BACKGROUND: Determine whether true exercise-associated interindividual response differences (IIRD) occur in cardiorespiratory fitness as a result of exercise-based cardiac rehabilitation in heart transplant patients. METHODS: Using data from a recent (2023) meta-analysis of 9 randomized controlled trials representing 296 patients (163 exercise, 133 control), an aggregate data meta-analysis of treatment effects (change outcome differences between exercise and control groups) was conducted as well as an IIRD meta-analysis using the inverse variance heterogeneity model. The primary outcome was cardiorespiratory fitness (VO 2max) in ml/kg/min. RESULTS: Statistically significant and clinically important increases equivalent to 14.5% were observed for VO 2max in ml/kg/min (X 3.0, 95% confidence interval (CI) 2.4 to 3.7 ml/kg/min, p < 0.001; Q 11.8, p = 0.16; I2 32.0%, 95% CI 0% to 68.8%; Tau2 0.4). The 95% prediction interval (PI) was 1.2 to 4.7 ml/kg/min. However, no statistically significant IIRD were observed (X 0.6, 95% CI -1.1 to 1.4 ml/kg/min; Tau2 2.9). The 95% PI was -2.7 to 2.8 ml/kg/min. CONCLUSIONS: While exercise-based cardiac rehabilitation increases VO 2max in ml/kg/min in heart transplant patients, a lack of true exercise-associated IIRD exists. A need exists for additional well-designed randomized controlled trials of longer duration to determine the long-term effects of exercise-based cardiac rehabilitation on VO 2max in ml/kg/min heart transplant patients.

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