The effect of cardiovascular rehabilitation on physical strain tolerance – does gender really matter?
Abstract
Background/Aim. Gender as a risk factor for cardiovascular diseases has been the subject of research in numerous studies. All of them warn of shortcomings in the diagnosis and treatment of women with a coronary artery disease. The aim of this study is to determine whether there is a difference in the effects of cardiovascular rehabilitation (CVR) on the tolerance of physical strain related to gender in examinees with the coronary artery disease. Methods. The study involved 684 patients, 506 (74.0%) men and 178 (26.0%) women. All respondents were referred to the CVR program after surviving a heart attack, percutaneous coronary intervention or surgical myocardial revascularization. During a three-week program of CVR, patients were subjected to the dosed and personalized physical training. At the beginning and at the end of rehabilitation, all patients were tested for physical strain. Results. The average strain level in men was significantly higher in the second test (t = 4.368; p < 0.001). Also, the duration of the test was significantly longer in the second test (Z = 11.836; p < 0.001). In women, the average strain level was significantly higher (t = 5.352; p < 0.001), and the duration of the test was significantly longer in the second test (Z = 7.471; p < 0.001). Conclusion. A three-week program of CVR led to an improvement in the tolerance of physical strain in both men and women. Our research once again proved that women have an equal benefit as men from the implementation of CVR. Nevertheless, women rarely participate in the CVR programs. It is necessary to make additional efforts in order to further educate physicians and other medical staff about the importance of sending women to the CVR program.
References
WHO updates fact sheet on Top 10 causes of Death. Availa-ble from: http//communitymedicine4asses.com (updated 2017 January 27).
Roger VL. Epidemiology of myocardial infarction. Med Clin North Am 2007; 91(4): 537−52; ix.
Sanchis-Gomar F, Perez-Quilis C, Leischik R, Lucia, A. Epidemi-ology of coronary heart disease and acute coronary syndrome. Ann Transl Med 2016; 4(13): 256.
Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Bor-den WB, et al. on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics–2013 update: a report from the American Heart Association. Circulation 2013; 127(1): e6-e245.
Benjamin EJ, Muntner P, Alonso A, Bittencourt MS, Callaway CW, Carson AP, et al. Heart Disease and Stroke Statistics-2019 Update: A Report From the American Heart Association. Cir-culation 2019; 139(10): e56−e528.
Lerner DJ, Kannel WB. Patterns of coronary heart disease mor-bidity and mortality in the sexes: a 26-year follow-up of the Framingham population. Am Heart J 1986; 111(2): 383−90.
Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J 2010; 18(12): 598−602.
Kim C, Redberg RF, Pavlic T, Eagle KA. A systematic review of gender differences in mortality after coronary artery bypass graft surgery and percutaneous coronary interventions. Clin Cardiol 2007; 30(10): 491−5.
Goel K, Lennon RJ, Tilbury RT, Squires RW, Thomas RJ. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the com-munity. Circulation 2011; 123(21): 2344−52.
Ades PA, Pashkow FJ, Nestor JR. Cost-effectiveness of cardiac rehabilitation after myocardial infarction. J Cardiopulm Re-habil 1997; 17(4): 222−31
Shepherd CW, While AE. Cardiac rehabilitation and quality of life: a systematic review. Int J Nurs Stud 2012; 49(6): 755−71.
Franco OH, de Laet C, Peeters A, Jonker J, Mackenbach J, Nussel-der W. Effects of physical activity on life expectancy with car-diovascular disease. Arch Intern Med 2005; 165(20): 2355−60.
Leon AS, Franklin BA, Costa F, Balady GJ, Berra KA, Stewart KJ, et al. Cardiac rehabilitation and secondary prevention of coronary heart disease: an American Heart Association scien-tific statement from the Council on Clinical Cardiology (Sub-committee on Exercise, Cardiac Rehabilitation, and Preven-tion) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity), in collabo-ration with the American association of Cardiovascular and Pulmonary Rehabilitation. Circulation 2005; 111(3): 369−76.
Piepoli MF, Corra U, Benzer W, Bjarnason-Wehrens B, Dendale P, Gaita D, et al. Secondary prevention through cardiac rehabili-tation: from knowledge to implementation. A position paper from the Cardiac Rehabilitation Section of the European As-sociation of Cardiovascular Prevention and Rehabilitation. Eur J Cardiovasc Prev Rehabil 2010; 17(1): 1−17.
Clark AM, Hartling L, Vandermeer B, McAlister FA. Meta-analysis: secondary prevention programs for patients with cor-onary artery disease. Ann Intern Med 2005; 143(9): 659−72.
Maines TY, Lavie CJ, Milani RV, Cassidy MM, Gliililand YE, Murgo JP. Effects of cardiac rehabilitation and exercise pro-grams on exercise capacity, coronary risk factors, behavior, and quality of life in patients with coronary artery disease. South Med J 1997; 90(1): 43−9
Mampuya WM. Cardiac rehabilitation past, present and future: an overview. Cardiovasc Diagn Ther 2012; 2(1): 38.
Cardiac rehabilitation programs. A statement for healthcare professionals from the American Heart Association. Circula-tion 1994; 90(3): 1602−10.
Taylor C, Houston Miller N, Ahn D, Haskell W, DeBusk RF. The effect of exercise training programs on psychological im-provement in uncomplicated postmyocardial infarction pa-tients. J Psychosom Res 1986; 30(5): 581–7.
Bjarnason-Wehrens B, McGee H, Zwisler AD, Piepoli MF, Benzer W, Schmid JP, et al. Cardiac rehabilitation in Europe: results from the European cardiac rehabilitation inventory survey. Eur J Cardiovasc Prev Rehabil 2010; 17(4): 410−8.
