A Call for Intervention Research to Overcome Barriers to Women's Enrollment in Outpatient Cardiac Rehabilitation Programs

Abstract

this issue of the Journal of Women's Health, Beckie and Beckstead 1 present findings of their randomized trial that tested differential improvements on measures of global quality of life (QOL) between two methods of providing a 12-week cardiac rehabilitation (CR) program to a sample of 225 women (predominantly Caucasian) from a single institution in the southeastern United States: (1) a traditional CR program that included men as well as women in the sessions or (2) a tailored women-only CR program that included motivational interviewing guided by the transtheoretical model of behavior change. The authors concluded that the group of women who participated in the tailored program had greater improvement in their global QOL scores than the women allocated to the traditional CR program, and QOL improvements were sustained at the 6-month follow-up assessment among those in the tailored group but not those in the traditional program.Although Beckie and Beckstead are to be applauded for their efforts to address the unique needs and preferences of women by redesigning components of a traditional CR program so that participants may better optimize psychosocial aspects of their cardiac recovery, the clinical significance of the differences achieved in QOL scores between intervention groups and the sustained change over time in QOL demonstrated in the tailored group are not yet established in the field. The practical implications of the findings are not evident at this time. The authors reference published work based on the Enhancing Recovery in Coronary Heart Disease (ENRICHD) trial 2 to suggest that the demonstrated change in QOL among women in the tailored group may be characterized as a ''moderate effect'' or greater. Beckie and Beckstead acknowledged that more research is needed to sort out the relative contributions of the tailored multifaceted intervention that involved social support, motivational interviewing, and matching stages of change to enhance QOL among women, including research that will evaluate the effectiveness of such CR interventions among samples with greater representation of racial=ethnic minorities and broader clinical contexts. More research also is warranted to determine the clinical significance of QOL on health and related behavioral outcomes associated with cardiac recovery of women, including outcomes that may be sustained beyond 6 months after program completion.One of the underlying premises of the study by Beckie and Beckstead 1 is that traditional CR programs are not meeting the unique gender-specific CR preferences and needs of women with coronary heart disease (CHD). They argued that the trial was justified in part to test the effect of a women-only CR program that may better respond to the psychosocial needs of women, and by doing so they also addressed poor CR completion rates among women enrolled in traditional CR programs. The latter point was not well supported by the findings, as the women allocated to the traditional CR group had very impressive rates of completion. Women alloca...