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IHD Chest Pains – Helps to prevent Risk of further heart attacks

Evidence summary (Updated 2022)
A small body of good quality randomised controlled data shows physical activity and cardiac rehabilitation will reduce the risk of further cardiac events(1–4).
A large meta-analysis of over 1000 participants who underwent PCI for cardiovascular disease showed that risk of cardiac death, chest pain and future myocardial infarction was significantly reduced.(5)
However Long et al found low grade evidence for risk reduction in exercise-based cardiac rehabilitation in preventing MI (RR 0.33, 95% CI 0.07 to 1.63; 254 participants; 3 studies) and cardiovascular-related hospital admissions (RR 0.14, 95% CI 0.02 to 1.1; 101 participants; 1 study; very low-quality evidence).(6)

A recent Cochrane review found reductions in the risk of repeat myocardial infarction in both the short term?(RR 0.72, 95% CI 0.55 to 0.93; 22 trials; number needed to treat for an additional beneficial outcome (NNTB) 75, 95% CI 47 to 298; high certainty evidence) and long-term(RR 0.67, 95% CI 0.50 to 0.90; 10 trials).(7)

Quality of Evidence
B – moderate quality

Strength of recommendation
1 – strong recommendation

Physical activity can be recommended to reduce the risk of further cardiac events in most patients with ischaemic heart disease and should be undertaken unless there are compelling reasons NOT to do so. There is however some conflicting evidence with less significant findings.


  1. Belardinelli R, Paolini I, Cianci G, Piva R, Georgiou D, Purcaro A. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 37:1891–1900.
  2. Taylor. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. (ue 7. Art. No: CD001800).
  3. Lawler. Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: A systematic review and meta-analysis of randomized controlled trials. Am Hear J Oct. 162:571–584.
  4. Hambrecht R, Walther C, Mobius-Winkler S, Gielen S, Linke A, Conradi K, et al. Percutaneous coronary angioplasty compared with exercise training in patients with stable coronary artery disease: a randomized trial. Circulation. 109(1371):1378.
  5. Zhang H, Chang R. Effects of Exercise after Percutaneous Coronary Intervention on Cardiac Function and Cardiovascular Adverse Events in Patients with Coronary Heart Disease: Systematic Review and Meta-Analysis. J Sports Sci Med [Internet]. 2019 [cited 2022 Oct 7];18(2):213. Available from: /pmc/articles/PMC6543998/
  6. Long L, Anderson L, Dewhirst AM, He J, Bridges C, Gandhi M, et al. Exercise-based cardiac rehabilitation for adults with stable angina. Cochrane database Syst Rev [Internet]. 2018 Feb 2 [cited 2022 Oct 7];2(2). Available from:
  7. Dibben G, Faulkner J, Oldridge N, Rees K, Thompson DR, Zwisler AD, et al. Exercise-based cardiac rehabilitation for coronary heart disease. Cochrane database Syst Rev [Internet]. 2021 Nov 6 [cited 2022 Oct 8];11(11). Available from: