Women less likely to complete cardiac rehabilitation programs

Regardless of what type of cardiac rehabilitation program they are enrolled in, women have poor attendance despite proven health benefits, researchers reported in Mayo Clinic Proceedings.

“Participating in a cardiac rehab program greatly reduces death and hospitalization, as well as helps in improving the quality of life for heart patients,” Sherry L. Grace, PhD, a health faculty member at York University and senior scientist at the University Health Network, both in Toronto, said in a press release.

Despite this, recent research including a meta-analysis published in the Canadian Journal of Cardiology in 2014 found that women utilized cardiac rehabilitation less than men.

To explore the reasons why women have poorer adherence to cardiac rehabilitation, Grace and colleagues conducted CR4HER, a single blind, three parallel-arm, pragmatic, randomized controlled trial. The researchers assigned participants to one of the following cardiac rehabilitation programs: supervised mixed-sex, supervised women-only or home-based. They measured adherence to the program as well as improvements in exercise capacity.

One hundred sixty-nine low-risk patients with CAD were randomly assigned into the three cardiac rehabilitation groups after baseline assessments that included a self-report survey. Twenty-seven (16%) women did not attend the program at all, and 43 (25.4%) attended a different type of cardiac rehabilitation than what they were assigned. According to Grace and colleagues, the mean percentage of prescribed sessions attended overall was 54.46 ± 35.14%. For just those who enrolled in cardiac rehabilitation after referral, the mean percentage of prescribed sessions attended was 63.6 ± 29.29%.

Only 90 participants completed their cardiac rehabilitation program; of those, 58 (64.4%) had both pre- and postcardiac rehabilitation cardiopulmonary exercise testing. Six participants did not complete their program because of poor health.

In an as-treated analysis, home-based cardiac rehabilitation participants attended a higher percentage of sessions (75.32%) compared with women-only participants (59.94%) and mixed-sex participants (65.51%; P < .05).

Overall, functional capacity increased for all women (P < .001). The researchers also found that women assigned at-home cardiac rehabilitation had lower functional capacity after the program than women assigned mixed-sex cardiac rehabilitation (P < .05). Functional capacity was measured as peak volume oxygen consumption per minute on the exercise stress test.

The researchers cited some limitations of their study and cautioned against broad interpretation of the findings. Many women did not attend the cardiac rehabilitation to which they were assigned, and the home-based program was based on adherence to phone calls only, not exercise, and so participants might not have exercised at the same intensity level as those participants in the supervised cardiac rehabilitation programs. The sample size was small and the secondary outcome of improvements in functional capacity was only measured in half of the sample.

“Clearly, other means to improve women’s adherence to the cardiac rehabilitation program than program model choice are warranted,” Grace and colleagues wrote.

However, the researchers suggested that alternate program models should not be completely ruled out as way to increase women’s adherence to cardiac rehabilitation.

“The results suggest that women should be encouraged to participate in cardiac rehab, offering them the program model of their choice,” study researcher Liz Midence, MSc, a PhD candidate at York University, said in the release.

For example, women with caregiving or transportation issues might prefer a home-based program, whereas other women might prefer going into the center for exercise classes. Because of body image issues, some women might also prefer women-only classes.

“We should inform women of the benefits of cardiac rehab and use all the tools at our disposal to promote their full participation,” Midence said. – by Tracey Romero

Disclosure: The researchers report funding by the Heart and Stroke Foundation of Ontario.