1. In this systematic review and meta-analysis, the addition of exercise to usual care in patients with cardiovascular disease, hypertension, and type 2 diabetes was associated with improvements in all-cause mortality and serious adverse events.

2. Additionally, there were no significant differences in these findings across regions or between types of exercise and duration of follow-up.

Evidence Rating Level: 1 (Excellent)

Cardiovascular disease puts a significant burden on the healthcare system, and hypertension and type 2 diabetes remain the most prevalent risk factors and comorbidities of cardiovascular disease. Although exercise is one of the most important lifestyle interventions for cardiovascular disease, there has been limited research evaluating its benefits on important outcomes such as mortality risk, serious adverse events, and quality of life. As a result, the objective of the present systematic review and meta-analysis was to assess the effects of adding exercise to usual care in patients with hypertension, type 2 diabetes, and cardiovascular disease.

Of 32,739 identified records, 950 trials (n=21,633) were included in the analysis from database inception to 2020. All trials that evaluated the effects of adding exercise to usual care in patients with either hypertension, type 2 diabetes, or cardiovascular disease were included. The review was conducted according to PRISMA guidelines. Risk of bias was assessed using the Cochrane risk of bias tool. Statistical analyses were performed using fixed-effect and random effect models. The primary outcomes were all-cause mortality, serious adverse events, and quality of life.

The results demonstrated that exercise added to usual care conferred a benefit with respect to all-cause mortality and serious adverse events. There was also a benefit of added exercise on quality of life, however the effect size was small. Furthermore, there were no differences in outcomes based on region, type of exercise, duration of follow-up, or type of participants. Despite these findings, the study was limited by the high risk of bias, primarily due to the methodology of the included trials, which may have overestimated the benefits of exercise. Nonetheless, these results provided further evidence to suggest that exercise may improve important outcomes, such as all-cause mortality, for those with cardiovascular disease.

Click to read the study in British Journal of Sports Medicine

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