Aim: This review was undertaken to identify cardiac rehabilitation (CR) program components that facilitate adherence and yield improvements in physiological and psychosocial outcomes.
Methods: English language studies published since 2000 with adult women participants were included. Books, systematic reviews, and studies which did not analyze female separately were excluded. Electronic databases searched included: MEDLINE, Embase, CINAHL, Scopus, Sport Discus and the Cochrane Library. Search terms were: 'women', 'heart disease', 'exercise', and 'cardiac rehabilitation'. To determine which articles were appropriate, a step-wise elimination process was completed. Articles were blinded and then reviewed/eliminated by title, abstracts and finally the full article. The Canadian Task Force on Preventive Health Care Methodology was used to assess the quality of the articles. Four reviewers independently rated each article for evidence and internal validity. Quality of evidence (QE) was determined by evaluating the articles' design against the internal validity criteria from the US Preventive Services Task Force. The grade given to each recommendation reflected the strength of the supporting literature (where code A = good QE and substantial net benefit; B = good to fair QE supporting a moderate net benefit; C = fair QE with a small net benefit).
Results: This initial search yielded 1,084 articles which was reduced to 37 (combined sample of 3,807 subjects) after the step-wise elimination process. Ten articles examined the physiological effects of CR while 34 papers addressed quality of life (QoL), social support or adherence. Percent agreement between reviewers for the QE was higher (83%) than for internal validity (75%). The QE was variable while the majority of the articles were rated as having either good or fair internal validity.
Discussion: The strongest recommendation (code A) suggested a substantial net benefit for: 1) the inclusion of resistance training as an adjunct to aerobic training for improvements in QoL and 2) the implementation of women-specific educational programs and self management strategies. Evidence (code B) also suggested that for women with well preserved ventricular function self monitored walking program was as effective as supervised exercise in terms of physiological improvements and that CR programs need to be more client-centered and address individual preferences. Finally a stronger emphasis needs to be place on social support for women entering CR programs.