Gender Equality and Cardiac Rehab: Not a One-Size-Fits-All Solution

March 2019

Banner image: One size does not fit all
The traditional approach to cardiac rehab might not meet the needs and interests of all patients – especially women

March 8th is International Women’s Day, a day where women are globally recognized for their contributions and advancements in society. But could their next battle be against gender biases in the way society cares for them?

Due to barriers in sport and physical activity over the last century, many female cardiac patients today may not have grown up with the opportunity to participate in structured physical activity or sport, or understand the importance of cardiac rehab to aid in recovery from a cardiac event.

To help women recover and prevent subsequent cardiac events, cardiac rehab should be offered in multiple formats to better suit the needs of women, and patients ranging in age, physical fitness, and personal interests in the activities offered. Cardiac research should be intentional in including equal data on men and women for a better, more complete picture of the issues at hand, and how sex and gender differences affect one’s cardiac health.

A recent article published in Circulation by Dr. Jennifer Reed, a scientist in the Division of Cardiac Prevention and Rehabilitation, and director of the Exercise Physiology and Cardiovascular Health Laboratory at the University of Ottawa Heart Institute, and Dr. Kimberley Way, a postdoctoral fellow in the same lab, examines data on patients with cardiovascular disease who have completed high-intensity interval training (HIIT) programs.

We need to be cognisant that not every patient is the same. We need to have offerings that suit many needs and wants, which is a tough task to accomplish.

- Dr. Jennifer Reed, scientist, University of Ottawa Heart Institute

The piece highlights what Reed believes is missing from current cardiac rehab research. Specifically, Reed is interested in comparing HIIT to the standard cardiac rehab model, which generally consists of a one-hour, moderate-vigorous intensity continuous aerobic workout using equipment such as ellipticals, cycling machines, and treadmills. This approach is thought of as a “one-size-fits-all” model, which Reed says may not be suited to the needs and interests of all patients, especially women.

Dr. Jennifer Reed, University of Ottawa Heart Institute.
Dr. Jennifer Reed’s overall research program focuses on the role of exercise in cardiovascular disease prevention and rehabilitation as well as women’s health.

“We need to be cognisant that not every patient is the same,” says Reed. “We need to have offerings that suit many needs and wants, which is a tough task to accomplish.”

Reed says enrolment, participation, and completion of cardiac rehabilitation services at the University of Ottawa Heart Institute and other programs across Canada are low in female populations.

“While more women are being referred to cardiac rehab for secondary prevention services, fewer women enrol and complete such programs when compared to men,” explains Reed. “It’s important to acknowledge the differences between men and women and evaluate how both are treated and referred to programs, so healthcare providers can provide the best options for patients.”

Reed notes other barriers may deter women from participating in cardiac rehab programs, such as interest in the programs, transportation costs, timing, and commitment to caring for children or parents, and other responsibilities.

The question is: how do clinicians approach cardiac rehab programs to ensure accessibility and enjoyment for patients; to ensure enrolment and completion of the programs, while providing similar or superior cardiac benefits to patients as the traditional model? Reed suggests programs using HIIT may offer a solution to factors such as timing, accessibility, and enjoyment in the programs for cardiac patients.

Reed along with Senior Physiotherapist Marja-Leena Keast started the first women-only training program at the University of Ottawa Heart Institute called Cardio Dance, which combines the benefits of cardiac rehab services and HIIT. The program was designed using dance-based programs in the community such as Zumba, and the need to keep women engaged in their cardiac rehab program. Reed’s evaluation of the program demonstrates HIIT elicits:

  • similar or greater improvements in cardiovascular health when compared to the traditional model; and,
  • a shorter workout that is more convenient, individuals find it more enjoyable and enticing due to the intensity and interval format.

“When you compare women from the interval training program to the standard training program, both groups achieved similar improvements in body composition, waist circumference, and diastolic blood pressure, and mental health, but the waist circumference and mental health improvements were only clinically meaningful for the HIIT group,” explains Reed.

During her review of published literature on HIIT and cardiac rehab, Reed observed many publications lack equal data for men and women, and that most published data have included predominantly males.

“There are very few studies on HIIT that include an equal number or only women, and the current data includes samples with five times more men than women,” explains Reed.

The future of cardiac rehab programs should aim to increase accessibility, by offering multiple rehab program formats to better suit patients’ needs, including in the community or additional satellite campuses. Providers should also consider additional factors such as patients’ age, physical fitness, and personal interests.

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