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There are fundamental differences in the profile of female cardiac patients compared with male patients in cardiac rehabilitation. Generally women receiving cardiac rehabilitation are older than men[1]. Recent research has affirmed that physical activity reduces the risk of cardiovascular events and even death among men and women. Studies have also shown that a higher percentage of women with diabetes and hypertension benefit from rehabilitation[3]. For better success, exercise programs should consider individual differences to minimize risks, involve comprehensive, long-term interactions with a multidisciplinary team to assist in the medical, psychological and social needs of the patients[1].

Following MI and CABG male and female patients participate in rehabilitation programs for similar reasons. However, women are less likely to enrol (at a rate of 20%) in the programs than men. Reasons for this include a higher risk factor burden and more co-morbidities . On the other hand, for those women that complete a cardiac rehabilitation program, the improvement in exercise capacity with rehabilitation training is similar to or even greater than the success in male patients[4]

Lack of enrolment or continued participation in cardiac rehabilitation for patients of both sexes can be due to :

  • longer driving time

  • unavailable transportation

  • interference with other life activities

  • depression

Depression has been found to be an independent risk factor for development and recurrence of CHD.  Dpressive disorders are not very well documented in CHD pts that are enrolled in CR.  Treating depression will allow for better adherance to lifestyle modification programs and completion of cardiac rehabilitation programs .

Practical concerns specific to female patients included:

  • older age

  • increased liklihood of living alone and an inability or unwillingness to drive unaccompanied [1]

These concerns may not be expressed but must be addressed to increase the rehabilitation potential for women and men.

Some of the critical success factors in a cardiac rehabilitation program as reported by Moore et. al[2]:

  • feeling safe during exercise, by way of monitoring

  • support by peer group

  • staff who are pleasant and encouraging

  • exercising without feeling tired

  • exercising without symptoms

Women also tend to want more social interaction during exercise, emotional support from staff about their rehabilitation, and to be able to use exercise tools other than the cycle or treadmill. Limacher[1] suggests that physicians and cardiac rehabilitation programs should consider ways of encouraging more women to participate in cardiac rehabilitation, such as:

  • increasing group activities

  • educating family and friends

  • counselling, and exercise sessions

The rehabilitation environment can be enhanced by simple things such as background music during physical activity. The staff should be encouraged to provide positive reinforcement to the participants, a progress chart can be used to provide encouragement and enhance self-monitoring. Achievement needs to be noted and rewarded. Lastly, there should be opportunities for patients to build meaningful relationships with other participants and staff.

There is ongoing research to understand and improve rehabilitation; these suggestions are just the beginning.

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1. Limacher, M.C., (1998) Exercise and Rehabilitation in Women: Indications and Outcomes. Cardiology Clinics, 16(1): 27-36.

2. Moore, S.M., Kramer, F.M., (1996) Women’s and Men’s Preferences for Cardiac Rehabilitation Programs. J Cardiopulm Rehabil, 16:123.

3. Carhart, R.L., Ades, P.A., (1998) Gender Differences in Cardiac Rehabilitation. Cardiology Clinics, 16 (1): 37-43.

4. Cannistra, L.B., Balady, G.J., O’Malley, C.J. (1985) Comparison of the Clinical Profile and Outcome of Women and Men in Cardiac Rehabilitation. Am J Cardiol, 69: 263.

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