title: Cardiac Rehabilitation Program Adherence and Functional Capacity Among Women: A Randomized Controlled Trial.
abstract: OBJECTIVE
  To compare program adherence and functional capacity between women referred to supervised mixed-sex, supervised women-only, or home-based cardiac rehabilitation (CR).
  
  
  METHODS
  Cardiac Rehabilitation for Heart Event Recovery (CR4HER) was a single-blind, 3 parallel-arm, pragmatic randomized controlled trial. The study took place between November 1, 2009, and July 31, 2013. Low-risk patients with coronary artery disease were recruited from 6 hospitals in Ontario, Canada. Consenting participants completed a preprogram survey, and clinical data were extracted from charts. Participants were referred to CR at 1 of 3 sites. After intake assessment, including a graded exercise stress test, eligible patients were randomized to supervised mixed-sex, supervised women-only, or home-based CR. Six months later, CR adherence and exit assessment data were ascertained.
  
  
  RESULTS
  Of the 264 consenting patients, 169 (64.0%) were eligible and randomized. Twenty-seven (16.0%) did not attend, and 43 (25.4%) attended a different model. Program adherence was moderate overall (54.46%±35.14%). Analysis of variance revealed no significant differences based on per-protocol analysis (P=.63), but as-treated, home-based participants attended significantly more than did women-only participants (P<.05). Overall, there was a significant increase in functional capacity preprogram to postprogram (P<.001). Although there were no significant differences in functional capacity by model at CR exit based on per-protocol analysis, there was a significant difference on an as-treated basis, which sustained adjustment. Women attending mixed-sex CR attained significantly higher post-CR functional capacity than did women attending home-based programs (P<.05).
  
  
  CONCLUSIONS
  Offering women alternative program models may not promote greater CR adherence or functional capacity; however, replication is warranted. Other proven strategies such as action planning and self-monitoring should be applied.
  
  
  BACKGROUND
  clinicaltrials.gov Identifier: NCT01019135.
authors.affiliation: York University, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada. Electronic address: sgrace@yorku.ca.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Liz
authors.initials: L
authors.lastname: Midence
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Oh
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Brister
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Caroline
authors.initials: C
authors.lastname: Chessex
authors.affiliation: University Health Network, Toronto, Ontario, Canada.
authors.forename: Donna E
authors.initials: DE
authors.lastname: Stewart
authors.affiliation: Hamilton Health Sciences Centre, Hamilton, Ontario, Canada.
authors.forename: Heather M
authors.initials: HM
authors.lastname: Arthur
mesh_terms: D000203:Activities of Daily Living; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000503:physiopathology / Q000534:rehabilitation*; D005080:Exercise Test / Q000379:methods; D005081:Exercise Therapy / Q000379:methods*; D017079:Exercise Tolerance / Q000502:physiology; D005260:Female; D018575:Home Care Services, Hospital-Based / Q000592:standards; D006801:Humans; D008875:Middle Aged; D020380:Needs Assessment; D010349:Patient Compliance; D016896:Treatment Outcome