Effectiveness of Cardiac Rehabilitation Programs in Females Following an Acute
*Katie Carnelia PA-S and **Kenneth H. Pitetti, Ph.D
*Department of Physician Assistant, ** Department of Physical Therapy
Wichita State University, Wichita, KS
INTRODUCTION RESULTS DISCUSSION
In order to decrease morbidity and mortality • A total of 21 articles met inclusion criteria The results of the literature suggest females benefit
associated with myocardial infarctions (MI), cardiac •Direct Comparison between genders and CRP outcome, n=9. from CRP, including reduction of subsequent cardiac
rehabilitation programs (CRP) offer a viable option for Address specific parameters of CRP which illustrate females events, but not to the same degree as males.
improving physical capacity, reducing emotional are benefiting from CRP but often not to the same degree as However, it is suggested that females could benefit
distress, and modifying risk factors. Unfortunately, their male counterparts. from CRP to a greater degree since they start at a
many eligible patients are not referred or do not utilize •Indirect relationship of CRP outcome addressed through referral lower functional capacity. Multiple articles suggest a
CRP [1-4] despite the demonstrated benefits. [3,4] A and utilization patterns, n=6 CRP designed specifically for the unique needs of
primary concern is determining if current CRP are as Focus on referral and utilization rates for CRP between females. Areas of potential CRP improvement
effective for females as males. The focus of CRP genders. which support the problem that females are less likely include physical, such as exercise capacity,
have always tended to favor males, particularly since than males to be referred to, utilize, or adhere to CRP. emotional, such as stress adaptation, and
cardiovascular disease is more often associated with •Background information regarding CRP indications and potential psychological, such as lower levels of depression
males, despite evidence of cardiovascular disease as benefits, n=6. and anxiety. Despite demonstrated benefits, more
a leading cause of morbidity and mortality in both Illustrate the need for MI patients to use CRP, however they do studies should be conducted with a larger focus on
genders. [5-7] Given that “Optimal treatment is not not address the specific/quantitative outcome differences the needs of females, including insecurities as well
necessarily the same treatment for all,”  differences between genders. as physical shortcomings and emotional limitations
exist between male and female patients who suffer •Articles excluded for lack of relevancy to the question/problem
from an MI. For instance, males frequently present or when outcome was not divided by gender, n=5 CONCLUSIONS
with the defined, classical symptoms of an MI (i.e., •Overall grade based on levels of evidence – B While the incidence of MI is increasing in females,
chest pain, pain down the left arm and shortness of the present CRP practices still fail to understand and
Breakdown of Levels of Evidence: Level 1 n= 7,
breath) during the 6th or 7th decade of life. On the address the multidimensional differences between
Level 2 n= 10, Level 3 n= 4
other hand, females usually do not present with these males and females in terms of responding to and
classical symptoms but rather more nonspecific Figure 1 - Literature Review Diagram adhering to CRP. Since clinical profiles vary from
symptoms (atypical chest pain and concurrent males and females in that females present at an
comorbidities like hypertension and diabetes) do not older age with more comorbidities, a more
usually occur until the 8th or 9th decade. Knowing specialized CRP for females may be more effective.
this, it is vital to assess the effectiveness of current As was illustrated in this review, females do benefit
CRP to determine if females are receiving the from CRP, even though the extent is unclear since
maximal benefit. females have not been the focus of many high-
quality studies. Therefore, it is important for health
care professionals to recognize the unique needs of
METHODS females so optimal cardiac rehabilitation
A systematic literature review was performed to identify opportunities are encouraged in order to minimize
evidence-based research addressing gender the negative effects of an MI.
differences in mulitple areas of CRP including clinical
presentation, referral/utilization patterns, and REFERENCES
Mitchell R, Muggli M, Sato A. Cardiac rehabilitation: participating in an exercise program in a quest to
outcomes. The following electronic databases were survive. Rehabil Nurs. Nov-Dec 1999;24(6):236-239.
 Heid G, Schmelzer M. Influences on women's participation in cardiac rehabilitation. Rehabilitation
searched for articles from 1986 to 2006: MedLine, Nursing. 2004;29(4):116-121.
 Moore S, Dolansky M, Ruland C, Pashkow F, BLackburn G. Predictors of women's exercise
CINHAL, PyschInfo and Cochrane. The following maintenance after cardiac rehabilitation. J Cardiopulmonary Rehabil. 2003;23:40-49.
 Beswick A, Rees K, West R, et al. Improving uptake and adherence in cardiac rehabilitation: Literature
MeSH terms were used to identify articles: cardiac review. J of Advanced Nursing. 2004;49(5):538-555.
 Halm M, Penque S, Doll N, Beahrs M. Women and cardiac rehabilitation: Referral and compliance
patterns. J of Cardiovascular Nursing. 1999;13(3):83-92.
rehabilitation, gender differences, compliance, Deshotels A, Planchock N, Dech Z, Prevost S. Gender differences in perceptions of quality of life in
cardiac rehabilitation patients. J Cardiopulm Rehabil. Mar-Apr 1995;15(2):143-148.
effectiveness, myocardial infarction, women, females  Burell G, Granlund B. Women's hearts need special treatment. Internation J of Behavioral Medicine.