GENDER DIFFERENCES IN CARDIAC REHABILITATION

doi:10.1016/S0733-8651(05)70382-9

Cardiology Clinics

Volume 16, Issue 1, 1 February 1998, Pages 37-43

https://doi.org/10.1016/S0733-8651(05)70382-9 Get rights and content

It is now widely recognized that comprehensive cardiac rehabilitation has substantial benefits in patients with cardiovascular disease. In addition to a reduction in mortality, well-established benefits include an improvement in exercise tolerance, decreased symptoms of angina and dyspnea, optimization of blood lipid levels, and an overall improvement in psychosocial well-being.³⁵ Despite the fact that cardiovascular disease is the leading cause of death for women in the United States with more than 250,000 deaths each year, most studies of cardiac rehabilitation have not included a substantial number of women. Furthermore, because of the small number of women included in the meta-analysis outcome studies of cardiac rehabilitation, it is not clear whether the mortality benefits demonstrated in men apply to women.22, 23

Section snippets

WOMEN IN CARDIAC REHABILITATION

There are fundamental differences in the profile of female cardiac patients compared with male patients in cardiac rehabilitation. Women, on average, are 10 years older than men when they initially present with symptoms of cardiovascular disease and are nearly 20 years older than men at the time of occurrence of a myocardial infarction.¹⁵ This is reflected in the observation that women entering cardiac rehabilitation are older than men.⁵ Women also tend to have more comorbid conditions than

DETERMINANTS OF PARTICIPATION IN CARDIAC REHABILITATION

Despite the proven benefits of cardiac rehabilitation, studies have shown that only a small percentage of patients eligible for cardiac rehabilitation actually participate.¹⁴ In a study of patients 62 years or older, Ades and co-workers² reviewed various factors that predicted cardiac rehabilitation participation. Only 15% of women eligible entered an early outpatient rehabilitation program compared with 25% of men. Multivariate analysis revealed that the strength of the recommendation from the

OUTCOMES OF CARDIAC REHABILITATION

It is well documented that supervised exercise training results in improved measures of exercise tolerance (e.g., total treadmill time, maximal oxygen consumption) in cardiac patients.22, 23, 35 For most of these studies, however, populations were made up of more than 80% men, with many studies enrolling exclusively male patients. As previously mentioned, women begin cardiac rehabilitation programs at a lower level of cardiopulmonary fitness as measured by maximal oxygen uptake (V o₂ max in

PROGRAM ISSUES

The medical and psychosocial needs of men and women in cardiac rehabilitation differ, and this must be recognized in all aspects of rehabilitation program design such that positive outcomes and adherence can be maximized. As mentioned previously, women benefit from more social support and more interactions with staff and other patients than do men. One simple suggestion that came from the focus group study of Moore¹⁸ was to use name tags. Recognizing that women are more likely to have more

CONCLUSIONS

Female cardiovascular patients differ from male patients in baseline clinical and physiologic profiles. Studies that have analyzed the effects of cardiac rehabilitation protocols frequently did not include women or did not have sufficient numbers to analyze outcomes of female patients separately. When the female response to cardiac rehabilitation has been systematically studied, similar benefits as seen in men have generally been demonstrated. In fact, some researchers, such as Cannistra and

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Cited by (39)

