Cardiovascular rehabilitation (CR) improves health outcomes and well-being and may reduce death and re-hospitalization rates by 20%. Nonetheless, programs are underutilized and girls are much less more likely to participate than men, in order that they don’t reap these advantages. This primary global comparative study into barriers to using CR in men and girls assesses the extent of those barriers and discusses ways during which patients can overcome them. It determined that men and women face some common, but additionally many various barriers, and barriers differ by global region. The study appears within the Canadian Journal of Cardiology, published by Elsevier.

Lead investigator Sherry L. Grace, PhD, CRFC, Faculty of Health, York University and KITE – Toronto Rehabilitation Institute, University Health Network, University of Toronto, explains: “The advantages of cardiac rehab participation are remarkable, plus patients get back their vitality and may return to their meaningful life roles. Unfortunately, women face many structural barriers to attending – from the person to health system levels. We developed the Cardiac Rehab Barriers Scale (CRBS) almost 25 years ago to higher characterize them, and it stays probably the most widely used and rigorous measurement scale to evaluate these barriers.”

While the CRBS has been translated into greater than 20 languages, before the current study it had never been administered to patients in multiple country at a time and had only been administered in a complete of 25 countries. There had only been two studies during which women’s and men’s barriers were compared.

Prof. Grace and co-lead investigator Gabriela Ghisi, PT, PhD, CRFC, also of KITE – Toronto Rehabilitation Institute, University Health Network, University of Toronto, add, “It was time to look at CR barriers on a worldwide comparative basis to assist us understand sex differences and girls’s most important barriers so we will address them, and hence have more women enrolling and fully participating in CR.”

On this cross-sectional study, the CRBS was administered globally via a web-based survey to over 2,000 patients from 16 countries across all six World Health Organization regions. Members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) community helped recruit participants by identifying cardiac inpatients who were eligible for CR and patients who were just starting CR. That is the primary international study of CR utilization barriers, including data from all world regions, and presents the primary quantitative barrier data from Africa in addition to from several Western Pacific and European countries. About 42% of the participants were women.

The study’s findings show that although female cardiac patients have a somewhat greater burden of barriers within the Western Pacific and Americas than men, men and girls have major barriers, which have to be addressed to optimize CR utilization. Women’s barriers were best within the Western Pacific and South East Asian regions in comparison with other regions, with lack of CR awareness as the best barrier in each. Men within the Eastern Mediterranean region reported greater barriers than women. Women who were unemployed reported significantly greater barriers than those that were employed.

Amongst women not enrolled in CR programs, their best barriers weren’t knowing about CR, program not contacting them after referral, cost, and finding exercise tiring or painful. Amongst women who were enrolled in a program, their best barriers to session adherence were distance, travel, family responsibilities, and difficulties in accessing sessions that require attendance in person (i.e., transportation).

Through the study — also for the primary time — potential mitigation strategies to assist overcome these barriers were provided to participants, akin to talking with a healthcare provider about attending to a program or doing a home-based program. Over 70% of girls and 40% of men rated the barrier-specific information provided as either “helpful” or “very helpful.” These observations should encourage the appliance of all these mitigation strategies, in addition to the event of further research on lively mitigation strategies to enhance adherence to CR programs.

Prof. Grace already has further research underway to check if the strategies to mitigate the most important barriers identified can lead to more CR participation. “We hope this may result in more women enrolling in CR, and that would definitely positively impact their health outcomes and well-being.”

She urges, “Patients could have legitimate barriers to attending CR, but we recommend they discuss them with healthcare providers, as there are proven strategies to beat them. Please help spread the word that CR is offered in most countries of the world and saves lives!”

A resource for patients to evaluate their very own barriers together with mitigation suggestions are provided on ICCPR’s website.

CR is a chronic disease management program where patients are supported by a team of healthcare professionals over several months through medical risk factor management, structured exercise, in addition to patient education and counseling.