Sex differences in the physiological responses to cardiac rehabilitation: a systematic review

Are the Cardiovascular Benefits and Potential Risks of Physical Activity and Exercise Dependent on Race, Ethnicity, or Sex?

Physical activity (PA) is established as a cornerstone of cardiovascular health, however, disparities in participation exist across sociocultural groups, which in turn affect cardiovascular outcomes. Evidence suggests that although the positive cardiovascular effects of exercise are consistent across populations, notable differences in the magnitude of these benefits exist for racial and ethnic minorities and the female sex. Women derive greater protection from PA compared with men, with reduced rates of sudden cardiac death. In this review we examine the complex interplay of race and/or ethnicity and sex on the cardiovascular benefits associated with PA and exercise, cardiovascular adaptations to exercise, risks of sudden cardiac death, and "excessive" volume of exercise. Understanding these factors is crucial for developing targeted interventions to promote cardiovascular health and offset disparities.

A multi-site mixed-method evaluation of 'Cardiac College for Women' implementation: perspectives of cardiac rehabilitation patients and providers

A Cardiac College for Women curriculum was developed to address the dearth of women-focused cardiac rehabilitation (CR) education. This study investigated: (1) patient utilization of the education; (2) acceptability and applicability of the education; as well as (3) patient and CR providers' experiences implementing it. This was a multi-site, mixed-methods study. After baseline assessments at an academic CR program in two Canadian provinces, the 12 weekly 30 min structured in-person group education sessions were led by staff in the relevant discipline, with supporting online videos and written materials. Women reported their engagement with the education in weekly diaries, and completed a survey post-program. Semi-structured virtual interviews were held with willing participants and staff delivering the intervention. Transcripts were analyzed concurrently by two researchers independently via NVIVO using text condensation, followed by consensus reconciliation and multi-source validation. Forty patients participated in the women-focused education program, with 28 completing weekly diaries and 36 post-intervention surveys. Participants attended 80% of sessions (67%-89%). They spent an average of 30 min/week engaging additionally with the online education, with 83% rating the weekly content applicable (73%-100%). Overall acceptability was rated 4.3 ± 1.7/5. Twelve patients and 5 staff participated in interviews. Four themes were identified: contextual considerations, staffing and implementation issues, valued aspects, and suggestions for improvement. In conclusion, Cardiac College for Women was established as highly acceptable and applicable to patients, supporting their self-management. The women-specific CR education materials were also established as readily implementable by CR staff.