title: Sex Differences in Cardiac Rehabilitation Adherence: A Meta-analysis.
abstract: Cardiac rehabilitation (CR) participation is associated with significantly lower mortality, and this benefit has been established as dose-dependent. Because it has been suggested that women are adherent to CR programs less than men, the objective of this study was to review CR adherence among women and men, and to determine whether a sex difference exists.
  
  
  
  MedLine, CINAHL, EMBASE, PsycINFO, and the Cochrane databases were systematically searched. Titles and abstracts were screened, and selected full-text articles were independently considered on the basis of predefined inclusion/exclusion criteria. Data from included articles were extracted by 2 authors independently and assessed for quality. The meta-analysis was undertaken with predefined subgroup analyses.
  
  
  
  The search identified 5148 articles, of which 149 were fully examined for inclusion consideration. Fourteen studies reporting data on 8176 participants (2234 [27.3%] women) were included. Overall, CR adherence ranged from 36.7% to 84.6% of sessions, with a mean of 66.5 ± 18.2% (median, 72.5%). Men and women enrolled in CR adhered to 68.6% and 64.2% of prescribed sessions, respectively (mean difference = -3.6; 95% confidence interval, -6.9 to -0.3). The sex difference persisted in studies of high quality, that were undertaken in Canada, published since 2010, and where programs were longer than 12 weeks' duration and offered fewer than 3 sessions per week.
  
  
  
  To our knowledge, this is the first meta-analysis to systematically report CR adherence rates, and results suggest that patients adhere to more than two-thirds of prescribed sessions. CR adherence is significantly lower among women than men. Identified strategies to promote adherence need to be tested among women.
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Oosenbrug
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Raquel Pedercini
authors.initials: RP
authors.lastname: Marinho
authors.affiliation: York University, Toronto, Ontario, Canada.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Marzolini
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tracey J F
authors.initials: TJ
authors.lastname: Colella
authors.affiliation: Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.
authors.forename: Maureen
authors.initials: M
authors.lastname: Pakosh
authors.affiliation: York University, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada. Electronic address: sgrace@yorku.ca.
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000072038:Cardiac Rehabilitation; D002318:Cardiovascular Diseases / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D055502:Secondary Prevention; D012737:Sex Factors