Sex differences in cardiac rehabilitation

OBJECTIVE: To determine and compare the baseline characteristics and outcomes between men and women in a Canadian cardiac rehabilitation program. DESIGN: Nonrandomized, retrospective, observational study with a before and after research design. SETTING: The Prevention and Rehabilitation Centre at the University of Ottawa Heart Institute, Ottawa, Ontario, a tertiary cardiac care centre. PATIENTS: Three hundred and eighty-seven patients, 82% male aged 59 +/- 10 years and 18% female aged 61 +/- 4 years, who were enrolled in the on-site cardiac rehabilitation program between November 1, 1995 and April 1, 1997. INTERVENTION: A three-month, multifactorial cardiac rehabilitation program that incorporates exercise training, risk factor modification, education and psychosocial support. MAIN RESULTS: Fewer than 20% of all rehabilitation participants (n = 70; 18%) were women; most participants were under 65 years of age. More women than men had a primary diagnosis of myocardial infarction (42% versus 28%, respectively), whereas men were more likely than women to have had coronary artery bypass grafting (45% versus 23%, respectively). Men and women had similar mean baseline measures of body mass index, blood pressure and glucose levels, whereas women had significantly higher mean baseline measures of total cholesterol (5.6 mmol/L versus 5.0 mmol/L for men, P less than or equal to 0.001), low density lipoprotein (LDL) cholesterol (3.4 mmol/L versus 3.1 mmol/L, P = 0.012) and high density lipoprotein (HDL) cholesterol (1.2 mmol/L versus 1.0 mmol/L, P less than or equal to 0.001). Baseline LDL to HDL ratios were 3.3 for men and 3.0 for women (not significant), and total cholesterol to HDL ratios were 5.4 and 4.9 for men and women, respectively. Men had a higher exercise capacity than women coming into the program (metabolic equivalent [METs] 6.6 versus 4.9, respectively, P less than or equal to 0.001), had a higher baseline activity level (1114 kcal/week versus 617 kcal/week, P = 0.001) and scored higher than women in all health-related quality of life scores. After the program, there were no significant sex differences in improvement in MET level, physical activity or risk factor profile. Although men exercised more than women (increase of 557 kcal/week versus 343 kcal/week, respectively), this was not statistically significant. In health related quality of life scores, both men and women improved in all scores, although women reported less increase than men in their level of overall vitality (P = 0.016). CONCLUSION: Women are the minority of cardiac rehabilitation patients, although they appear to benefit equally well from the program.