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Canadian Journal of Cardiology

Women's Health Behaviours and Psychosocial Well-Being by Cardiac Rehabilitation Program Model: A Randomized Controlled Trial

Published:February 02, 2016DOI:https://doi.org/10.1016/j.cjca.2015.10.007

      Abstract

      Background

      Cardiac rehabilitation (CR) is associated with significantly lower mortality and improved psychosocial well-being. However, women are less likely to participate than men. This trial tested whether participation in women-only CR results in better health behaviours and psychosocial outcomes than do other models.

      Methods

      Cardiac Rehabilitation for her Heart Event Recovery (CR4HER) was a single-blind randomized trial with 3 parallel arms. Low-risk cardiac patients were recruited from 6 sites in Ontario. Consenting participants completed surveys assessing health behaviours (physical activity, diet, medication adherence, smoking) and psychosocial well-being (social support, quality of life, depressive symptoms) and wore pedometers for 7 days. After intake assessment, eligible participants were randomized to mixed-sex, women-only, or home-based CR. Participants were mailed follow-up surveys and pedometers 6 months later.

      Results

      One hundred sixty-nine patients were randomized, and 116 (68.6%) were retained. Self-reported physical activity increased among women in mixed-sex and women-only CR groups (per protocol and as treated, P < 0.05). Diet improved among women in women-only CR groups (as treated, P < 0.05). Quality of life improved among women in mixed-sex (per protocol and as treated, P < 0.05) and women-only CR groups (per protocol, P < 0.05; as treated, P < 0.01). After testing, women in the mixed-sex CR group had higher anxiety symptoms than did those in the women-only group (per protocol, P = 0.017), and those in the mixed-sex CR group had higher depressive symptoms than did those in the women-only group (as treated, P = 0.001). Analyses adjusted for confounding variables revealed no significant differences in any outcome by model. Post hoc equivalency tests were computed on a per-protocol basis, and all outcomes were equivalent by model.

      Conclusions

      Behavioural and psychosocial outcomes were largely equivalent regardless of model; however, women-only programs may confer an advantage for anxiety and depressive symptoms.

      Résumé

      Introduction

      La réadaptation cardiaque est associée à un taux de mortalité significativement moindre et à une amélioration du bien-être psychologique. Toutefois, les femmes sont moins susceptibles que les hommes de prendre part à un tel programme. Cette étude avait pour but de déterminer si les programmes de réadaptation cardiaque réservés aux femmes permettaient d’améliorer davantage les comportements en matière de santé et le bien-être psychologique des patientes que d’autres modèles de programme de réadaptation cardiaque.

      Méthodes

      L’étude CR4HER (Cardiac Rehabilitation for her - Heart Event Recovery) était un essai mené à simple insu, avec répartition aléatoire et trois groupes parallèles. Des patientes à faible risque cardiaque ont été recrutées dans six centres situés en Ontario. Les patientes ayant consenti à prendre part à l’étude ont rempli un questionnaire visant à évaluer leur comportement en matière de santé (activité physique, habitudes alimentaires, observance du traitement médical, tabagisme) et leur bien-être psychologique (soutien social, qualité de vie, symptômes de dépression), et ont ensuite porté un podomètre pendant sept jours. Après l’évaluation initiale, les participantes admissibles ont été réparties au hasard à un programme de réadaptation cardiaque mixte, à un programme réservé aux femmes ou à un programme à domicile. Six mois plus tard, les participantes ont reçu par la poste un questionnaire de suivi et un podomètre.

      Résultats

      Des 169 patientes réparties au hasard, 116 (68,6 %) ont été retenues. Les résultats de l’auto-évaluation effectuée par les participantes indiquent une augmentation de l’activité physique dans le groupe de réadaptation cardiaque mixte et dans celui réservé aux femmes (selon le protocole et selon le traitement, p < 0,05). Une amélioration des habitudes alimentaires a été observée dans le groupe réservé aux femmes (selon le traitement, p < 0,05). La qualité de vie s’est améliorée chez les patientes qui prenaient part au programme mixte (selon le protocole et selon le traitement, p < 0,05) et chez celles du programme réservé aux femmes (selon le protocole, p < 0,05; selon le traitement, p < 0,01). Des tests ont toutefois révélé que les patientes qui faisaient partie du groupe mixte présentaient plus de symptômes d’anxiété que celles du groupe réservé aux femmes (selon le protocole, p = 0,017) et que les patientes du groupe mixte montraient plus de symptômes de dépression que celles du groupe réservé aux femmes (selon le traitement, p = 0,001). Les analyses ajustées en fonction des variables de confusion n’ont révélé aucune différence significative entre les résultats des différents modèles de programme de réadaptation cardiaque. Les tests d’équivalence a posteriori ont été réalisés en fonction du protocole et l’ensemble des résultats obtenus étaient équivalents, quel que soit le modèle de programme qui avait été suivi.

      Conclusion

      Les résultats comportementaux et psychosociaux ont été essentiellement les mêmes, peu importe le modèle de programme de réadaptation cardiaque, mais il semble que le programme réservé aux femmes confère un avantage en ce qui a trait à la gestion des symptômes d’anxiété et de dépression.
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      Linked Article

      • Erratum
        Canadian Journal of CardiologyVol. 33Issue 12
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          In the article, “Women's Health Behaviours and Psychosocial Well-Being by Cardiac Rehabilitation Program Model: A Randomized Controlled Trial” (Can J Cardiol 2016;32:956-62.), by Midence et al., the authors of regret to advise that the following corrections are required in order to rectify errors in relationship to our use of the Morisky Medication Adherence Scale (MMAS-4). These corrections are listed below:
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