improvement was shown between additional exercise compared to standard care in improving VO_2peak, maximal power output or quality of life. No studies evaluated the effect of exercise on cognitive recovery. Conclusions: Exercise significantly improves functional recovery in the post-surgical elderly cardiac population, however uncertainty still exists with regard to which modes of exercise and their specific parameters are most effective in improving cognitive recovery.