Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Ghisi, Gabriela Lima de Melo; Marzolini, R. Kin Susan; Price, Jennifer; Beckie, Theresa M.; Mamataz, Taslima; Naheed, Aliya; Grace, Sherry L.

doi:10.1016/j.cjca.2022.06.021

Cited by 27 publications

(45 citation statements)

References 199 publications

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“…It is worth noting that in our programme, we offer women-only sessions as the CR option for female patients. In Arab countries such as Qatar, women-only CR is related to religious beliefs and cultural values around gender segregation, so females can exercise comfortably 48. Generally, women participating in women-only CR programmes are significantly more comfortable in their workout attire and perceive the environment as less competitive 49.…”

Section: Discussionmentioning

confidence: 99%

“…While the International Council of Cardiovascular Prevention and Rehabilitation 2022 Clinical Practice Guideline for Women-Focused Cardiovascular Rehabilitation does recommend that women should be provided the choice of participating in hospital-based or a hybrid model…. it also states among its recommendations that ‘the CR environment should be optimised to meet women’s preferences, values and goals’, including consideration of privacy and that ‘inclusion of male support persons in some elements of women-only programmes might not be appropriate’ 48. Furthermore, lack of human resources is perceived as the greatest barrier to CR provision overall.…”

Section: Discussionmentioning

confidence: 99%

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Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

et al. 2023

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The COVID-19 pandemic resulted in the cessation of approximately 75% of cardiac rehabilitation (CR) programmes worldwide. In March 2020, CR phase II (CRP2) services were stopped in Qatar. Multiple studies had shown safety, effectiveness, reduced cost of delivery and improved participation with hybrid CR. A multidisciplinary team reviewed various alternative models for delivery and decided to implement a hybrid CRP2 exercise programme (HCRP2-EP) to ensure continuation of our patient care. Our aim was to enrol in the HCRP2-EP 70% of all eligible patients by 30 September 2020. Institute for Health Care Improvement’s collaborative model was adopted. Multiple plan–do–study–act cycles were used to test change ideas. The outcomes of the project were analysed using standard run chart rules to detect the changes in outcomes over time. This project was implemented from March 2020, and the male patients enrolled between August 2020 and April 2021, with sustained monthly median enrolment above target of 70% throughout. As for our secondary outcome, 75.8% of the male patients who completed HCRP2-EP showed a meaningful change in peak exercise capacity of ≥10% (mean change 17%±6%). There were no major adverse events reported, and the median Patient Satisfaction Score was 96% well above the institutional target of 90%. This shows a well-designed quality improvement programme is an appropriate strategy for implementing HCRP2-EP in a clinical setting, and HCRP2-EP is a feasible, effective and safe intervention in eligible male patients with cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

et al. 2023

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“…CR is traditionally delivered in a supervised setting (Ghisi et al, 2022), which leads to capacity constraints and patient barriers to access, resulting in under‐utilization (Grace et al, 2021). For instance, in India (Babu et al, 2020), there is only 1 CR “spot” for every 160 incident ischemic heart disease patients per year (Turk‐Adawi et al, 2019), such that the unmet need for CR in India is over 3 million “spots” per year ‐ the greatest of any country in the world (Pesah et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…Women's CR barriers have been extensively studied, and include lack of transportation/distance, depression/anxiety, lack of support/encouragement, comorbidities, and associated concern over pain or fatigue during exercise, as well as time conflicts due to their multiple role obligations (Grace et al, 2009; Supervia et al, 2017). It has been suggested that CR tailored to women and offered remotely could address these barriers (Ghisi et al, 2022).…”

Section: Introductionmentioning

confidence: 99%

Technology‐based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle‐income setting: A randomized controlled trial protocol

