Cardiac rehabilitation I (original) (raw)
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Cardiac rehabilitation I: review of psychosocial factors
Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. There are gender differences in recovery from coronary events, which may be due physiological, sociodemographic, or psychosocial factors. Cardiac rehabilitation programs have beneficial effects on coronary recovery. The following presents a review of the literature from MedLine (1997–2001) and PsychInfo (1984 –2001) on gender differences in participation in cardiac rehabilitation programs, with a focus on depression, anxiety, self-efficacy and social support. A critical analysis of gaps in the literature as well as areas for future research are presented.
Background: Despite its proven benefits and need, women are significantly less likely than men to participate in and complete cardiac rehabilitation (CR). Thus, there are few reports of CR outcomes among women, particularly when compared with women who do not participate in CR. The purpose of this study was to prospectively assess psychosocial and behav-ioral changes, comparing women who participated in CR with those who did not. Methods: One hundred fifty-seven female cardiac inpatients from three hospitals consented to participate in a prospective study, and 110 (79%) were retained 18 months postdischarge. A mailed survey discerned CR participation 9 months postdischarge. Quality of life (Short-Form Health Survey Physical and Mental Component Summary [SF-12 PCS and MCS]), exercise behavior (Health-Promoting Lifestyle Profile II [HPLPII]), Exercise Benefits and Barriers Scale (EBBS), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]) were assessed in hospital and 18 months postdischarge. Results: Fifty-one (45.1%) women self-reported participating in CR at 1 of 18 sites, and site-verified participation was 82.43% 29.97% of prescribed sessions. For CR participants, paired t tests assessing change from hospitalization to 18 months postdischarge revealed significant improvements in physical quality of life (p 0.001), anxiety (p 0.05), and exercise behavior (p 0.01). Women who did not participate in CR experienced significant improvements in physical quality of life (p 0.02), and depressive symptoms (p 0.03) but not exercise behavior. Conclusions: Following a cardiac event, female patients improved their physical quality of life and affect, but only patients who participated in CR increased their exercise behavior. Given the cardiac benefits of exercise and that women are often sedentary and given that this exercise behavior was sustained post-CR, these findings are signficant. Randomized controlled trials of women's CR outcomes are needed.
A Cardiac Rehabilitation Program to Improve Psychosocial Outcomes of Women with Heart Disease
Journal of Women's Health, 2008
Heart disease in women is characterised by greater disability and a higher rate of morbidity and early death after an acute coronary event compared with men. Women also have lower participation rates than men in cardiac rehabilitation. This study sought to describe development of a nurse-directed cardiac rehabilitation program tailored to the needs of women following an acute cardiac event to address their psychological and social needs.
Cardiac rehabilitation II: referral and participation
General Hospital Psychiatry
Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. Substantial health risks continue following ischemic coronary events (ICEs), but secondary prevention efforts, including cardiac rehabilitation (CR), have beneficial effects on both early and late mortality and morbidity. This prospective study examined the relationship among psychosocial factors and CR referral and participation patterns in 906 (586 men, 320 women) patients from the coronary intensive care unit (CICU) over the course of six months. Only 30% of participants were referred to CR programs, with significantly fewer women being referred. A logistic regression analysis was used to determine whether depression, anxiety, self-efficacy, or social support predicted CR participation six months following an ICE, while controlling for sociodemographic factors. Results show that higher family income, greater anxiety symptomatology, and higher self-efficacy were significantly predictive of CR participation at six months. Implications for women's recovery from an ICE are discussed.
General Hospital Psychiatry, 2002
Cardiovascular disease (CVD) is the leading cause of death and disability for women and men. Substantial health risks continue following ischemic coronary events (ICEs), but secondary prevention efforts, including cardiac rehabilitation (CR), have beneficial effects on both early and late mortality and morbidity. This prospective study examined the relationship among psychosocial factors and CR referral and participation patterns in 906 (586 men, 320 women) patients from the coronary intensive care unit (CICU) over the course of six months. Only 30% of participants were referred to CR programs, with significantly fewer women being referred. A logistic regression analysis was used to determine whether depression, anxiety, self-efficacy, or social support predicted CR participation six months following an ICE, while controlling for sociodemographic factors. Results show that higher family income, greater anxiety symptomatology, and higher self-efficacy were significantly predictive of CR participation at six months. Implications for women's recovery from an ICE are discussed.
International journal of nursing studies, 2011
Depression is known to co-occur with coronary heart disease (CHD). Depression may also inhibit the effectiveness of cardiac rehabilitation (CR) programs by decreasing adherence. Higher prevalence of depression in women may place them at increased risk for non-adherence. To assess the impact of a modified, stage-of-change-matched, gender-tailored CR program for reducing depressive symptoms among women with CHD. A two-group randomized clinical trial compared depressive symptoms of women in a traditional 12-week CR program to those completing a tailored program that included motivational interviewing guided by the Transtheoretical Model of behavior change. Women in the experimental group also participated in a gender-tailored exercise protocol that excluded men. The Center for Epidemiological Studies Depression (CES-D) Scale was administered to 225 women at baseline, post-intervention, and at 6-month follow-up. Analysis of Variance was used to compare changes in depression scores over ...
