Characteristics of women attending a phase 3 cardiovascular rehabilitation program: is there a need for a more tailored intervention?
Authors: Lemos Pires M , Borges M , Sa G , Pinto R , Pinto F , Melo X , Abreu A 
Published: May 2023

Abstract

Funding Acknowledgements
Type of funding sources: None.

Background
Cardiovascular disease (CVD) remains the main reason for mortality in women, however there are well identified discrepancies between men and women attending cardiovascular rehabilitation (CR) programs. Men are usually more referred and have higher adherence to CR programs than women. Understanding the characteristics of women attending long-term CR programs might be useful to better adapt and motivate future women with CVD to adhere in a higher scale.

Purpose
To describe characteristics of women with CVD attending a long-term phase III CR program and to compare with men the attendance rates and chosen exercise modality preferences.

Methods
Patients with CVD in a phase III long-term CR program were screened for the following assessments: 1) cardiorespiratory fitness through cardiopulmonary exercise testing; 2) body mass index (BMI); 3) physical activity (accelerometery); 4) social, demographic variables (questionnaires); 5) attendance rates (sessions attended/sessions planned) and dropout. When admitted, CVD patients chose to attend either the supervised exercise phase III CR sessions in a face-to-face model or an online model, and if they wanted to attend 2x or 3x/week. Chi-square and independent-samples Mann-Whitney U test was used.

Results
From the 206 CVD patients assessed, 19.9% were women (n=41, mean age 61 ± 11 years, 70.7% coronary artery disease, 53.7% married, 73.2% higher education, 43.9% retired, 39% working full time). From the 41 women screened, 39 enrolled the CR program and 17.9% dropped out before 12 months of program completion (4 women dropped before 6 month of program completion). The main reason of dropout was due to work/CR sessions conciliation. When asked to select the exercise modality, 56.4% chose the 3x/week face-to-face model, 28.2% the 2x/week face-to-face model and 15.4% the online model. When compared to men, women tend to choose the online modality and the 2x/week face-to-face model more than men (x2= 9.298; df=2; p=0.010). Regarding baseline assessments, 63.4% of women completed the assessment for cardiorespiratory fitness (VO²peak=17.11 ± 3.71 ml/kg/min), 80.5% for BMI (29.17 ± 5.58 kg/m²) and 78% for physical activity (38.55 ± 23.88 min/day of moderate to vigorous physical activity). When comparing attendance at 6 months, women have significantly lower attendance rates than men (56.87 ± 2.86% vs 70.24 ± 1.63%, p=0.001).

Conclusion
The low sample of women, compared to men, in this CR program, their characteristics, types of session modalities chosen, and lower attendance rates suggests that changes in long-term phase III CR programs are needed to tackle this disparity. Individualized and personalized strategies should be created targeting this population according to their needs, motivations and characteristics. A women-tailored phase III long-term CR program, with different session modalities and schedules, might be the future path to undertake.