Cardiac Rehabilitation In Women Research Articles

Cardiac Rehabilitation in Older u.s. Women: Challenges and Opportunities

Despite its documented benefit and Class Ia recommendations in most cardiovascular clinical practice guidelines of the American Heart Association/American College of Cardiology, cardiac rehabilitation is woefully underutilized in older U.S. women. Numerous studies document the decreased application of cardiac rehabilitation in women compared to men and in older compared to younger patients, with this intersection creating a perfect storm for older women with cardiovascular disease. This manuscript summarizes the challenges presented by this situation and offers opportunities for improvement of cardiovascular care for older women.

Cardiac rehabilitation in women. Have we improved care in recent years?

Abstract Funding Acknowledgements Type of funding sources: None. Main funding source(s): Ninguna. Introduction Cardiovascular disease is the main cause of morbidity and mortality worldwide, but there are inequalities in diagnosis and treatment between men and women. Although there is greater awareness of cardiovascular disease in women, diagnostic techniques are less used in women, they receive fewer pharmacological and invasive treatments, and have less access to cardiac rehabilitation. Objective To compare the assistance offered to men and women in our Cardiac Rehabilitation Unit up to 2018 with the assistance given from 2019 to 2022. Methods Patients treated in the Cardiac Rehabilitation Unit before 2018 (group 1) and from 2019 to 2022 (group 2) were analyzed, comparing the characteristics of male and female patients, as well as the attendance rate to Cardiac Rehabilitation and treatments indicated. Results In group 1, we analyzed the data of 399 patients, 19.8% women. In group 2, which included 167 patients, the rate of women rose to 26.3%, this difference being statistically significant (p<0. 05). Women were older than men in both groups (63 vs 59 years in group 1; 64 vs 59 years in group 2), less smokers (26.3% vs 57.3% in group 1; 25% vs 50.4% in group 2). The percentage of hypertensive patients was the same in both sexes in group 2. Until 2018, fewer coronary angiographies were performed on women (94% vs 99%, p<0.05); however, in the second period (group 2, 2019-2022), the percentage was similar in both sexes, (96% vs 98%, p= n.s.). Revascularization is less, possibly due to the characteristics of coronary disease in women (Table 1). Lipid-lowering treatments are used equally in both groups (Table 1). Conclusion In recent years, care for cardiovascular disease in women has been improving. The percentage of women who are included in Cardiac Rehabilitation program and who undergo coronary angiography has increased. The raising awareness that this disease has the same severity in both sexes has allowed the optimal medical treatment implemented to be similar.

Exercise-based cardiac rehabilitation in women with heart failure: a review of enrollment, adherence, and outcomes.

Exercise-based cardiac rehabilitation (CR) is an evidence-based recommendation for patients with stable heart failure (HF). Less clear is how effective exercise-based CR is for women with HF. The aim of this review was to synthesize the evidence for the effects of exercise-based CR on mortality, hospitalizations, exercise capacity, and quality of life (QOL) among women with HF. We identified 18 studies comprising 4917 patients, of which 1714 were women. The interventions evaluated consisted of various combinations of supervised in-hospital and out-patient sessions as well as home-based programs that included aerobic (walking, treadmill, bicycle) and resistance training. The interventions ranged from 12 to 54weeks, with a frequency of 2-7 sessions per week, lasting from 30 to 105min per session. Because of a paucity of sex-specific analyses of the outcomes, it was not possible to draw conclusions for women. There was limited evidence for mortality benefit for men or women participating in exercise-based CR. There was more substantial evidence for reductions in hospitalizations for the participants. Generally, exercise training improved exercise capacity. The effects of exercise-based CR on QOL were mixed with most studies favoring CR at 3months but not at 4, 5, and 12months. Moreover, generally, the physical dimension of QOL but not the mental dimensions improved. Recommendations for future research to reduce the gap in knowledge about the effects of exercise-based CR for women are offered.

Cardiac transplant and exercise cardiac rehabilitation.

