title: A prospective, controlled multisite study of psychosocial and behavioral change following women's cardiac rehabilitation participation.
abstract: BACKGROUND
  Despite its proven benefits and need, women are significantly less likely than men to participate in and complete cardiac rehabilitation (CR). Thus, there are few reports of CR outcomes among women, particularly when compared with women who do not participate in CR. The purpose of this study was to prospectively assess psychosocial and behavioral changes, comparing women who participated in CR with those who did not.
  
  
  METHODS
  One hundred fifty-seven female cardiac inpatients from three hospitals consented to participate in a prospective study, and 110 (79%) were retained 18 months postdischarge. A mailed survey discerned CR participation 9 months postdischarge. Quality of life (Short-Form Health Survey Physical and Mental Component Summary [SF-12 PCS and MCS]), exercise behavior (Health-Promoting Lifestyle Profile II [HPLPII]), Exercise Benefits and Barriers Scale (EBBS), and anxiety and depressive symptoms (Hospital Anxiety and Depression Scale [HADS]) were assessed in hospital and 18 months postdischarge.
  
  
  RESULTS
  Fifty-one (45.1%) women self-reported participating in CR at 1 of 18 sites, and site-verified participation was 82.43% +/- 29.97% of prescribed sessions. For CR participants, paired t tests assessing change from hospitalization to 18 months postdischarge revealed significant improvements in physical quality of life (p < 0.001), anxiety (p < 0.05), and exercise behavior (p = 0.01). Women who did not participate in CR experienced significant improvements in physical quality of life (p = 0.02), and depressive symptoms (p = 0.03) but not exercise behavior.
  
  
  CONCLUSIONS
  Following a cardiac event, female patients improved their physical quality of life and affect, but only patients who participated in CR increased their exercise behavior. Given the cardiac benefits of exercise and that women are often sedentary and given that this exercise behavior was sustained post-CR, these findings are significant. Randomized controlled trials of women's CR outcomes are needed.
authors.affiliation: York University, Toronto, ON, Canada.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.forename: Keerat
authors.initials: K
authors.lastname: Grewal
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
authors.forename: Beth L
authors.initials: BL
authors.lastname: Abramson
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
mesh_terms: D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D001007:Anxiety / Q000453:epidemiology; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D003863:Depression / Q000453:epidemiology; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D009864:Ontario; D011446:Prospective Studies; D011788:Quality of Life; D018434:Sickness Impact Profile; D012944:Social Support; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016387:Women's Health