Many Women in Cardiac Rehab Have Low Fitness Level

Women in cardiac rehabilitation following a heart attack or bypass surgery have an average fitness level of patients with more serious heart conditions, according to a report in the medical journal Circulation.

The study examined 2,896 patients who were participating in a cardiac rehabilitation program following hospitalization due to a recent cardiac event.

The researchers evaluated patients to determine their aerobic fitness level, which affects the heart's ability to pump blood, as well as their skeletal muscle function.

Results showed that, overall, men were more aerobically fit than women, but both men and women showed lower fitness capacities than anticipated.

"I was surprised by several of our results," says study author Dr. Philip A. Ades, director of preventive cardiology and cardiac rehabilitation at the University of Vermont College of Medicine.

"The biggest surprise was how low the fitness levels were in women," remarks Dr. Ades. "The average woman in this study fell in the fitness range where cardiologists often consider heart transplantation in heart failure patients."

Aerobic Fitness Low for Women

The study was conducted on patients at the University of Vermont and Henry Ford Hospital in Detroit between January 1996 and December 2004.

All of the patients studied had been previously hospitalized because they experienced a heart attack, bypass surgery, angioplasty, or chronic angina.

Patients in the rehabilitation program were tested using an exercise treadmill stress test, and their oxygen consumption was measured at their peak level of exercise.

Among the findings:

• At the beginning of the study, men had significantly higher aerobic fitness capacities than women.
• Aerobic capacity diminished in both men and women with age but diminished more significantly in men.
• Previous cardiac events had an impact on aerobic capacity in both men and women. The lowest fitness levels were seen in patients who had had coronary bypass surgery, while patients who had had procedures like cardiac catheterization were the most fit.
• The average increase in aerobic fitness capacity was 17 percent - 18 percent in men and 12 percent in women.

"The smaller increase in aerobic capacity in women came as a surprise, and we don't have a good explanation for it," says Dr. Ades.

"Other studies have found that women are less fit than men when entering rehab, but they generally have shown the same relative improvement," he notes.

Organized Cardiac Rehab Key to Success

Dr. Ades adds that participants in the study were probably more fit than patients who opted not to enter cardiac rehabilitation.

Previous studies reported that patients who decide not to enroll in rehabilitation are usually less healthy and less aerobically fit than those who participate in a rehabilitation program.

"This study was important, because there has been little data on directly measured fitness levels in these patients," says Dr. Ades. "It also emphasizes the importance of cardiac patients doing organized cardiac rehab, because without it, the majority of these patients would remain quite disabled."

"The take-home message to cardiac surgeons and interventional cardiologists is that the job is only half done when bypass surgery or coronary stenting is satisfactorily performed," remarks Dr. Ades. "These patients remain sorely in need of rehabilitation despite optimal in-hospital care."

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