Cardiac transplantation is the final therapeutic option for patients with end-stage heart failure. Most patients experience a favorable functional ability post-transplant. However, episodes of acute rejection, and multiple comorbidities such as hypertension, diabetes mellitus, chronic kidney disease and cardiac allograft vasculopathy are common. The number of transplants has increased steadily over the past two decades with 3,817 operations performed in the United States in 2021. Patients have abnormal exercise physiologic responses related to surgical cardiac denervation, diastolic dysfunction, and the legacy of reduced skeletal muscle oxidative capacity and impaired peripheral and coronary vasodilatory reserve resulting from pre-transplant chronic heart failure. Cardiorespiratory fitness is below normal for most patients with a mean peak VO2 of approximately 60% of predicted for healthy persons. Cardiac transplant recipients are therefore excellent candidates for Exercise-Based Cardiac Rehabilitation (CR). CR is safe and is a recommendation of professional societies both before (pre-rehabilitation) and after transplantation. CR improves peak VO2, autonomic function, quality of life, and skeletal muscle strength. Exercise training reduces the severity of cardiac allograft vasculopathy, stroke risk, percutaneous coronary intervention, hospitalization for either acute rejection or heart failure, and death. However, there are deficits in our knowledge regarding CR for women and children. In addition, the use of telehealth options for the provision of CR for cardiac transplant patients requires additional investigation.

Clinical Outcomes of Cardiac Rehabilitation in Women with Coronary Artery Disease-Differences in Comparison with Men.

This study evaluated the clinical outcomes of cardiac rehabilitation (CR) in women with coronary artery disease (CAD) in comparison to men. Methods: Patients after acute coronary syndrome or after revascularization procedures (106 women, 180 men) were consecutively admitted to a comprehensive outpatient CR program, comprising of 45-min ergometer interval training three times a week for eight weeks. The training intensity was determined on the basis of training heart rate, calculated following an exercise test. Patients were divided into subgroups according to age (≤55, >55 years), BMI (<25, ≥25 kg/m2), left ventricular ejection fraction (LVEF; ≤40%, 41–49%, ≥50%), and number of affected coronary vessels. Results: After eight weeks, exercise capacity increased significantly by 0.6 ± 0.77 MET (women) and by 1.0 ± 0.74 MET (men). The greatest benefit was observed in men, women under 55 years, women with LVEF 41–49%, and women with single-vessel CAD. An outpatient CR program appears less beneficial for women, especially those over 55 years, with two or three coronary vessels affected with atherosclerosis or with LVEF > 50%. In women with CAD, eight weeks of 45-min interval training, with sessions three times a week, is insufficient to improve exercise capacity to an extent that is considered a predictor of mortality risk reduction.

Underutilization of Cardiac Rehabilitation in Women: BARRIERS AND SOLUTIONS.

Despite the known benefits of cardiac rehabilitation (CR), it remains underutilized particularly among women. The aim of this review was to provide an overview regarding women in CR, addressing barriers that may affect enrollment and attendance as well as to discuss the training response and methods to optimize exercise-related benefits of CR. The review examines original studies and meta-analyses regarding women in CR. Women are less likely to engage in CR compared with men, and this may be attributed to lack of referral or psychosocial barriers on the part of the patient. Furthermore, despite having lower levels of fitness, women do not improve their fitness as much as men in CR. This review summarizes the current literature and provides recommendations for providers regarding participation and adherence as well as optimal methods for exercise training for women in CR.

Enhancing the appeal of cardiac rehabilitation for women: development and pilot testing of a women-only yoga cardiac rehabilitation programme.

