Women participating in Phase 3 Cardiac Rehabilitation: a

Women participating in Phase 3 Cardiac Rehabilitation: a

Women participating in Phase 3 Cardiac Rehabilitation: a comparison between mixed and female only exercise groups? Shirley Ingram, Elaine Hand, Noeleen Fallon, Caroline Finn, Nora Flynn, Joan Love Cardiac Rehabilitation Dept Adelaide & Meath Hospital, Dublin, Ireland [email protected] CHD in Women Young males (35-44 years) have a C.H.D. rate 6 times higher than that of women of the same age (University of Glasgow, 2001).

As women reach menopause, they lose the high levels of circulating oestrogen that confers protection from heart disease. In postmenopausal women, C.H.D. has been found to be the leading cause of death and disability. CVD kills 55% of women and 43% men (ESC 2005) & women develop C.H.D. an average of 10 years later in life than men (Castelli, 1988). CVD is more lethal in women, one year post MI 42% will be dead (compared to 24% of men) Graham 2005 ESC Initiatives for women

AHA go red for women 2004 AHA guidelines for CVD prevention in women. (Mosca et al Circulation 2004;109;672-693) ESC 2005 Women and CR Women were not included in most of the early studies of CR Women benefit from CR in terms of functional capacity at least as much as men (Brezinka & Kittel, 1996)

The benefit may be to a greater extent due to greater overall improvements in exercise capacity (Lavie & Milani 1995) and quality of Life (Verril et al 2001) Women and CR men have been found to be more likely to be referred to and attend rehabilitation than women (Benz Scott et al 2002) Physicians who care for women do not refer to CR (Benz Scott et al 2002) despite a physicians recommendation being a powerful enrolment predictor (Ades et al 1992)

Even when referred women less likely to attend. The number of female participants in CR programmes ranges between 4.4% and 11%. Jolliffe et al (2002) Fewer women complete CR (Richardson et al 2000) Barriers to women attending CR Many barriers: older age, transport, lack of social support (Benz Scott et al 2002) Staff perceptions of barriers: male orientated, lack of privacy (Thomas 1996)

When women were asked: disliked male priority, mens club feeling, not enough talking and social interaction (Moore at al 1996) Aim Perception that CR programs are male-orientated, with regards to class schedules, educational materials, and privacy of facilities. Evenson and Fleury (2000) It has been suggested that tailoring CR programmes to women may increase participation. The aim of this study was to compare variables between women who attended female only phase 3 exercise groups to women

who attended phase 3 in groups with males. Methodology Women were randomly assigned to mixed v female only phase 3 exercise groups as they were removed from the waiting list and offered phase 3 for an 8 week period. HADS (Zigmond & Snaith1983) DASI (Hlatky et al 1989) Attendance Compliance > 60% (Oldridge & Jones 1983) Paired t tests were used to compare

scores pre and post treatment. Total Phase 1 seen 725 Male 530 (73%) Female 195 (25.8%) 10 MARCH 2005 -14TH march 2006 th Proceed to Phase 3 AMNCH (% of phase 1) Male (38%) Female (31.2%) Commenced Phase 3 AMNCH (% of referred) Male 229 (65.6%) Female 78 (66%) Completed >60%

Phase 3 Male 170 (74.2%) Female 40 (62.8%) Total referred for Phase 3 Male 349 (65.8%) Female 118 (60.5%) Female only (FO) 35 (45%) Female mixed (FM) 43 (55%) Compliance > 60% FO 22 (63%) FM 27 (63%) Results

35 Female only group (FO) (Average age =64.6yrs) 43 Mixed group (FM) (Average age=60.7yrs) Nursing int. FO 21(60%) FM 26 (60.4%) Nursing interventions Male 137 (59.8%) Smoking status current FO (28.5%) FM (30%) SO attendance FO (5.7%) FM (4.6%) Results: Anxiety & Depression 68.5% in the FO group and 60.4% in the FM

group completed the HADS pre & post CR there was a decrease in anxiety scores for all after cardiac rehab (p<0.0001) decrease in depression scores for all at the end of cardiac rehab (p<0.0001) no significant difference in anxiety (p = 0.1798) and depression between groups (p = 0.1056). Past history of depression FO group 3 (8.5%) FM group 9 (20.9%)

Results: Physical Function increase in METS scores for all after rehab sessions (p<0.0001) no significant difference in the increase in METS scores between women who attended same sex groups and women who attended mixed groups (p = 0.2429). Discussion: referral rates

60.5% of women referred to Phase 3. 31.2% referred to AMNCH centre Compares favourably to referral rates of 15-20% in literature (Ades 1992, Barber 2001) This study showed commencement of phase 3 by 66% of women referred Uptake was found to be 49% in men and 34% in women (p<0.001) (McGee & Horgan, 1992). of 583 surviving M.I. patients offered CR (415 males, 168 females), Compliance & Drop out What is compliance? What is drop out?

