BACKGROUND: Optimal physical activity levels have health benefits for patients with an acute coronary syndrome (ACS) and are an important goal of cardiac rehabilitation (CR). PURPOSE: To systematically review literature regarding short-term (< 6 months after completion of CR) and long-term effects (>= 6 months after completion) of standard CR on physical activity levels in patients with ACS. DATA SOURCES: PubMed, Embase, CINAHL and PEDro were systematically searched from 1990 till 2012. STUDY SELECTION: Randomized clinical trials (RCTs) investigating CR for patients with ACS reporting physical activity level. DATA EXTRACTION: Two reviewers independently selected articles, extracted data and assessed methodological quality. Result were summarized with a best-evidence synthesis. Results were categorized in: (1) centre-based/home-based CR versus no intervention, (2) comparison of different durations of CR, (3) comparison of two types of CR. DATA SYNTHESIS: A total of 26 RCTs was included. Compared to no intervention, there was at most conflicting evidence for centre-based CR and moderate evidence for home-based CR for short-term effectiveness. Limited and no evidence was found for long-term maintenance for centre-based and home-based CR respectively. When directly compared to centre-based CR, moderate evidence showed that home-based CR has better long-term effects. There was no clear evidence that increasing training volume, extending duration of CR or adding an extra intervention to CR is more effective. LIMITATIONS: Because of variety in included RCTs in CR interventions and outcome measures, pooling of data was not possible. Therefore, we used a best-evidence synthesis. CONCLUSIONS: It would appear that centre-based CR is not sufficient to improve and maintain physical activity habits. Home-based programmes might be more successful, but literature on this is limited. More research on finding successful interventions to improve activity habits is needed.

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