Effects of Exercise on Aerobic Capacity and Quality of Life in Patients with Coronary Heart Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Abstract

Purpose

This study aimed to investigate the effects of exercise on aerobic capacity and quality of life (QOL) in coronary heart disease (CHD) patients and to determine the optimal exercise prescription for this patient population.

Methods

We conducted a comprehensive search across Embase, PubMed, Cochrane, Web of Science, and Scopus, encompassing data published up to April 21, 2026. Data were pooled utilizing the standardized mean difference (SMD) and 95% confidence interval. Studies were included if they met the following criteria: (1) randomized controlled trials (RCTs); (2) comprised both an intervention arm and a control arm whose participants maintained normal daily activities, habitual routines, or received standard care; (3) focused on CHD patients; and (4) used peak oxygen uptake (VO_2peak), maximal oxygen consumption (VO_2max), or QOL as outcome measures. Data were pooled utilizing the standardized mean difference (SMD) and 95% confidence interval, and methodological quality was appraised with the Cochrane Risk of Bias tool for randomized trials.

Results

A total of 23 articles met the inclusion criteria. Exercise significantly improved aerobic capacity (SMD, 0.65, P < 0.001) and QOL (SMD, 0.42, P < 0.001) in CHD patients. Aerobic exercise (aerobic capacity, SMD, 0.76, P < 0.001; QOL, SMD, 0.49, P = 0.003), exercise conducted for > 3 times per week (aerobic capacity, SMD, 0.71, P < 0.001; QOL, SMD, 0.68, P = 0.01), < 60 min per session (aerobic capacity, SMD, 0.72, P < 0.001; QOL, SMD, 0.57, P < 0.001), < 180 min per week (aerobic capacity, SMD, 0.75, P = 0.002; QOL, SMD, 0.70, P < 0.001) were more effective in improving aerobic capacity and QOL.

Conclusion

Exercise significantly augments aerobic capacity and, consequently, QOL in CHD patients. Aerobic protocols characterized by sessions shorter than 60 min, executed more than three times weekly, and totaling fewer than 180 min per week conferred the greatest improvements in both endpoints. However, the review is constrained by potential performance bias arising from the inherent unblinding of exercise interventions, the confounding possibility of spontaneous recovery in post-coronary artery bypass graft patients, and residual heterogeneity attributable to the diversity of QOL assessment instruments employed. The protocol is registered with PROSPERO, registration number CRD42024591105.

Keywords

Exercise / Coronary heart disease / Aerobic capacity / Quality of life

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