Efficacy and safety of exercise rehabilitation across the valve intervention pathway: A systematic review and meta-analysis
- 1Department of Cardiac Surgery, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology
- 2Department of Urology, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, School of Medicine, University of Electronic Science and Technology of China
Abstract
Background: The benefits and safety of exercise-based rehabilitation across the valve intervention pathway remain uncertain. We assessed its effects on exercise capacity, cardiac function, postoperative recovery, and reported adverse events.
Methods: We searched eight English and Chinese databases for randomised controlled trials of rehabilitation initiated before, around, or after surgical or transcatheter valve intervention. Outcomes were 6-min walk distance (6MWD), peak oxygen uptake (peak VO ₂ ), left ventricular ejection fraction (LVEF), postoperative length of stay, reported adverse events, and pulmonary complications. Principal analyses used random-effects models. We assessed outcome-specific risk of bias with RoB 2 and evidence certainty with GRADE, and performed subgroup interaction and sensitivity analyses. PROSPERO registration: CRD420261509016.
Results: Twenty-nine trials were included. Rehabilitation increased 6MWD (19 trials; mean difference [MD] 40.95 m, 95% CI 27.10 to 54.81), peak VO ₂ [eight trials; standardised mean difference (SMD) 0.32, 0.07 to 0.57], and LVEF (14 trials; MD 4.41 percentage points, 2.26 to 6.56), and shortened postoperative hospital stay (16 trials; MD −1.77 days, −2.41 to −1.13). Reported adverse events were less frequent [14 estimable trials; risk ratio (RR) 0.53, 0.33 to 0.85], as were pulmonary complications (seven trials; RR 0.62, 0.50 to 0.77). Heterogeneity was substantial for 6MWD, LVEF, and hospital stay. Prediction intervals crossed the null for all outcomes except pulmonary complications. The peak VO ₂ result was no longer statistically significant after excluding high-risk results. Evidence certainty was low for pulmonary complications and very low for the other outcomes.
Conclusion: Exercise-based rehabilitation may improve functional and postoperative outcomes around valve intervention, but the magnitude and applicability of benefits remain uncertain. Diverse event definitions prevent the pooled adverse-event result from establishing exercise-specific safety. Larger trials with standardised interventions, outcome assessment, and longer follow-up are needed.
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BibTeX
@article{lin2026efficacy,
title = {{Efficacy and safety of exercise rehabilitation across the valve intervention pathway: A systematic review and meta-analysis}},
author = {Shanshan Lin and Haitao Wang and Ying Zhu and Dian Zhao and Tao Yu and Keli Huang and Xinlei He and Qin Jiang},
journal = {Frontiers in Cardiovascular Medicine},
year = {2026},
month = oct,
doi = {10.3389/fcvm.2026.2004830},
url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.2004830/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of exercise rehabilitation across the valve intervention pathway: A systematic review and meta-analysis
AU - Shanshan Lin
AU - Haitao Wang
AU - Ying Zhu
AU - Dian Zhao
AU - Tao Yu
AU - Keli Huang
AU - Xinlei He
AU - Qin Jiang
PY - 2026
DA - 2026/10/29
JO - Frontiers in Cardiovascular Medicine
DO - 10.3389/fcvm.2026.2004830
UR - https://www.frontiersin.org/articles/10.3389/fcvm.2026.2004830/full
AB - Background: The benefits and safety of exercise-based rehabilitation across the valve intervention pathway remain uncertain. We assessed its effects on exercise capacity, cardiac function, postoperative recovery, and reported adverse events. Methods: We searched eight English and Chinese databases for randomised controlled trials of rehabilitation initiated before, around, or after surgical or transcatheter valve intervention. Outcomes were 6-min walk distance (6MWD), peak oxygen uptake (peak VO ₂ ), left ventricular ejection fraction (LVEF), postoperative length of stay, reported adverse events, and pulmonary complications. Principal analyses used random-effects models. We assessed outcome-specific risk of bias with RoB 2 and evidence certainty with GRADE, and performed subgroup interaction and sensitivity analyses. PROSPERO registration: CRD420261509016. Results: Twenty-nine trials were included. Rehabilitation increased 6MWD (19 trials; mean difference [MD] 40.95 m, 95% CI 27.10 to 54.81), peak VO ₂ [eight trials; standardised mean difference (SMD) 0.32, 0.07 to 0.57], and LVEF (14 trials; MD 4.41 percentage points, 2.26 to 6.56), and shortened postoperative hospital stay (16 trials; MD −1.77 days, −2.41 to −1.13). Reported adverse events were less frequent [14 estimable trials; risk ratio (RR) 0.53, 0.33 to 0.85], as were pulmonary complications (seven trials; RR 0.62, 0.50 to 0.77). Heterogeneity was substantial for 6MWD, LVEF, and hospital stay. Prediction intervals crossed the null for all outcomes except pulmonary complications. The peak VO ₂ result was no longer statistically significant after excluding high-risk results. Evidence certainty was low for pulmonary complications and very low for the other outcomes. Conclusion: Exercise-based rehabilitation may improve functional and postoperative outcomes around valve intervention, but the magnitude and applicability of benefits remain uncertain. Diverse event definitions prevent the pooled adverse-event result from establishing exercise-specific safety. Larger trials with standardised interventions, outcome assessment, and longer follow-up are needed.
SN - 2297-055X
ER -