Menezes

D’Souza

Ramachandran

et al. 2022

Research in Nursing & Health

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Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower-resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology-based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) intervention on functional capacity, risk factors, quality of life, heart-health behaviors, symptoms, and morbidity will be tested among women with CVD in a middle-income country. Following a pilot study, a single-center, single-blinded, 2 parallel-arm (1:1 SNOSE) superiority trial comparing an eCR intervention (TaCT) to usual care, with assessments preintervention and at 3 and 6 months will be undertaken. One hundred adult women will be recruited. Permuted block (size 10) randomization will be applied.The 6-month intervention comprises an app, website, SMS texts with generic heart-health management advice, and bi-weekly 1:1 telephone calls with a nurse trainee. Individualized exercise prescriptions will be developed based on an Incremental Shuttle Walk Test (primary outcome) and dietary plans based on 24 h dietary recall. A yoga/relaxation video will be provided via WhatsApp, along with tobacco cessation support and a moderated group chat. At 3 months, intervention engagement and acceptability will be assessed. Analyses will be conducted based on intent-to-treat. If results of this novel trial of womenfocused eCR in a middle-income country demonstrate clinically-significant increases in functional capacity, this could represent an important development for the field considering this would be an important outcome for women and would translate to lower mortality.

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“…[15][16][17] Individualized SP programs that incorporate sex-specific components hold promise for improving the health behaviors of women. [18][19][20] Moreover, mobile health (mHealth) technology has the potential to increase scalability of SP through broader reach seamlessly in daily life and improved intervention effectiveness. 21 Although technology-enhanced home-based cardiac rehabilitation (CR) offers a possible adjunct to poor CBCR participation, 22 evidence for improved reach and effectiveness for women is limited.…”

mentioning

confidence: 99%

A Mobile Health Behavior Change Intervention for Women With Coronary Heart Disease

Beckie

Sengupta

Dey

et al. 2023

Journal of Cardiopulmonary Rehabilitation and Prevention

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C enter-based cardiac rehabilitation (CBCR), the gold standard of secondary prevention (SP) of coronary heart disease (CHD), 1 provides irrefutable health benefits. 2 Support for healthy behavior change is a vital component of contemporary CBCR. 3 However, fewer women than men are referred to CBCR 4,5 and as few as 10-20% of women enroll with up to a 56% noncompletion rate. [6][7][8][9] Welldocumented barriers contribute to the underutilization of CBCR 10 including inadequate health insurance and costly copayments. 11 Women with transportation challenges, less social support, family obligations, depression, or anxiety and women of color are least likely to utilize CBCR. 8,[12][13][14] These barriers have prompted the need to redesign and expand SP alternatives for women. [15][16][17] Individualized SP programs that incorporate sex-specific components hold promise for improving the health behaviors of women. [18][19][20] Moreover, mobile health (mHealth) technology has the potential to increase scalability of SP through broader reach seamlessly in daily life and improved intervention effectiveness. 21 Although technology-enhanced home-based cardiac rehabilitation (CR) offers a possible adjunct to poor CBCR participation, 22 evidence for improved reach and effectiveness for women is limited. 23 Theoretically driven mHealth SP interventions designed specifically for women unable to access CBCR are lacking. 24 Our previously developed gender-specific CBCR 25,26 was translated to a gender-specific mHealth SP behavior change intervention, called HerBeat. Descriptions of the theoretical underpinnings, system architecture, and usability testing of our prototype are found elsewhere. 27,28 HerBeat focuses on improving the health behaviors of women (eg, physical activity [PA], eating behavior, and stress management). Our primary aim was to evaluate, in a randomized controlled pilot study, whether participants in the HerBeat compared with participants in the educational usual care (E-UC) group improved exercise capacity (EC) at 3 mo measured by the 6-min walk test (6MWT). Secondary outcomes included PA, blood pressure (BP), resting heart rate (RHR), body mass index (BMI),

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Women-Focused Cardiovascular Rehabilitation: An International Council of Cardiovascular Prevention and Rehabilitation Clinical Practice Guideline

Cited by 27 publications

References 199 publications

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

Developing and delivering a hybrid Cardiac Rehabilitation Phase II exercise program during the COVID-19 pandemic: a quality improvement program

Technology‐based Comprehensive Cardiac Rehabilitation Therapy (TaCT) for women with cardiovascular disease in a middle‐income setting: A randomized controlled trial protocol

A Mobile Health Behavior Change Intervention for Women With Coronary Heart Disease

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