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Table 2 Randomized women-focused CR trial design, and summary of utilization (N = 11), plus availability study

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

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

Beckie et al. [46,47,48,49,50,51,52,53] 2010; USA

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

Gary et al. [61,62,63] 2003; USA

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

Grace et al. (CR4HER trial) [21, 64,65,66,67] 2014; Canada

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

Wojcieszczyk et al. [83, 84] 2012; Poland

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

  1. When program utilization data were not available, information from each assessment point was extracted as a proxy
  2. AC active comparison, AC1 active comparison control group 1, AC2 active comparison control group 2, AT aerobic training, CDs compact discs, CHD coronary heart diseases, CR cardiac rehabilitation, HF heart failure, LSD least significant difference, MI myocardial infarction, NR not reported, UC usual care, n/a not applicable, PMR progressive muscle relaxation, SA stable angina, SD standard deviation, wks weeks