Lessons learned from community- and home-based physical activity programs: A narrative review of factors influencing women’s participation in cardiac rehabilitation

Abstract

Background Cardiovascular disease remains a leading cause of death in women. Despite the well-known benefits of cardiac rehabilitation, it remains underutilized, especially among women. Physical activity programs in the community, however, attract a large female population, suggesting that they overcome barriers to physical activity encountered by women. The characteristics of interventions that extend beyond the traditional cardiac rehabilitation model and promote physical activity merit examination. Objectives This narrative review aimed to: (a) summarize women’s barriers to attend cardiac rehabilitation; (b) examine the characteristics of community- and home-based physical activity or lifestyle coaching interventions; and (c) discuss which barriers may be addressed by these alternative programs. Methods Studies were included if they: (a) were published within the past 10 years; (b) included ≥70% women with a mean age ≥45 years; (c) implemented a community- or home-based physical activity intervention or a lifestyle education/behavioral coaching program; and (d) aimed to improve physical activity levels or physical function. Results Most interventions reported high (≥70%) participation rates and significant increases in physical activity levels at follow-up; some improved physical function and/or cardiovascular disease risk factors. Community- and home-based interventions address women’s cardiac rehabilitation barriers by: implementing appealing modes of physical activity (e.g. dancing, group-walking, technology-based balance exercises); adapting the program to meet participants’ needs; offering flexible options regarding timing and setting (e.g. closer to home, the workplace or faith-based institutions); and promoting social interactions. Conclusion Cardiac rehabilitation can be enhanced by understanding the specific needs of women; novel elements such as program offerings, convenient settings and opportunities for socialization should be considered when designing cardiac rehabilitation programs.

The feasibility of implementing high-intensity interval training in cardiac rehabilitation settings: a retrospective analysis

“…an inconvenient/long distance) of the classes reduced their attendance. This is consistent with previous findings showing that when CR offerings are not easily accessible or convenient, it may be a barrier to cardiac patient participation [28,29]. Given our high attendance, other community exercise programs may consider implementing HIIT for those with CVD.…”

The Feasibility of Implementing High-Intensity Interval Training in Cardiac Rehabilitation Settings: A Retrospective Analysis

“…an inconvenient/long distance) of the classes reduced their attendance. This is consistent with previous ndings showing that when CR offerings are not easily accessible or convenient, it may be a barrier to cardiac patient participation (28,29). Given our high attendance, other community exercise programs may consider implementing HIIT for those with CVD.…”

Sex differences in physical and mental health following high-intensity interval training in adults with cardiovascular disease who completed cardiac rehabilitation

“…HIIT may maximize adherence by addressing frequently cited barriers to traditional CR (e.g. lack of time, motivation and enjoyment) (Grace et al 2009;Vidal-Almela et al 2020).…”

“…Traditionally, CR has implemented moderate-to-vigorous intensity continuous training [MICT] (Pelliccia et al 2021). Lack of: interest, time, motivation and enjoyment are frequently cited barriers to traditional MICT-based CR (Grace et al 2009;Vidal-Almela et al 2020;Chindhy et al 2020). To address such barriers, alternative exercise paradigms might usefully be explored.…”