The benefits of cardiac rehabilitation in coronary heart disease: A gender issue?
Revista portuguesa de cardiologia, 2014
Introduction and Objectives: Coronary heart disease is the leading cause of death in women worldwide and several studies have shown that they are under-represented in cardiac rehabilitation therapy. The objectives of this study were to assess the prevalence of women in a cardiac rehabilitation program and to assess their response to this intervention. Methods: This is a retrospective study of 858 patients who attended an exercise-based cardiac rehabilitation program after an acute coronary syndrome or elective percutaneous coronary intervention, between January 2008 and December 2012. The patients were analyzed by gender, and the impact of the intervention on cardiovascular risk factors and NT-proBNP was studied. In a subgroup of 386 patients the impact on functional capacity, resting heart rate, chronotropic index and heart rate recovery was also analyzed. Results: Only 24% of the 858 patients who attended the program were women. Women showed statistically significant improvements in all cardiovascular risk factors, NT-proBNP, functional capacity and heart rate recovery (p<0.05) after the program. There were also improvements in resting heart rate and chronotropic index, but these were not statistically significant (p=0.08 and p=0.40, respectively) and when the improvements in these two parameters were compared between genders, there was no statistically significant difference (p=0.33 and p=0.17, respectively). Conclusions: Only 24% of the patients attending the program were women. We found that they benefited from cardiac rehabilitation therapy, with significant improvements in cardiovascular risk factors and in most of the prognostic markers studied.
American Journal of Cardiology, 1995
To evaluate the effect of cardiac rehabilitation and exercise training on depression after major cardiac events, we studied 338 consecutive patients in whom a major cardiac event had occurred 4 to 6 weeks previously and who were participating in phase II cardiac rehabilitation consisting of 36 sessions over a 3-month period. Depressive symptoms and other behavioral characteristics and quality-of-life parameters were analyzed by validated questionnaire. Depression was prevalent in patients with coronary heart disease, occurring in 20% of the patients evaluated. At baseline, depressed patients had lower exercise capacity, reduced high-density lipoprotein cholesterol level, and higher triglyceride levels; had lower scores for mental health, energy or fatigue, general health, pain, overall function, well-being, and total quality of life; and had greater scores for somatization, anxiety, and hostility than those of nondepressed patients. After cardiac rehabilitation, depressed patients had marked improvements in depression scores and other behavioral parameters (anxiety, somatization, and hostility) and quality of life. Depressed patients also showed improved exercise capacity, percentage of body fat, and levels of triglycerides and high-density lipoprotein cholesterol. Depressed patients exhibited statistically greater improvements in certain behavioral and quality-of-life parameters than did nondepressed patients. Two thirds of the patients who were initially depressed resolved their symptoms by study completion. In conclusion, depression is reduced in patients with symptomatic coronary heart disease patients enrolled in cardiac rehabilitation. Greater emphasis is needed to ensure that depressed patients are referred to and attend formal cardiac rehabilitation programs after major cardiac events. (Am Heart J 1996;132:726-32.)
Background: Cardiac rehabilitation (CR) is associated with significantly lower mortality and improved psychosocial well-being. However, women are less likely to participate than men. This trial tested whether participation in women-only CR results in better health behaviours and psychosocial outcomes than do other models. Methods: Cardiac Rehabilitation for her Heart Event Recovery (CR4HER) was a single-blind randomized trial with 3 parallel arms. Low-risk cardiac patients were recruited from 6 sites in Ontario. Consenting participants completed surveys assessing health behaviours (physical activity, diet, medication adherence, smoking) and psycho-social well-being (social support, quality of life, depressive symptoms) and wore pedometers for 7 days. After intake assessment, eligible participants were randomized to mixed-sex, women-only, or home-based CR. Participants were mailed follow-up surveys and pedome-ters 6 months later.
Journal of Rehabilitation Medicine, 2008
To examine gender differences in clinical characteristics and physiological and psychosocial outcomes at entry into phase II cardiac rehabilitation. Design: Cross-sectional study. Subjects: The study comprised 442 consecutive patients with cardiac diseases assessed at entry into a phase II cardiac rehabilitation programme. Methods: Clinical characteristics of the patients, such as age, education, marital status, employment and body mass index, were obtained from hospital records. Oxygen uptake, handgrip and knee extensor muscle strength were measured to assess physiological outcomes. Self-efficacy for physical activity, hospital anxiety depression scale and health-related quality of life assessed by Short Form-36 were evaluated to assess psychosocial outcomes. Results: The number of married women and their levels of education, employment and body mass index were significantly lower, and their ages higher, than those of the men. Measures of physiological outcome in women were significantly lower than those in men. Measures of self-efficacy for physical activity and Short Form-36 physical and emotional subscale scores were lower and anxiety levels higher in women than in men. Conclusion: Cardiac rehabilitation programmes exclusively for women focusing on physiological outcomes, group counselling, and training to enhance physical and emotional domains may encourage increased participation by women in cardiac rehabilitation.