Geographic issues in cardiac rehabilitation utilization: A narrative review
2010, Health and Place
Citation Excerpt :
Female non-attendees rated transportation problems (2.85±1.49) significantly higher than male non-attendees (2.42±1.35; p<0.05). Indeed, the unique constellation of characteristics of female cardiac patients such as being more likely to be a widow, have a dependent spouse, live alone, and lack social support when compared with men (Carhart and Ades, 1998) may also explain why transportation might be a more important factor than distance in CR underutilization for women. Future research is needed to explore whether provision of transportation through shuttle buses for instance may have positive effects on women's geographic barriers for CR.
The purpose of this study was to review the current evidence regarding the relationship between geographic indicators and cardiac rehabilitation (CR) utilization among coronary heart disease (CHD) patients.
Seventeen articles were identified for inclusion, where nine studies assessed rurality, 10 studies assessed travel time/distance, and two of these studies assessed both. Nine of the 17 studies (52.9%) showed a significant negative relationship between geographic barrier and CR use. Four of the 17 studies (23.5%) showed a null relationship, while four studies (23.5%) showed mixed findings. Inconsistent findings identified appeared to be related to restricted geographic range, regional density, and socioeconomic status.
Overall, 52.9% of the identified studies reported a significant negative relationship between geographic indicators and CR utilization. This relationship appeared to be particularly consistent in North American and Australian settings, but somewhat less so in the United Kingdom where there is greater population density and availability of public transport.
Exercise and heart rate recovery
2006, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
Cannistra and colleagues23 reported similar results in their study in which women increased the MET level by 30%. Several studies have shown that there was no significant difference in improvement of exercise capacity, represented by MET level, between men and women.22 Men and women in this study improved their HRR at similar rates, which was a consistent finding with other measures of exercise improvement.
This study examines whether heart rate recovery (HRR) improves as a result of exercise training during cardiac rehabilitation (CR).
A retrospective study was performed that included 100 patients who completed phase II CR and had entry and exit exercise stress tests. HRR was compared for the sample. Improvements in HRR were compared between gender and age groups. Correlation between age and HRR was performed.
The total sample improved HRR (P = .020). There was no significant difference in the improvement of HRR based on gender, indicating males and females improve at similar rates (P = .833). Similarly, there was no significant difference in the improvement of HRR based on age, indicating older subjects improve similarly to younger subjects (P = .700). There was no relationship between age and HRR; therefore, as age increases there is no decrease in HRR.
HRR improves in patients who complete CR.
Effect of cardiac rehabilitation on functional outcomes after coronary revascularization
2003, American Heart Journal
Background Current guidelines recommending cardiac rehabilitation (CR) after coronary revascularization are largely based on early studies that evaluated only a subset of the population and failed to assess the impact of CR on a patient's perception of their functional status. The main objective of this study was to evaluate the impact of CR in a diverse contemporary population on patient functional outcomes. Methods We studied the effect of CR on 6-month SF-36 Physical Functioning (PF) in 700 patients (mean age 67 ± 11 years, 37% women) who underwent coronary bypass grafting or percutaneous intervention from August 1998 to July 2000. Results Overall CR participation was 24%. At baseline, CR participants had higher PF (mean 62.5 vs 52.5, P < .001). After adjusting for baseline clinical variables and PF score, CR was associated with significant improvement in 6-month PF (+5.0, 95% CI 1.0-9.0). This improvement was observed in all patient subgroups, but tended to be greater in magnitude in men versus women, patients aged <70 years versus ≥70 years, and patients with coronary bypass grafting versus patients with percutaneous intervention. CR participants also tended to be more likely to engage in regular exercise (63% vs 55%, P = .06) and modify their diet (82% vs 73%, P = .07). Rates of rehospitalization and repeat revascularization were similar among CR participants and nonparticipants. Conclusions CR after coronary revascularization is associated with improved functional outcomes and adoption of secondary preventive measures. Innovative strategies to facilitate CR enrollment and tailoring programs to better address the needs of all patient subgroups would extend these benefits to more eligible patients. (Am Heart J 2003;145:445-51.)
Listening to patients: Choice in cardiac rehabilitation
2006, European Journal of Cardiovascular Nursing
'Add women & stir' - The biomedical approach to cardiac research!
2004, European Journal of Cardiovascular Nursing
The Comparison of High-Intensity Interval Training Versus Moderate-Intensity Continuous Training after Coronary Artery Bypass Graft: A Systematic Review of Recent Studies
2022, Journal of Cardiovascular Development and Disease

View all citing articles on Scopus

: Address reprint requests to Robert L. Carhart, Jr, MD, Cardiovascular Division, SUNY-HSC at Syracuse, 750 East Adams Street, Syracuse, NY 13210

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GENDER DIFFERENCES IN CARDIAC REHABILITATION

Section snippets

WOMEN IN CARDIAC REHABILITATION

DETERMINANTS OF PARTICIPATION IN CARDIAC REHABILITATION

OUTCOMES OF CARDIAC REHABILITATION

PROGRAM ISSUES

CONCLUSIONS

Am Heart J

Am J Cardiol

Am J Cardiol

Am Heart J

Lancet

Predictors of cardiac rehabilitation participation in older coronary patients

Arch Intern Med

Skeletal muscle and cardiovascular adaptations to exercise conditioning in older coronary patients

Circulation

Exercise conditioning in older coronary patients: Submaximal lactate response and endurance capacity

Circulation

Differences in the use of procedures between women and men hospitalized for coronary heart disease

N Engl J Med

Coronary angiographic changes with lovastatin therapy: The Monitored Atherosclerosis Regression Study (MARS)

Ann Intern Med

A case-management system for coronary risk factor modification after acute myocardial infarction

Ann Intern Med

A comparison of the recovery period for women and men after an acute myocardial infarction

Heart Lung

A physiologic comparison of young and older athletes

J Appl Physiol

The relationship of upper body obesity and cardiovascular risk factors in mildly-obese premenopausal women

J Cardiopulm Rehabil

Distribution of adipose tissue and risk of cardiovascular disease and death: A 12 year follow up of participants in the population study of women in Gothenburg, Sweden

BMJ

Scientific evidence of the value of cardiac rehabilitation services with emphasis on patients following myocardial infarction: Section I. Exercise conditioning component [position paper]

J Cardiopulm Rehabil

Recovery from myocardial infarction and coronary artery bypass surgery in women: Psychosocial factors

J Women Health