Title: Women’s Outcomes Following Mixed-Sex, Women-Only, and Home-Based Cardiac
Rehabilitation Participation and Comparison by Sex
Version: 2 Date: 31 Aug 2021
Reviewer's report:
You sought to compare outcomes of outpatient cardiac rehabilitation in  a large cohort of
women who  self-selected  either traditional mixed sex classes, women only classes, and home
based rehabilitation without in person classes.    A control group of men who attended mixed
sex classes was included. You hypothesized, based on previous work by other investigators,
that women only classes would result in more favorable outcomes (CRF, CV risk factors,
psychosocial function).  Unfortunately, results did not support your hypothesis and the most
favorable outcomes in women occurred with the mixed sex group.  You are to be congratulated
for providing insights into this important question regarding cardiovascular health in women.
General questions/suggestions:
It would be helpful to know how soon after hospitalization ( for those patients who required
hospitalization)  that cardiac rehabilitation began.  In addition, what were the reasons that one
program provided 6 months and the other program 4 months of rehabilitation?   Were the
methods of  exercise prescription, exercise  training, risk factor modification education, etc. ,
standardized for the 2 programs.  Where the staff at both programs comparable in terms of
credentials and experience?
How was the option of mixed sex classes, women only classes and home based cardiac
rehabilitation introduced to the patients?  Do you have insights into why most of the women
selected mixed sex classes over women only classes and home-based cardiac rehabilitation?
It would also be useful  to report  the dose of exercise training in terms of frequency, intensity,
duration, and progression for each of the 3 types of  programs based on the activity logs of the
patients.  This may help explain the superiority of the mixed sex approach.
You indicated that body composition was assessed using bioelectrical impedance.  However,
you do not provide data for %body fat or lean body mass changes during the study.  why?
With regards to the change in cardiovascular risk factors, were you able to determine if patients
altered their dietary practices as a result of rehabilitation? Was the use of medications that
potentially improve cardiovascular risk factors stable during the rehabilitation programs?  Do
you have data for fasting blood glucose?
The 41% drop out rate is a limitation.  How does this compare to other reports in the literature?
Your cardiac rehabilitation model of 4-6 months is longer than what is typical in other locations.
Do you have insights into the  effect of program length on dropout rates?  Where the dropout
rates similar for the 4 and 6 month programs?
Specific recommendations:
1. abstract,  line 10:   The variable "VO2" is actually METs.
2. abstract,  line 12;  "HDL" should read "HDL cholesterol".
3. introduction, 2nd para, Line 5:  "is" should read "are".
4.  page 6, line 3:  Here it states that patients with transplant, stroke, etc.  were not included,
however later in the paper including the tables these patients appear to be included in the study.
5. page 15, conclusions:  "HDL" should read "HDL cholesterol".