From: Nature, availability, and utilization of women-focused cardiac rehabilitation: a systematic review
Study author, year, country | Nature of comparison arm(s); # centres | Participants/sample: size (% female), mean age; ethnocultural background; CHD type [& % HF]; males for comparison (y/n) | Results |
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Andersson et al. [42], 2010; Sweden | AC: physiotherapy (8 sessions = 2×/wk for 4 wks, bicycling or aerobic exercise; information on healthy food and adverse effects of nicotine provided); 1 centre | N = 149 (100% female); mean age: 53.4 ± 6.2 yrs; ethnocultural background: NR; CHD type: MI (65.2%) (& 0% HF); Males for comparison: no | NR |
Arthur et al. [43] 2007; Canada | AC: AT (48 sessions = 2×/wk for 24 wks, 40 min; moderate intensity; using stationary cycles, treadmills, arm ergometers, stair climbers; received other components of comprehensive CR); 1 centre; | N = 92 (100% female); mean age: NR; ethnocultural background: NR; CHD type: MI (& 0% HF); Males for comparison: no | Women-focused CR: 46 randomized, 42 (91.3%) enrolled, 37 (80.4%) completed; AC: 46 randomized, 40 (86.9%) enrolled, 35 (76.1%) completed |
Asbury et al. [44] 2008; UK | UC control (with symptom monitoring only); 1 centre; | N = 64 (100% female); mean age: 57.3 ± 8.6 yrs; ethnocultural background: NR; CHD type: cardiac syndrome X (& 0% HF); Males for comparison: no | Women-focused CR: 32 randomized, 30 (93.8%) enrolled, 28 (87.5%) completed |
AC: Traditional CR (36 sessions = 3×/wk for 12 wks; aerobic training by treadmill walking, cycling or rowing; eight education classes of 1 h duration on CHD risk factor modification before each exercise session); 1 centre | N = 252 (100% female); mean age: 61.6 ± 10.0 yrs; ethnocultural background: caucasian 82.0%; CHD type: MI (4.4%), chronic SA (12%), (& 0% HF); Males for comparison: no | Women-focused CR: 141 randomized, 137 (97.2%) enrolled, 133 (94.3%) completed; AC: 111 randomized, 99 (89.2%) enrolled, 99 (89.2%) completed | |
Mean number of 36 exercise sessions attended: Women-focused CR 32 ± 9; AC 28 ± 12; Significant difference between the two groups (p < 0.001) | |||
Mean percent attendance at education sessions: Women-focused CR 87 ± 24; AC 56 ± 30; Significant difference between the two groups (p < 0.001) | |||
Clark et al. (Women Take Pride trial) [55,56,57,58] 2003; USA | AC: women tailored group format (7 sessions = 1×/wk for 6 wks, then at 6 months another session, all f2f, 6–8 women/group); UC (routine care with physician); multi-centre (12) | N = 575 (100% female); mean age: 72.8 ± 7.9 yrs; ethnocultural background: caucasian 82.8%; CHD type: MI (41.7%), SA (37.6%), (& 23% HF); Males for comparison: no | Women-focused CR: 201 randomized, 197 (98.0%) enrolled, 164 (81.6%) completed; AC: 190 randomized, 185 (97.3%) enrolled, 166 (87.4%) completed |
Feizi et al. [35] 2012; Iran | AC1: PMR (2 f2f sessions, 16-muscle groups, then practice PMR 15 min daily at home) AC2: phase III CR (with aerobic exercise including walking with gradually increasing intensity and duration of maximum 40 min; stretching, educational pamphlet and Cds also provided to practice) vs UC [no CR or PMR]); 1 centre; | N = 40 (100% female); mean age: 50.9 ± 6.9 yrs; ethnocultural background: NR; CHD type: cardiac syndrome X (& 0% HF); Males for comparison: no | Women-focused CR: 11 randomized, 11 (100.0%) enrolled, 11 (100.0%) completed; AC1: 11 randomized, 11 (100.0%) enrolled, 11 (100.0%) completed; AC2: 11 randomized, 11 (100.0%) enrolled, 11 (100.0%) completed |