Cooper A, Lloyd G, Weinman J, Jackson G. Why patients do not attend cardiac rehabilitation: role of intentions and illness be-liefs. Heart 1999; 82(2): 234−6.
Evenson KR, Fleur, J. Barriers to outpatient cardiac rehabilita-tion participation and adherence. J Cardiopulm Rehabil Prev 2000; 20(4): 241−6.
Dunlay SM, Witt BJ, Allison TG, Hayes SN, Weston SA, Koepsell E, et al. Barriers to participation in cardiac rehabilitation. Am Heart J 2009; 158(5): 852−9.
Burns K, Camaione D, Froman R, Clarck III BA. Predictors of referral to cardiac rehabilitation and cardiac exercise self-efficacy. Clin Nurs Res 1998; 7(2): 147–63.
Daly J, Sindone AP, Thompson DR, Hancock K, Chang E, Davidson P. Barriers to participation in and adherence to cardiac reha-bilitation programs: a critical literature review. Prog Cardio-vasc Nurs 2002; 17(1): 8−17.
Heid HG, Schmelzer M. Influences on women's participation in cardiac rehabilitation. Rehabil Nurs 2004; 29(4): 116−21.
Marzolini S, Brooks D, Oh PI. Sex differences incompletion of a 12-month cardiac rehabilitation programme: an analysis of 5922 women and men. Eur J Cardiovasc Prev Rehabil 2008; 15(6): 698–703.
Witt BJ, Jacobsen SJ, Weston SA, Killian JM, Meverden RA, Alli-son TG, et al. Cardiac rehabilitation after myocardial infarc-tion in the community. J Am Coll Cardiol 2004; 44(5): 988−96.
Daniels KM, Arena R, Lavie CJ, Forman DE. Cardiac rehabili-tation for women across the lifespan. Am J Med 2012; 125(9): 937. e1−7.
Caulin-Glaser T, Blum M, Schmeizl R, Prigerson HG, Zaret B, Mazure CM. Gender differences in referral to cardiac rehabili-tation programs after revascularization. J Cardiopulm Rehabil 2001; 21(1): 24−30.
Scott LA, Ben-Or K, Allen JK. Why are women missing from outpatient cardiac rehabilitation programs? A review of multi-level factors affecting referral, enrollment, and completion. J Womens Health (Larchmt) 2002; 11(9): 773−91.
Samayoa L, Grace SL, Gravely S, Scott LB, Marzolini S, Colella TJ. Sex differences in cardiac rehabilitation enrollment: a me-ta-analysis. Can J Cardiol 2013; 30(7): 793–800.
Maas AH, Appelman YE. Gender differences in coronary heart disease. Neth Heart J 2010; 18(12): 598−602.
Jneid H, Thacker HL. Coronary artery disease in women: dif-ferent, often undertreated. Cleve Clin J Med 2001; 68(5): 441−8.
Wenger NK. Women and coronary heart disease: a century af-ter Herrick: understudied, underdiagnosed, and undertreated. Circulation 2012; 126(5): 604−11.
Lavie CJ, Milani RV. Effects of cardiac rehabilitation and ex-ercise training on exercise capacity, coronary risk factors, be-havioral characteristics, and quality of life in women. Am J Cardiol 1995; 75(5): 340−43.
Balady GJ, Jette D, Scheer J, Downing J. Changes in exercise ca-pacity following cardiac rehabilitation in patients stratified ac-cording to age and gender. Results of the Massachusetts Asso-ciation of Cardiovascular and Pulmonary Rehabilitation Mul-ticenter Database. J Cardiopulm Rehabil 1996; 16(1): 38–46.
Colbert JD, Martin BJ, Haykowsky MJ, Hauer TL, Austford LD, Arena RA, et al. Cardiac rehabilitation referral, attendance and mortality in women. Eur J Prev Cardiol 2015; 22(8): 979−86.
Oosenbrug E, Marinho RP, Zhang J, Marzolini S, Colella TJ, Pa-kosh M, et al. Sex differences in cardiac rehabilitation adher-ence: a meta-analysis. Can J Cardiol 2016; 32(11): 1316−24.
Njølstad I, Arnesen E, Lund-Larsen PG. Smoking, serum lipids, blood pressure, and sex differences in myocardial infarction: a 12-year follow-up of the Finnmark Study. Circulation 1996; 93(3): 450−6.
Roeters van Lennep JE, Westerveld HT, Erkelens DW, van der Wall EE. Risk factors for coronary heart disease: implications of gender. Cardiovasc Res 2002; 53(3): 538−49.
Lavie CJ, Milani RV. Effects of cardiac rehabilitation and ex-ercise training on low-density lipoprotein cholesterol in pa-tients with hypertriglyceridemia and coronary artery disease. Am J Cardiol 1994; 74(12): 1192−5.
Schopfer DW, Forman DE. Cardiac Rehabilitation in Older Adults. Can J Cardiol 2016; 32(9): 1088−96.
Chauvet-Gelinier JC, Bonin B. Stress, anxiety and depression in heart disease patients: A major challenge for cardiac rehabilita-tion. Ann Phys Rehabil Med 2017; 60(1): 6−12.
Lee KK, McAllister DA, Adamson PD, Shah ASV, Mills NL. P3671Effectiveness of oral P2Y12 inhibition in men and women with cardiovascular disease: a meta-analysis and mod-elling study. Eur Heart J 2017; 38(Suppl 1): doi:10.1093/eurheartj/ehx504.p3671