The European Society of Cardiology recommends cardiac rehabilitation (CR) that includes exercise training to treat people after heart valve surgery. However, the strength of evidence supporting this intervention is uncertain.

This Cochrane Review summarizes the current evidence to assess the benefits and harms of exercise-based CR compared with no exercise training in adults following heart valve surgery or repair, including both percutaneous and surgical procedures.

This is an update of a Cochrane Systematic Review (CSR) published in 2016. The CSR included six trials published and/or registered up to January 10, 2020, with a total of 364 adult participants.

The exercise-based interventions consisted of combined aerobic and resistance training that began from one day to three months after surgery. In some cases, it also included a psychological intervention and an exercise training element, both undertaken before the surgery. The dose and intensity of training prescribed ranged from 20 to 60 minutes per session in two to three sessions per week, except for one trial that recommended up to four hours per day. The total duration of the exercise programs ranged between trials from approximately one month to more thanthree months.

The evidence to support exercise-based CR is lacking; furthermore, the quality of the available evidence was very low. Therefore, the authors are uncertain whether exercise-CR reduces mortality, hospitalization, and health-related quality of life in adults who underwent heart valve surgery. High-quality (low risk of bias) evidence on the impact of CR is needed to inform clinical guidelines and routine practice.

Comment by Francesco Agostini