{
  "abstract": "Background: Traditional centre-based cardiac rehabilitation (CBCR) reduces cardiovascular mortality but suffers from suboptimal participation due to logistical barriers. Hybrid cardiac rehabilitation (Hybrid CR) has emerged as a flexible alternative, yet previous reviews have treated it as a monolithic intervention. This study evaluated the comparative effectiveness of Hybrid CR versus CBCR, stratified by delivery model structure: “front-loaded” (initial intensive centre-based block) versus “mixed” (concurrent alternating sessions).\n\nMethods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing Hybrid CR with CBCR. PubMed/MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, and EMBASE were searched through October 2025. Outcomes included functional capacity (peak exercise oxygen uptake, VO₂peak; metabolic equivalents, METs; 6-minute walk distance), Health-Related Quality of Life (HRQoL), program attrition, and cardiovascular risk factors. Data were pooled using random-effects models.\n\nResults: Twelve RCTs (n = 1,383) met the inclusion criteria. Hybrid CR showed no statistically significant difference compared with CBCR for functional capacity (Hedges’ g = 0.13, 95% CI -0.02 to 0.27; p = 0.09). Subgroup analysis showed no statistically significant differences for both front-loaded (g = 0.16) and mixed (g = 0.07) models. Program attrition did not differ significantly between groups (log RR = 0.03, p = 0.44). No significant differences were observed for lipid profiles or blood pressure. While overall HRQoL was similar between hybrid CR and CBCR, a mixed-model subgroup represented by a single study showed lower HRQoL compared with CBCR (g = − 0.86), identifying a potentially important outcome pattern that requires confirmation in additional studies. The certainty of evidence varied by outcome and was high for 6-minute walk distance, low for peak oxygen uptake, and very low for HRQoL and cardiometabolic outcomes.\n\nConclusions: Hybrid CR showed functional-capacity outcomes comparable to traditional CBCR, with no statistically significant differences observed between front-loaded and mixed delivery structures. However, certainty of evidence varied across outcomes and was limited for several secondary outcomes, particularly HRQoL and cardiometabolic measures. Further high-quality trials are needed to confirm whether specific hybrid delivery structures offer differential benefits.\n\nPROSPERO registration: CRD420251170627.\n\nSupplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12872-026-06388-2.",
  "abstract_shown": true,
  "affiliations": [
    "Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, Malaysia",
    "Department of Health, Sport, and Human Physiology, University of Iowa, Iowa City, USA",
    "Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, Malaysia"
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 5,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Runhao Li"
    },
    {
      "affs": [
        0
      ],
      "name": "Zhe Zhang"
    },
    {
      "affs": [
        1
      ],
      "name": "Gary L. Pierce"
    },
    {
      "affs": [
        2
      ],
      "name": "Anwar Bin Suhaimi"
    },
    {
      "affs": [
        0
      ],
      "name": "Selina Khoo"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/90x3ax35ky2va.bib",
  "cited_by": 0,
  "doi": "10.1186/s12872-026-06388-2",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13737676/",
  "id": "90x3ax35ky2va",
  "issns": [
    "1471-2261"
  ],
  "landing_url": "https://doi.org/10.1186/s12872-026-06388-2",
  "language": "en",
  "licence": "CC-BY-NC-ND-4.0",
  "licence_label": "CC BY-NC-ND 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc-nd/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Systematic Review"
    ],
    [
      "openalex",
      "2705|Cardiac Health and Mental Health"
    ]
  ],
  "openalex": "W7201961940",
  "pdf_url": null,
  "pmcid": "PMC13737676",
  "pmid": "42983642",
  "published": "2026-08-08",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/90x3ax35ky2va.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:22:48Z",
      "native_id": "PMC13737676",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s12872-026-06388-2"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiac Health and Mental Health",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Front-loaded and mixed delivery models in hybrid cardiac rehabilitation: a systematic review and meta-analysis",
  "title_text": "Front-loaded and mixed delivery models in hybrid cardiac rehabilitation: a systematic review and meta-analysis",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:22:48Z",
  "url": "https://research.draconitic.com/paper/90x3ax35ky2va",
  "venue": "BMC Cardiovascular Disorders",
  "versions": []
}