Within weeks of COVID-19 being declared a pandemic, cardiac rehabilitation (CR) programs around the world suspended in-person services due to social distancing measures put in place to help flatten the curve.
Considering the unprecedented disruption to the delivery of traditional CR delivered at hospitals and other health care settings, CR has ‘gone virtual’ by shifting to home-based programs that make use of communication technologies – including phone and videoconferencing, email, smartphone apps and wearable fitness tech – to facilitate the continuum of care for patients with cardiovascular disease (CVD).
The problem is, while CR programs are an effective, multidisciplinary, and proven secondary prevention strategy to optimize cardiovascular health, COVID-19 has exacerbated gender inequalities – amid the pandemic, the rapid shift to virtual CR has presented unique challenges to women with CVD.
“Cardiovascular disease is a leading cause of death among Canadian women,” says Dr. Carley O’Neill, a postdoctoral research fellow working in the Exercise Physiology and Cardiovascular Health Laboratory directed by Dr. Jennifer Reed at the University of Ottawa Heart Institute (UOHI). “Exercise improves physical and mental health and CVD management. Unfortunately, during the pandemic, women have been experiencing an increase in caregiving responsibilities, job insecurities, and domestic violence, impacting their ability to prioritize their health.”
In a recently published paper appearing in the April 2021 issue of Applied Physiology, Nutrition, and Metabolism, Dr. O’Neill and her fellow researchers highlight women with CVD frequently also have a greater number of modifiable risk factors, such as physical inactivity, stress and anxiety, leading to worse physical and mental health compared to men.
Moreover, the various social, economic, ethnic, and political inequalities women experience further increase their risk of CVD.
“If the unique needs of women with CVD are not considered during the current and future coronavirus responses, gender-related inequities and inequalities for both CVD and COVID-19 infection and mortality will grow.”
- Dr. Carley O’Neill
To increase exercise participation among women with CVD in all communities during the pandemic and over the long-term, the research of Dr. O’Neill and her colleagues reveals virtual exercise programs must be feasible, flexible and fun, reflecting basic needs and strategies, including the following:
Include a friend, partner, or family member to promote social interactions.
Split up longer sessions into shorter ones and keep workout structures flexible.
Include several options (e.g., walking, aerobic dancing, resistance training, online fitness classes) allowing women to choose the exercise most enjoyable for them.
Use an exercise diary or tracker to set small and achievable goals, increase motivation, and remain active long-term.
Cover home-based cardiac rehabilitation.
“Women comprise a large proportion of essential workers who are ensuring access to essential supplies and services throughout the pandemic,” adds Dr. O’Neill. “Combined with their heightened caregiving responsibilities and financial instability, women are also predisposed to burnout and psychological distress.”
Meeting the escalating mental health needs of women with CVD amid the pandemic would improve the management of CVD risk factors and quality of life. For example, women with CVD would benefit from flexible working hours, ease of access and extended hours of operation of COVID-19 assessment and vaccination centres to accommodate their busy schedules, and increased opportunities for virtual connection and social interactions.
“The unique needs of women with CVD are often overlooked and their voices minimized,” says Dr. O’Neill. “While we continue to fight the spread of COVID-19, we must also be steadfast in advocating for women’s cardiovascular health in all communities across Canada.”