Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception to January 2020. Randomized controlled trials on the effects of maintenance CR in cardiovascular disease patients who had graduated from CR were included. Level of evidence was evaluated with GRADEPro. 819 citations were identified, with 10 trials (21 papers) included (5,238 participants; 859 (16.4%) female). Maintenance CR resulted in lower low-density lipoprotein (mean difference (MD) -0.58; 95% confidence interval (CI) -1.06 to -0.10, n = 392) and greater quality of life (MD 0.28, 95% CI 0.05 to 0.52, n = 118) when compared to usual care only. Outcomes for women and sex differences were mixed. In conclusion, maintenance programs appear to sustain patient's quality of life, but more focus on women's outcomes is needed.

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