Home versus centre exercise-based cardiac rehabilitation after coronary artery bypass grafting: a systematic review and meta-analysis.

BACKGROUND

Exercise-based home-based cardiac rehabilitation (HBCR) is an alternative to exercise-based centre-based cardiac rehabilitation (CBCR) following coronary artery bypass grafting (CABG); however, its effects on functional capacity, psychological outcomes, and health-related quality of life remain uncertain.

OBJECTIVES

To evaluate exercise-based HBCR compared with exercise-based CBCR or usual care (UC) after CABG.

METHODS

The protocol was registered in PROSPERO (CRD420251238099) on 23 November 2025, followed by the formal systematic search on 25 November 2025 in PubMed (MEDLINE), Embase, Cochrane CENTRAL, Web of Science, and CINAHL. Randomized controlled trials comparing exercise-based HBCR with CBCR or UC were included. Outcomes included peak oxygen uptake (VO₂), waist-hip ratio (WHR), health-related quality of life (HRQoL), anxiety, and depression. Mean differences (MDs) with 95% confidence intervals (CIs) were pooled.

RESULTS

Nine trials (n = 991) were included. No significant difference in peak VO₂ was observed between HBCR and CBCR (MD = -0.22, 95% CI -1.24 to 0.80; I² = 0%). Anxiety favored HBCR over UC (MD = -2.85, 95% CI -5.05 to -0.65), but heterogeneity was extreme (I² = 90%). No significant difference in depression was observed (MD = -1.83, 95% CI -4.15 to 0.48; I² = 95%). HRQoL and body composition were each reported by only two studies and were not meta-analyzed.

CONCLUSION

Evidence suggests no significant difference in functional capacity between exercise-based HBCR and CBCR. Evidence for patient-reported and psychosocial outcomes remains limited and inconclusive, and no firm conclusions can be drawn. Findings should be interpreted cautiously given the small number of studies and substantial heterogeneity.