Effects of cardiac rehabilitation and exercise training on exercise capacity, coronary risk factors, behavioral characteristics, and quality of life in women

Despite the known benefits of cardiac rehabilitation, limited data are available on the outcome of this treatment in women, and this secondary prevention strategy may be underutilized. To assess the gender differences in baseline exercise capacity, indexes of obesity, lipid profiles, behavior characteristics, and components of quality of life, as well as the improvements in these components after a secondary prevention program, we retrospectively reviewed data from 458 patients (83 women and 375 men) enrolled in a phase II cardiac rehabilitation and exercise program after a major cardiac event. At baseline (6 weeks after the cardiac event and before rehabilitation), exercise capacity (−9%, p = 0.08) and ratio of low-density lipoprotein cholesterol/ high-density lipoprotein cholesterol (−14%, p < 0.01) were lower, but total cholesterol (+7%, p < 0.01), high-density lipoprotein cholesterol (+25%, p < 0.0001), low-density lipoprotein cholesterol (+8%, p < 0.01), and percent body fat (+15%, p < 0.0001) were higher in women than in men with coronary artery disease. In addition, with regard to quality of life, women had lower scores for energy (p = 0.06), function (p < 0.01), and total quality of life (p < 0.05) than men. After cardiac rehabilitation and exercise training, women had significant improvements in exercise capacity (+33%, p < 0.0001) and percent body fat (−7%, p < 0.001), which compared favorably with the improvements (+40% and −5%, respectively) seen in men, but improvements in body mass index and lipids were not statistically significant. Although most behavioral traits and measures of quality of life significantly improved in women, depression, hostility, and measures of mental health were not significantly reduced. However, improvements in all these risk factors, behavioral traits, and components of quality of life were statistically similar in men and women. Because women have a lower exercise capacity, energy, function score, and total quality of life score at baseline, these improvements after cardiac rehabilitation may be of greater clinical benefit to women than to men. These data reaffirm that women should be routinely referred to and vigorously encouraged to participate in outpatient cardiac rehabilitation and exercise training after major cardiac events.