Cochrane Review: Exercise-Based Cardiac Rehabilitation Cuts Heart Attacks 28% and Hospital Admissions 35%

A Cochrane systematic review published September 17, 2026, has found that exercise-based cardiac rehabilitation reduces heart attacks by 28% and all-cause hospital admissions by 35% compared with no rehabilitation program, and probably reduces deaths, in people with coronary heart disease. The review, led by Dr. Grace Dibben and Professor Rod Taylor at the University of Glasgow, pooled data from 107 randomized controlled trials involving 26,886 participants, most of whom had experienced a heart attack, a revascularization procedure, or angina. The findings are most directly relevant to hospital and cardiology programs that refer patients to rehabilitation after a cardiac event, but they also inform community pharmacists who counsel patients on secondary prevention and medication adherence after discharge.

This update adds 22 new trials and nearly 3,500 participants to the existing evidence base, including studies from low- and middle-income countries testing culturally adapted formats such as yoga and tai chi. A key new finding is that home-based and digitally supported rehabilitation programs appear to work as well as traditional centre-based ones. "This new research shows you don't even have to go into a rehab centre to benefit -- you can participate from home and still see the benefits," said Dr. Dibben. Despite the evidence, uptake remains low in many health systems; the review cites UK national audit data showing participation rates of 44.5% in England and 71.3% in Wales among eligible acute coronary syndrome patients, figures the authors attribute partly to transport, work, and caregiving barriers that disproportionately affect women, older adults, and people in lower-income communities. Canada does not have an equivalent national audit cited in this review, but access barriers to in-person, hospital-based cardiac rehabilitation are a recognized issue here too, and the finding that home-based programs are comparably effective is directly relevant to closing that gap.

Practice guidance for pharmacists

• Ask patients recovering from a myocardial infarction, PCI, or cardiac surgery whether they have been referred to a cardiac rehabilitation program, and encourage a referral conversation with their prescriber if not.
• Reassure patients who are anxious about exercising after a cardiac event that appropriately prescribed activity is safe for most people and is part of evidence-based recovery, rather than a risk to avoid.
• Where a patient faces transportation, scheduling, or caregiving barriers to a centre-based program, mention that home-based and digitally supported cardiac rehabilitation options now have comparable evidence of benefit, so they can raise this with their care team.
• Use cardiac rehabilitation follow-up visits as a checkpoint for medication adherence review, since secondary-prevention drug therapy (antiplatelets, statins, beta-blockers, ACE inhibitors/ARBs) and structured exercise are complementary, not competing, interventions.
• Note that the review's benefits were shown across validated quality-of-life measures as well as hard cardiac outcomes, which can help motivate a patient who is more focused on daily functioning than long-term risk reduction.

The full review, an update of a Cochrane analysis first published in 2001, is available through the Cochrane Database of Systematic Reviews. The authors say further work is needed to understand how home-based and digital models perform for specific subgroups, including the women who remained underrepresented (17% of participants) across the pooled trials.