The present systematic review and meta-analysis examines studies published in the past 10 years that described cardiac rehabilitation (CR) enrollment among women and men, to determine whether a significant sex difference persists despite the evidence supporting the benefits of CR to women as well as men. Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases were systematically searched for peer-reviewed articles published from July 2000 to July 2011. Titles and abstracts were screened, and the 623 selected full-text articles were independently screened based on predefined inclusion/exclusion criteria (guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses; PRISMA) and assessed for quality using the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement form. The meta-analysis was undertaken using Review Manager software. Twenty-six eligible observational studies reporting data for 297,719 participants (128,499 [43.2%] women) were included. On average, 45.0% of men and 38.5% of women enrolled in CR. In the pooled analysis, men were more likely to be enrolled in CR compared with women (female enrollment vs male enrollment odds ratio, 0.64; 95% confidence interval, 0.57-0.72; P < 0.00001). Heterogeneity was considered high (I(2) = 78%). In the subgroup analyses, systematic CR referral during inpatient tertiary care resulted in significantly greater enrollment among women than nonsystematic referral. Overall, rates of CR enrollment among women are significantly lower compared with men, with women being 36% less likely to enroll in a rehabilitation program.

Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in cardiac rehabilitation (CR), programmes which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists. We searched Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases for studies reporting CR referral rates in women and men published between July 2000 and July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on predefined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE. Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) met the inclusion criteria. In the pooled analysis, women (39.6%) were significantly less likely to be referred to CR compared to men (49.4%; odds ratio 0.68, 95% confidence interval 0.62–0.74). Heterogeneity was considered significant (I²= 90%). There was no change in significant findings when subgroup analyses were conducted, examining fee for service vs. no fee, high-quality studies vs. others, or studies pooled by different study methodologies. CR referral remains low for all patients, but is significantly lower for women than men. Evidence-based interventions to increase referral for all patients, including women, need to be instituted. It is time to ensure broader implementation of these strategies.

Background: Although aerobic training (AT) and resistance training (RT) have been shown to improve functional abilities in patients post stroke, few patients participate, with many doing so for only a short duration. Purpose: To retrospectively identify factors that affect adherence to a home-based exercise program adapted for stroke patients in a cardiac rehabilitation program during and after program completion. Methods: Fourteen participants (age 63 ± 3 years, 37 ± 34 months post stroke) attended the rehabilitation center on a weekly (24 weeks) and then monthly (2 months) basis. Patients were required to complete 4 AT and 1 to 2 RT sessions away from the center each week. A 16-item survey exploring adherence to home-based workouts was administered. Results: Seven patients were currently participating (mean time in program, 19.4 ± 8 weeks) and 7 had graduated (mean of 32.8 ± 28 weeks post graduation) from the program. Current participants had higher adherence than graduated participants to AT (100% vs 76%; P < .01) and RT (100% vs 55%; P < .01). The most common factors motivating participants were to improve overall health, improve functional abilities, and enhance confidence and to reduce musculoskeletal issues. The most common factors preventing workouts were lack of motivation, musculoskeletal issues, and fatigue. There was a negative correlation between age and adherence to AT in the graduated group. Conclusion: Adherence to home-based exercise is superior during participation in an organized group program, with decline after graduation.

Resistance training (RT) has only a permissive role as an adjunct to aerobic training (AT) in cardiac rehabilitation. To compare the effect of AT with combined RT and AT (CT) we searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, PreMedline, SPORT DISCUS, CINAHL (from the earliest date available to October 2009) for randomized controlled trials (RCTs), examining effects of CT versus AT on body composition, cardiovascular fitness (VO(2peak)), strength, and quality-of-life (QOL) in coronary artery disease (CAD) (excluding heart failure). Two reviewers selected studies independently. Twelve studies met the study criteria (229 AT patients, 275 CT patients). Compared with AT, CT decreased percent body fat by -2.3% (WMD (weighted mean difference); 95% CI: -3.59 to -1.02), decreased trunk fat (SMD (standardized mean difference): -0.56; 95% CI: -0.96 to -0.15) and increased fat-free mass by 0.9 kg (WMD; 95% CI: 0.39 to 1.36) in three studies (n = 106). Similarly CT was associated with larger increases in lower body strength (seven studies, n = 225, SMD: 0.77; 95% CI: 0.49 to 1.04) and upper body strength (eight studies, n = 262, SMD: 1.07; 95% CI: 0.76 to 1.38). Compared to AT, CT improved peak work capacity (three studies, n = 92, SMD: 0.88; 95% CI: 0.45 to 1.31) and there was a trend for CT to increase VO(2peak) by 0.41 ml/kg/min (nine studies, n = 399, WMD; 95% CI: -0.05 to 0.88). Qualitative analysis of QOL data favors CT. Study withdrawals were similar for AT (14.2% ± 13.2) and CT (11.5% ± 15.5). No serious adverse events were reported. CT is more effective than AT in improving body composition, strength, and some indicators of cardiovascular fitness, and does not compromise study completion or safety when compared to AT.

Background . Cognitive benefits obtained from exercise in healthy populations support the idea that aerobic and resistance training (AT+RT) would confer benefit for poststroke recovery. However, there is little evidence regarding the effectiveness of such programs. Objective . To evaluate the effects of a 6-month exercise program of AT+RT on cognition in consecutively enrolled patients with motor impairments ≥10 weeks poststroke. Methods . Outcomes were measured before and after 6 months of AT+RT on 41 patients. Cognition was measured by the Montreal Cognitive Assessment (MoCA). Secondary measures included evaluation of gas exchange anaerobic threshold (ATge), body composition by dual energy X-ray absorptiometry, and depressive symptoms by questionnaire. Results . There were significant improvements in overall MoCA scores (22.5 ± 4.5 to 24.0 ± 3.9, P < .001) as well as in the subdomains of attention/concentration (4.7 ± 1.7 to 5.2 ± 1.3, P = .03) and visuospatial/executive function (3.4 ± 1.1 to 3.9 ± 1.1, P = .002). There was a significant reduction in the proportion of patients meeting the threshold criteria for mild cognitive impairment (MCI) at baseline compared with posttraining (65.9% vs 36.6%, P < .001). In a linear regression model, there was a positive association between change in cognitive function and change in fat-free mass of the nonaffected limbs (β = .002; P = .005) and change in attention/concentration and change in ATge (β = .383; P ≤ .001), independent of age, sex, time from stroke, and change in fat mass and depression score. Conclusion . A combined training model (AT+RT) resulted in improvements in cognitive function and a reduction in the proportion of patients meeting the threshold criteria for MCI. Change in cognition was positively associated with change in fat-free mass and ATge.