Despite its demonstrated benefits, cardiac rehabilitation (CR) attendance, and completion is suboptimal, particularly in women. The aims of this study were (i) to develop and pilot test a women-only yoga-based CR programme (the Women's Yoga CR Programme; WYCRP); (ii) to investigate programme acceptability; and (iii) to investigate attendance and completion of the WYCRP and continuation to Phase III community-based CR. Women eligible for CR at a tertiary hospital in Melbourne, Australia were recruited. Over a 6-month period in 2019, they were offered the WYCRP or usual CR. The WYCRP involved attendance at a 1-h yoga session following the usual 1-h mixed-sex education session, over a 7-week period. Participants completed pre- and post-programme questionnaires and attended focus groups to assess programme acceptability. Rates of attendance, completion, and continuation for the WYCRP were recorded and compared to those for the standard CR programme offered in 2018. In total, 27 women were eligible for the study and attended the initial CR assessment. Of those, 22 (81%) attended the WYCRP, 1 (4%) attended usual CR, and 4 (15%) did not attend CR. Ratings of programme acceptability were consistently positive; qualitative comments highlighted both physical and emotional benefits. While attendance at the WYCRP was not significantly higher than for usual CR the previous year (81% vs. 76%; P = 0.40), CR completion, and continuation were (95% vs. 56%; P = 0.02, and 72% vs. 12%; P < 0.001, respectively). This pilot study has demonstrated that women-only yoga-based CR is appealing to women and can improve women's CR completion and continuation. These preliminary findings support further development of women-only and yoga-based CR options.

Cardiac rehabilitation in women; comparison of enrollment, adherence and outcomes between heart failure and coronary artery disease

BackgroundThere is paucity of data on cardiac rehabilitation (CR) enrollment and outcomes in women with heart failure (HF). MethodsIn this retrospective analysis, we compared enrollment, adherence and outcomes between women with HF versus coronary artery disease (CAD)-related indications referred to a university-affiliated CR program from June 2014–July 2018. A multivariate regression analysis was performed to adjust for imbalanced variables at baseline and baseline value of each outcome to compare change in outcomes between HF and CAD groups ResultsA total of 538 women (HF=63 vs CAD=475) were included in the study. At baseline, women with HF were younger, had lower attendance to CR intake and worse perceived health, higher AACVPR risk category and lower exercise capacity but had similar enrollment, weight and dieatry habits when compared to women with CAD. Adjusted analyses showed that almost all cardiac rehabilitation outcomes except for positive affect (anxiety, depression symptoms, negative affect, dietary habits, perceived physical and mental health summary scores, exercise duration and capacity) improved significantly from baseline and in a similar fashion in both groups. Weight loss was significantly greater for women with CAD versus those with HF (CAD: Δ -1.12 ± 2.23 kg versus HF: Δ -0.66 ± 2.78 kg, p = 0.03). ConclusionDespite a lower attendance to CR intake, lower perceived physical health and higher baseline AACVPR risk in women with HF, they have similar CR enrollment, adherence and completion rates compared to women with CAD. Both groups showed significant but similar improvements from baseline in almost all cardiac rehabilitation outcomes. These findings should alert cardiology providers to help overcome obstacles for women with HF to attend CR intake.

Exercise training in women with cardiovascular disease: Differential response and barriers - review and perspective.

Exercise-based cardiac rehabilitation has a class 1A recommendation in coronary artery disease and heart failure based on its beneficial effects on mortality, morbidity and quality of life. However, the inter-individual response to exercise training is highly variable and influenced by both training and patient characteristics. Notably, men and women display a different training response, even when accounting for age, height and lean muscle mass. Most studies investigating exercise effects on various physiological outcomes focus on male patients. Because women are understudied, the scientific evidence for tailored exercise prescription in women is still limited. This narrative review summarises: (a) the underlying physiological determinants of the response to exercise training in women with cardiovascular disease, in which women rely more on fat than on carbohydrate oxidation during exercise, have lower aerobic capacities and smaller increases in cardiac function during exercise; (b) the benefits and barriers of exercise in women, in whom improving cardiometabolic risk and quality of life is weighed against socioeconomic and psychological needs; and (c) the relevance of different clinical endpoints in exercise trials such as maximum oxygen uptake, morbidity, mortality, training characteristics, quality of life and metabolic or vascular endpoints. Finally, we provide a perspective on how to improve referral, enrolment and adherence to exercise training in women, with structured approaches to inform the referring physician as well as the patient, and offering more flexible, gender-tailored or tele/smartphone-based programmes while addressing the socioeconomic and psychological needs of the patients. This may ultimately improve the admission, adherence and outcome of exercise-based cardiac rehabilitation in women.

