Following a cardiac event patients are returning home and back to work earlier than ever before. The Heart Manual continues to be the dominant intervention in home-based cardiac rehabilitation due to its ability to adapt and fit into everyday life, while respectful of other health conditions. The Heart Manual programmes are the only home based cardiac rehabilitation program with RCT evidence​​​ based on a UK population.

Following the seminal publication by Lewin et al (1992)1, there has been a wealth of robust evidence which has seen the Heart Manual cited in at least 390 peer reviewed articles and become a notable benchmark worldwide. If you would like to use the highly acclaimed Scottish programmes, please contact us at heart.manual@nhslothian.scot.nhs.uk. 

Evidence supporting the Heart Manual derives from a diverse range of studies. This includes systematic reviews, meta-analyses and clinical reviews of cardiac rehabilitation programs, as well as studies on the efficacy of home based cardiac rehabilitation. Evidence has also highlighted the Heart Manual’s efficacy in comparison to traditional cardiac rehabilitation, as well as proving cost-effective.

The Heart Manual has also informed National Guidelines, Professional Competence Guidelines and Government Policies, as seen below.

Recent Publications

  • Deighan C, Michalova L, Pagliari C, Elliott J, Taylor L, Ranaldi H. The Digital Heart Manual: pilot study of an innovative cardiac rehabilitation programme developed for and with users. Patient Education and Counselling. 2017. Available from: doi: 10.1016/j.pec.2017.03.014
  • Hanschke V, Manataki A, Alexandru C, Papapanagiotou P, Deighan C, Taylor L, Robertson D. Designing a Social Machine for the Heart Manual Service. In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies - Volume 5: HEALTHINF. Portugal: Biomedical Engineering Systems and Technologies, 2017.

Key studies:


Due to the large number of studies involving the Heart Manual, the following are those which are published by high impact journals.

  • ​Dalal HM, Doherty P, Taylor RS. Cardiac rehabilitation. BMJ: British Medical Journal. 2015;351. Available from: doi:http://dx.doi.org/10.1136/bmj.h5000. 
  • Dalal HM, Zawada A, Jolly K, Moxham T, Taylor RS. Home based versus centre based cardiac rehabilitation: Cochrane systematic review and meta-analysis. BMJ: British Medical Journal. 2010;340. Available from: doi:10.1136/bmj.b5631.
  • Sandesara PB, Lambert CT, Gordon NF, Fletcher GF, Franklin BA, Wenger NK, et al. Cardiac rehabilitation and risk reduction: Time to “rebrand and reinvigorate”. Journal of the American College of Cardiology. 2015;65(4): 389-395. Available from: doi:10.1016/j.jacc.2014.10.059.

  • Jolly K, Lip GYH, Taylor RS, Rafferty J, Mant J, Lane D. The Birmingham rehabilitation uptake maximisation study (BRUM): a randomised controlled trial comparing home-based with centre-based cardiac rehabilitation. Heart 2009;95(1):36-42. Available from: doi:10.1136/hrt.2007.127209.

  • Dalal HM, Evans PH, Campbell JL, Taylor RS, Watt A, Read KLQ et al. Home-based versus hospital-based rehabilitation after myocardial infarction: A randomized trial with preference arms - Cornwall Heart Attack Rehabilitation Management study (CHARMS). International Journal of Cardiology. 2007;119(2):202-211. Available from: doi:10.1016/j.ijcard.2006.11.018.

  • Taylor RS, Watt A, Dalal HM, Evans PH, Campbell JL, Read KL et al. Home-based cardiac rehabilitation versus hospital based rehabilitation: A cost effectiveness analysis. International Journal of Cardiology. 2006;119(2):196-201. Available from: doi:10.1016/j.ijcard.2006.07.218.

  • Heron N, Kee F, Donnelly M, Cardwell C, Tully M, Cupples M. Behaviour change techniques in home-based cardiac rehabilitation: a systematic review. British Journal of General Practice. 2016. Available from: doi: 10.3399/bjgp16X686617.

  • Clark RA, Conway A, Poulsen V, Keech W, Tirimacco R, Tideman P. Alternative models of cardiac rehabilitation: a systematic review. European Journal of Preventive Cardiology. 2013;22(1):35-74. Available from: doi:10.1177/2047487313501093.

  • Clark M, Kelly T, Deighan C. A systematic review of the Heart Manual literature. European Journal of Cardiovascular Nursing. 2011;10(1): 3-13. Available from: doi:10.1016/j.ejcnurse.2010.03.003.

  • Lacey E, Musgrave A, Freeman RJ, Tod, AM, Scott, P. Psychological morbidity after myocardial infarction in an area of deprivation in the UK: Evaluation of a self-help package. European Journal of Cardiovascular Nursing. 2004;3(3):219 - 224. Available from: doi:10.1016/j.ejcnurse.2004.06.005.

  • Mc Clure T, Haykowsky MJ, Schopflocher D, Hsu Zy, Clark AM. Home-based secondary prevention programs for patients with coronary artery disease: a meta-analysis of effects on anxiety. Journal of Cardiopulmonary Rehabilitation and Prevention. 2013;33(2):59-67. Available from: doi:10.1097/HCR.0b013e3182828f71.

  • Soares D, Magalhaes S, Viamonte S. Home Based Programs and Application of New Technologies in Cardiac Rehabilitation. International Journal of Physical Medicine & Rehabilitation. 2013;1(7). Available from doi:10.4172/2329-9096.1000158.

  • Blair J, Corrigall H, Angus NJ, Thompson DR, Leslie S.  Home versus hospital-based cardiac rehabilitation: A systematic review.  Rural and Remote Health. 2011;11(2):1532. Available from: http://www.rrh.org.au/articles/subviewnew.asp?ArticleID=1532.


National Guidelines:

  • Irish Association of Cardiac Rehabilitation. Cardiac Rehabilitation Guidelines. Dublin: Irish Association of Cardiac Rehabilitation; 2013.

  • National Institute for Health and Care Excellence. MI: Secondary Prevention. [CG172]. London: National Institute for Health and Care Excellence; 2013.

Professional Competence Guidance:

  • Roth AD. & Pilling SA. Competence framework for working with people with persistent physical health problems. London: University College, 2015.


Government Policies:






1 Lewin B, Robertson IH, Cay EL, Irving JB, Campbell M. Effects of self help post-myocardial-infarction rehabilitation on psychological adjustment and use of health services. Lancet. 1992;339(8800):1036-40​