AC: education-only control (received 1×/wk home visits for 12 wks); 1 centre; | N = 32 (100% female); mean age: 68.0 ± 11.0 yrs; ethnocultural background: caucasian 59.3%; CHD type: 100% HF; Males for comparison: no | Women-focused CR: 16 randomized, 16 (100.0%) enrolled, 15 (93.8%) completed; AC: 16 randomized, 16 (100.0%) enrolled, 13 (81.3%) completed | |
AC1: supervised mixed-sex CR (48 sessions = 2×/wk for 24 wks, 60 min; aerobic exercise via stationary bicycle/treadmill/walking and education classes); AC2: home-based CR (27 sessions = 3 supervised and 1×/wk for 24 wks phone calls along with education materials); 3 centres | N = 169 (100% female); mean age: 63.64 ± 10.42 yrs; ethnocultural background: caucasian 62.5%, CHD type: AMI (35.8%), (& 0% HF); Males for comparison: no | Women-focused CR: 55 randomized, 35 (63.6%) enrolled, 59.94% (SD: NR) session adherence, 21 (38.2%) completed; AC1: 59 randomized, 40 (67.8%) enrolled, 65.51% (SD: NR) session adherence, 21 (35.6%) completed; AC2: 55 randomized, 24 (43.6%) enrolled, 75.32% (SD: NR) session adherence, 20 (36.4%) completed | |
There was a significant difference in CR adherence by program model (p < 0.001). Home-based CR participants adhered to a significantly higher percentage of sessions than participants in women-focused CR (post-hoc LSD test, p = 0.03) | |||
Turk-Adawi [25] 2020; International | Descriptive, global CR audit and survey | 203 countries in world; 111 (54.7%) offer CR; data collected in 93 (83.8%); n/a | Thirty-eight (40.9% of those offering CR) countries with CR offered women-only CR globally (18.7% of all countries globally) |
Overall, in countries that delivered it, on average 32.1% programs offered women-only CR. In Iran, Pakistan and Greece, it was delivered in > 50% of programs | |||
Provision of women-focused CR was greater in EMR region. Countries in the Western Pacific region had the lowest proportion of programs (1.2%) | |||
Programs that offered women-focused CR were more often: located in an academic or tertiary facility, served more patients/year, offered more components, treated more patients/session, offered alternative forms of exercise, had more staff (including cardiologists, dietitians, and administrative assistants, but not mental health care professionals), and perceived space and human resources to be less of a barrier to delivery than programs not offering women-focused CR (all p < 0.05), suggesting it is only feasible for larger, well-resourced programs to offer it | |||
Tsai et al. [81] 2019; Taiwan, China | UC: received regular health education; 2 centres; | N = 35 (100% female); mean age: 56.1 ± 5.6 years; ethnocultural background: NR, CHD type: coronary artery stenosis; 0% HF. Males for comparison: no | Women-focused CR: 17 randomized, 17 (100.0%) enrolled, 16 (94.1%) completed |
Tyni-Lenne et al. [82] 2002; Sweden | AC: relaxation therapy [16 sessions = 2×/wk for 8 wks, 60 min; consisted of modified Jacobson’s approach and autogenous training], UC: normal daily activities; 1 centre; | N = 24 (100% female); mean age: 55.0 ± 8.0 years; ethnocultural background: NR, CHD type: cardiac syndrome X. (& 0% HF). Males for comparison: no | Women-focused CR: 7 randomized, 7 (100.0%) enrolled, 6 (85.7%) completed; AC: 7 randomized, 7 (100.0%) enrolled, 6 (85.7%) completed |
AC1: Traditional CR (29 sessions = 3×/wk for 4wks, then 2×/wk for 8 wks, then 1×/wk for 1 wk; cycle ergometer), AC2: Traditional CR and cognitive behavior psychotherapy; 1 centre | N = 68 (100% female); mean age: 62.07 ± 6.00 years; ethnocultural background: NR, CHD type: MI (& 0% HF). Males for comparison: no | NR |