The Effects of Cardiac Rehabilitation on Mortality and Morbidity in Women: A META-ANALYSIS ATTEMPT.

Cardiac rehabilitation (CR) is associated with significant reductions in mortality and morbidity, but few women are included in trials. Therefore, a meta-analysis of the effects of CR in women is warranted. Randomized controlled trials from recent systematic reviews that included women attending comprehensive CR and reporting the outcomes of mortality and morbidity (hospitalization, myocardial infarction, bypass surgery, percutaneous coronary intervention) were considered for inclusion. An updated search of the literature was performed from the end date of the last search, based on the Cochrane strategy. Authors were contacted to provide results on women where none were reported. On the basis of 2 recent systematic reviews, 80 trials were identified. Fifty (62.5%) were excluded, most commonly due to lack of inclusion of women (n = 18; 22.5%). One trial was identified through the search update. Of 31 potential trials meeting inclusion criteria, 1 reported results on women and many were old, and hence data by sex were no longer available. Ultimately, data for women were available in 2 trials. Therefore, it was deemed inappropriate to undertake this meta-analysis. This review corroborates the dearth of data on CR in women despite the fact that cardiovascular disease is the leading cause of death in women. Given the totality of evidence, including reductions in mortality and morbidity in nonrandomized studies, and evidence of benefit for other important outcomes such as functional capacity and quality of life, women should continue to be referred to CR.

Benefit of cardiac rehabilitation in women: An experience of French centre

Cardiac rehabilitation consists of measures that allow patients to recover their functional capacity through physical exercise and secondary prevention measures. The aim of our study was to evaluate the impact of cardiac rehabilitation in French women compared to men. It's a retrospective study included 1700 patients admitted in cardiac rehabilitation centre of Léopold-Bellan hospital, Paris, France. All of them had clinical examination, an electrocardiogram, echocardiography, biological test and Ergospirometry. We included 439 women (group 1) and 1261men (group 2). The average age of patients was 62.8 ± 12.1 years in group 1 and 63.1 ± 12.4 years in group 2, they had more than three cardiovascular risk factors, hypertension and dyslipidemia was more frequent in women, they were overweight with an BMI at 28.9 ± 7.9 kg/m 2 in group 1 and 26.2 ± 7.3 kg/m 2 in group 2, clinical examination was normal. Transthoracic Echocardiography showed preserved Left-Ventricular ejection fraction (52.6 ± 12.9% in group 1 and 53.3 ± 12.4% in group 2). After 20 sessions of cardiac rehabilitation, patients showed lower BMI, especially in women (26.4 ± 5.3 kg/m 2 ),a significant improvement in the maximal work load, from 68.2 ± 25.6 to 91.2 ± 35.2 watt ( P = 0.01) in women and from 90.43 ± 34.1 to 110.37 ± 40.7 watts in men, a significant improvement in VO2max, from 17.1 ± 3.6 to 21.5 ± 6.3 mL/kg/min ( P = 0.01) in women and from 20.5 ± 5.1 to 23.2 ± 6.9 mL/kg/min ( P = 0.02) in men. This study demonstrates that cardiac rehabilitation is benefit for both men and women, to improve their exercise capacity and reduce their cardio vascular risk factors especially in women.

Cardiac rehabilitation in women: state of the art and strategies to overcome the current barriers.

