Title: Women’s Outcomes Following Mixed-Sex, Women-Only, and Home-Based Cardiac
Rehabilitation Participation and Comparison by Sex
Version: 2 Date: 20 Sep 2021
Reviewer:  Massimo Mapelli
Reviewer's report:
Dear Authors,
I am pleased to review the article “Women’s Outcomes Following Mixed-ex, Women-Only,
and House-Based Cardiac Rehabilitation Participation and Comparison by Sex”. In this
retrospective, 2 centres observational study, the authors studied cardiorespiratory fitness, risk
factors and psychosocial well-being in women participating in mixed-sex, women-only or home-
based cardiac rehabilitation, and conclude that non-gender-tailored women-only rehabilitation
was not advantageous. This is a well written and conducted study, that has potential for
publication, but few points must be addressed:
1. In the current trial, as I understood, patients were allowed to decide in which program (mixed-
sex or women-only) join for the rehabilitation. If so, don’t the authors think it could be a possible
selection bias? This must be discussed extensively;
2. Moreover, some patients decided to adhere to home-based programs. Did you study the
reasons for the choice of supervised programs at the centres or home-based programs? Please
explain;
3. According to Table 1 “mixed sex” patients are younger than “women only” patients (but I’m
not able to find a p wave for this difference), in fact VO2 peak (expressed as ml/kg/min is lower
according to the age). Please do the same analysis using peak VO2 expressed as a % of the
predicted values (i.e. using Wasserman equations);
4. Also for the comparison between male and female relative peak VO2 values (% of the
predicted) should be used. Peak VO2 expressed in ml/Kg/min is normally lower in women than
in men;
5. In the between group comparison (†) (table 3; mixed-sex to women-only cardiac
rehabilitation programs), are you comparing the discharge values or (as I believe) the change in
cardiorespiratory fitness parameters with the exercise? This should be specified;
6. I do not understand how did you calculate VO2 peak. Was a maximal ramp protocol CPET
conducted before and after rehab in each patients? Or was it just calculated by METs values?
This should be clarified in the methods section and discussed
7. Did you assess reasons for non-adherence to the cardiac rehabilitation program?
8. In the abstract the introduction is just dealing with the aim of the study. At least one
introduction sentence must be added;
9. A lot of dropout (more than 40%) of women. Could you please indicate it as a possible
limitation and specify in which of the group you had more dropouts (this could also be a good
topic to discuss)
10. Please check the results in abstract. A VO2 peak of 5.1 or 4.6 is extremely low and probably
not correct
11. In the method section the sentence “given the measurement error associated with the latter,
while results from the Toronto Rehab ….compared in the Toronto Rehab partecipants” is not
clear. Please re-formulate and specify how did you assess VO2 peak and in how many patients.
12. It is not clear to me why in Table 2 p values for categorical variables are missing.
13. Women that completed the home based model are negligible. I suggest to remove them
from the comparison tables (I.e. table 3) which is already crowded. Eventually a supplementary
(online only) table che be provided
Thank you very much for your submission.
With best regards,