>60% attendance Oldridge N, Jones N. Journal of Cardiopulmonary Rehabilitation 1983; 3: 257-262 14% (FO) 18% (FM) did not start 6% (FO) 5% (FM) dropped out in week one, majority gave no reason Good compliance of > 60% in both groups FO 22 (63%) FM 27 (63%) Comparable to males (74.2%) Compliance to Phase III 70% 60%

50% 40% 30% 20% 10% 0% Female Mixed Female Only Did not start DO in first w eek < 60% >60% Reasons for DNA & Drop out < 1 week Other illness

Not interested Female Mixed Work Female Only Social No reason given 0 2 4 6 8 10 Conclusion

Good referral rate to Phase 3 at this centre Good uptake of phase 3 Low drop out Good compliance > 60% of sessions No difference between the 2 groups re uptake & compliance Favourable responses for all women post CR re anxiety, depression and DASI No significant differences between

groups Recommendations Continue to encourage women to avail of phase 3 No need for special female only groups Need to research other aspects of women's participation i.e. the social aspect Women never have a half-hour in all their lives that they can call their own, without fear of

offending or of hurting someone. Why do people sit up so late, or, more rarely, get up so early? Not because the day is not long enough, but because they have 'no time in the day to themselves. [1852] Florence Nightingale http://womenshistory.about.com/ library/qu/blqulist.htm#N

Recently Viewed Presentations

  • BTEC Level 3 National Extended Certificate in Performing Arts ...

    BTEC Level 3 National Extended Certificate in Performing Arts ...

    UNIT 2 Developing Skills and Techniques for Live Performance (90 GLH) Exploring technical performance skills with a focus on developing skills and techniques in at least two performance styles. In this unit you will: A Understand the role and skills...
  • How to Use ProposalSpace Its Easy ! 02/27/2020

    How to Use ProposalSpace Its Easy ! 02/27/2020

    It is pretty intuitive, but an introduction will help. You will likely have questions, and I ask you to please take notes of those questions and we'll tackle them at the end. It is possible that we may cover your...
  • Clinical Discussion of Specific Populations Zhixia (Grace) Yan,

    Clinical Discussion of Specific Populations Zhixia (Grace) Yan,

    Pharmacology, Division 4. Office of Translational Sciences. Center for Drug Evaluation & Research. Disclaimer. The opinions contained in this presentation are my own and do not necessarily represent the views of the FDA. www.fda.gov. ... Cmax μ. g/mL) AUC (μ;...
  • Nazi Propaganda - Issaquah Connect

    Nazi Propaganda - Issaquah Connect

    Nazi Propaganda . If you look around the room you will notice several (41 to be exact) pieces of propaganda hanging on the walls, we are going to start with a gallery walk. Things to look for - Common themes....
  • Lecture 2 - Computer Science

    Lecture 2 - Computer Science

    If benchmark execution times are normalized to some reference machine, and means of normalized execution times are computed, only the geometric mean gives consistent results no matter what the reference machine is This has led to declaring the geometric mean...
  • Rise of the Ottoman Empire, C. 1299-1600 I.

    Rise of the Ottoman Empire, C. 1299-1600 I.

    Times New Roman Times Symbol Default Design Rise of the Ottoman Empire, C. 1299-1600 I. Introduction II. Origins of the Ottoman Empire III. Ottoman Dominance (1453- 1699) III. Ottoman Dominance (1453- 1699) IV. Sources of Ottoman Strength IV. Sources of...
  • Federal Public Service Workplace Mental Health Strategy

    Federal Public Service Workplace Mental Health Strategy

    The mental health and workplace well-being of Defence civilians is critical to the success of our organization. Senior leaders, through the SSE and THWS are committed to providing employees with a healthy, supportive workplace and the mental health and other...
  • Neighbourhood Planning - the story so far - CPRE Cheshire

    Neighbourhood Planning - the story so far - CPRE Cheshire

    CPRE Oxfordshire . Prof Gavin Parker. Professor of Planning, University of Reading ... Neighbourhood planning gives communities direct power to develop a shared vision for their neighbourhood and shape the development and growth of their local area. They are able...