: Cardiac rehabilitation is able to reduce cardiovascular mortality, and improves functional capacity and quality of life. However, cardiac rehabilitation participation rates are low and the current evidence has demonstrated sex differences for the access to cardiac rehabilitation programs. In this review, we discuss the benefits of cardiac rehabilitation in women with a specific focus on ischemic heart disease, heart failure, cardiac rehabilitation after cardiac surgery and after transcatheter aortic valve implantation, and peripheral artery disease. We also analyse the current limitations to cardiac rehabilitation for women in terms of accessibility and indications, reporting general, sex-specific, and healthcare-related barriers. Finally, we discuss the potential solutions and areas of development for the coming years.

Association Between Severity of Depression and Cardiac Risk Factors Among Women Referred to a Cardiac Rehabilitation and Prevention Clinic.

Depression comorbid with cardiovascular disease is associated with higher rates of morbidity and mortality, with studies suggesting that this is especially true among women. This study examined depressive symptoms and their relationship to cardiac risk factors among women referred to a women's cardiac rehabilitation and primary prevention program. A secondary analysis of data collected between 2004 and 2014 for 1075 women who completed a baseline assessment at the Women's Cardiovascular Health Initiative, a women-only cardiac rehabilitation and prevention program in Toronto, Canada. Descriptive statistics for sociodemographic variables, quality of life (SF-36), and cardiac risk factors were stratified by depression symptom severity using cutoff scores from the Beck Depression Inventory-2nd version (BDI-II) and compared with analysis of variance and χ statistics. Prevalence of antidepressant use among those with moderate to high depressive symptoms was assessed as an indicator of under- or untreated depression. Overall, 38.6% of women scored above the BDI-II cutoff for depression; 23.6% in the moderate or severe range. Socioeconomic status and quality of life decreased with increasing depression severity. Body mass index increased with depressive severity (P < .001), as did the percentage of individuals with below target age predicted fitness (P < .001). Only 39.0% of women in the moderate and severe BDI-II groups were taking antidepressants. In this sample, we found a significant prevalence of untreated and undertreated depressive symptoms among women with, or at high risk of developing, cardiovascular disease. Additional strategies are needed to identify these patients early and link them to appropriate treatment.

Rehabilitación cardiovascular en la mujer

Cardiac rehabilitation has proven to have an important impact on diminishing morbidity and mortality in patients with cardiovascular disease who access it. However, it has been shown to be generally underutilized, especially by women, secondary to specific factors related to gender differences. This favors the emergence of a higher incidence of comorbidity and disability, with individual health costs for patients, and irreparable social costs. Participation in, and adherence to, cardiac rehabilitation programs is lower for women than men, while the benefits and results are evident in both men and women. Cardiac rehabilitation in women requires adjustments in exercise prescriptions, the approach to goals, the type of communication, and the educational tools used as part of the strategy to combat barriers to patient access, permanence and program completion.

Cardiac Rehabilitation for Women.

Cardiac rehabilitation provides comprehensive secondary prevention services and improves outcomes among patients with coronary heart disease, systolic heart failure, and other cardiac rehabilitation indications. Worldwide, cardiac rehabilitation services are underutilized. Underutilization is more common among women than in men. This chapter reviews barriers to referral, enrollment, and adherence among women and potential interventions to improve women's participation in cardiac rehabilitation. Gender similarities and differences in clinical, behavioral, and health outcomes of cardiac rehabilitation are addressed, and gaps in the evidence base are discussed, pointing to areas of future research.

Enhancing Cardiac Rehabilitation in Women.

Enhancing Cardiac Rehabilitation in Women.

Women May Benefit From Cardiac Rehabilitation Programs Tailored to Their Specific Needs.

