The purpose of this special issue is to address cardiovascular health concerns that are of great significance for women's health. The three areas addressed, cardiovascular rehabilitation, physical activity, and clinical depression, are in great need of interventions that are specific and relevant to women. The authors in this issue address the psychosocial, physiological, and racial/ethnic factors that may improve the theoretical foundation for clinical practice interventions. The literature discussed and the findings presented by these authors remind us that there is scientific data to pursue clinical intervention research specific to the cardiovascular health of women.

Cardiac Rehabilitation in Women

Women are underrepresented in cardiac rehabilitation (CR) research and intervention programs. The literature emphasizes multiple factors that influence attrition from CR programs, with a few investigators reporting favorable outcomes for women who do stay in the programs.1 Among others resources, gender, cultural, racial/ethnic, psychosocial, and physiological factors have been identified as important, even for those who report favorable outcomes in women.2,3 Nevertheless, there is limited evidence to establish comprehensive CR programs that may provide favorable outcomes for women.

In this issue, Beckie4 describes the components of a unique theoretically based CR program that has the potential to meet the CR needs of women. The program was developed based on theoretical tenets of the Transtheoretical Model and the integration of relevant gender-related cognitive and behavioral approaches. This women-only program is distinctive for the integration of strategies based on women's health experiences and motivational interviewing principles.

As women are incorporated into the program, advanced-practice clinicians intervene with acceptance and empathy to foster adaptive behavioral changes, avoid resistance, and support self-efficacy. The author provides evidence of the thoughtful development of a psychoeducational intervention that offers the potential to improve the physiological, psychosocial, and cultural responses of women to cardiovascular rehabilitation.

Physical Activity

Despite the national efforts to increase physical activity in the population at large, it is well known that a sedentary lifestyle has become a typical health challenge in most families.5 Women of all ages are less likely to engage in vigorous or moderate levels of physical activity that promotes cardiovascular health. These findings are even more disconcerting among ethnic and racially diverse populations, with Latina women at the vanguard of physical inactivity and obesity.6,7 There has been a notable increase in the literature related to improving physical activity in Latina women; however, the lack of scientific and culturally based knowledge hampered our ability to develop culturally and gender-relevant interventions to increase physical activity in this population. In this issue, Keller and Fleury8 provide expert clinicians with an analytical review on factors that are known to influence physical activity and offer potential for interventions. Resources and psychosocial and cultural factors, such as the concern for the health of the family, are described. They also provide relevant practice implications to reduce physical activity disparities in Latina women.

Clinical Depression

Clinical depression is associated with poor health outcomes, particularly among women.9,10 Clinical depression influences medication adherence, overall psychosocial outcomes, perceptions, and functional recovery. Research in the surgical literature has shown the beneficial impact of perioperative cognitive and behavioral interventions to improve postsurgical recovery. Nevertheless, limited research has focused on women and cardiac surgery. As a result, there has been limited scientific guidance for interventions to manage clinical depression in women after cardiac surgery. The research study from Doering et al11 revealed findings on clinical depression among 75 older women who had coronary artery bypass surgery for the first time. The findings from this study provide significant data on the clinical and psychosocial characteristics that situate this group of women at risk for poor outcomes after cardiac surgery. The results on the differences in symptom frequency between nondepressed women and those found to be clinically depressed and on the intention-to-treat analysis of changes in clinical depression over time point out to the potential benefit for preoperative and perioperative clinical interventions to manage depression in women after cardiac surgery.

Teresa C. Juarbe, PhD, RN, FAHA

Guest Editor

Assistant Professor University of California, San Francisco

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