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=26.97m; 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 VO2peak, 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.