Women are much less likely than men to complete cardiac rehabilitation with only ≈15% to 20% of eligible women participating in comparison with 22% to 30% of eligible men. There are many reasons for this divide. Women are less likely to receive a referral for cardiac rehabilitation than men (39.6% versus 49.4%) even though the American Heart Association’s guidelines for treating women with cardiovascular disease recommend rehabilitation. “Women are less likely to get referred,” said Sherry L. Grace, a professor in the School of Kinesiology and Health Science at York University and the University Health Network in Toronto. “We also know that if they are referred they are less likely to go. There are structural and system barriers that we still need to address and overcome.” The onset of heart disease is often later in women than in men, and many women may be widowed, not able to drive, or otherwise lack the support they need to get to rehabilitation sessions, Grace explained. They may find exercising tiring or painful. They also may have caregiver responsibilities that hold them back from participating. “They put their family responsibilities in front of their health,” she said. To help boost women’s participation, some studies have found that tailoring cardiac rehabilitation programs …

Review of best practice in cardiac rehabilitation for women

Purpose: Cardiovascular disease is defined as damage to, or narrowing of, arteries due to atherosclerosis and is the leading cause of mortality and morbidity among women worldwide. Cardiovascular disease is recognized to be both a leading cause of mortality and an undertreated condition for women. The goals of this review manuscript are to present the current background literature specific to cardiac rehabilitation programs for women and serve as a knowledge translation strategy to help raise therapists’ awareness of the need for cardiac rehabilitation programs specifically designed for female patients. Methods: A review of best practice literature in cardiac rehabilitation for women. Results: With current increasing trends in risk factors, including stress, obesity, poor diet, smoking, and a sedentary lifestyle, the future burden could be overwhelming from the perspective of individuals’ health and health authorities’ resources. Conclusions: Emerging research clearly demonstrates the need for cardiac rehabilitation programs tailored for women and highlighting the unique features of program delivery that can reduce the risk of under-referral and treatment program dropout.

Cardiac Rehabilitation for Women

Traditionally women have been underrepresented in studies evaluating the efficacy of cardiac rehabilitation (CR). Yet, the available evidence suggests that CR is at least equally effective and for some outcome measures may be more effective in women compared to men. Despite these documented benefits, CR is underutilized in women, particularly older women. Many of the obstacles that deter women from enrolling and completing CR sessions have been identified and acknowledged by physicians and preventive health organizations. Despite a general understanding that exercise-based CR is a step toward a healthy life-style and ought to be undertaken to restore functional capacity and quality of life, only a minority of patients and healthcare providers are aware that CR is documented to save lives. Hence, CR should be regarded as equally important as adherence to pharmacologic secondary prevention measures, or – expressed differently – not participating in CR equals not filling the prescriptions after hospital discharge. This review highlights recent evidence for the benefits of CR on morbidity and mortality of women with cardiovascular diseases and suggests approaches to improve CR participation.

Cardiac rehabilitation and the therapeutic environment: the importance of physical, social, and symbolic safety for programme participation among women

To report an exploration of the multidimensionality of safety in cardiac rehabilitation programmes as perceived by women who were enrolled in the Women's Cardiovascular Health Initiative in Toronto, Canada. Cardiovascular disease is the leading cause of death among women. Although cardiac rehabilitation is clinically effective, significantly fewer women than men participate in available programmes. The literature identifies factors affecting women's cardiac rehabilitation participation, and provides possible explanations for this gender disparity. Although safety is mentioned among the barriers to women's cardiac rehabilitation participation, the extent to which safety contributes to programme participation, completion, and maintenance remains under-explored in the cardiac rehabilitation literature. We conducted an exploratory qualitative study to examine the role safety and place play for women engaged in cardiac prevention and rehabilitation at the Women's Cardiovascular Health Initiative. Methods. From 2005-2006, 14 participants engaged in semi-structured, qualitative interviews lasting 30-90 minutes. Discussions addressed women's experiences at the Women's Cardiovascular Health Initiative. Interview transcripts were analysed using thematic analysis. Three themes were developed: 'Safety', which was sub-categorized according to physical, social, and symbolic interpretations of safety, 'searching for a sense of place', and 'confidence and empowerment'. Feeling physically, socially, and symbolically safe in one's cardiac rehabilitation environment may contribute to programme adherence and exercise maintenance for women. Focusing on comprehensive notions of safety in future cardiac rehabilitation research could offer insight into why many women do not maintain an exercise regimen in currently structured cardiac rehabilitation and community programmes.