The effect of cardiovascular rehabilitation on physical strain tolerance - does gender really matter?

Background/Aim. Gender as a risk factor for cardiovascular diseases has been the subject of research in numerous studies. All of them warn of shortcomings in the diagnosis and treatment of women with a coronary artery disease. The aim of this study is to determine whether there is a difference in the effects of cardiovascular rehabilitation (CVR) on the tolerance of physical strain related to gender in examinees with the coronary artery disease. Methods. The study involved 684 patients, 506 (74.0%) men and 178 (26.0%) women. All respondents were referred to the CVR program after surviving a heart attack, percutaneous coronary intervention or surgical myocardial revascularization. During a three-week program of CVR, patients were subjected to the dosed and personalized physical training. At the beginning and at the end of rehabilitation, all patients were tested for physical strain. Results. The average strain level in men was significantly higher in the second test (t = 4.368; p < 0.001). Also, the duration of the test was significantly longer in the second test (Z = 11.836; p < 0.001). In women, the average strain level was significantly higher (t = 5.352; p < 0.001), and the duration of the test was significantly longer in the second test (Z = 7.471; p < 0.001). Conclusion. A three-week program of CVR led to an improvement in the tolerance of physical strain in both men and women. Our re-search once again proved that women have an equal benefit as men from the implementation of CVR. Nevertheless, women rarely participate in the CVR programs. It is necessary to make additional efforts in order to further educate physicians and other medical staff about the importance of sending women to the CVR program.


jšanja to
erancije fizičkog napora i kod muškaraca i kod žena.Naše istraživanje je još jednom dokazalo da žene imaju podjednaku korist od sprovođenja KVR.I pored toga žene u značajno manjoj meri participiraju u programima KVR.Neophodno je učiniti dodatni napor kako bi se medicinsko osoblje dodatno edukovalo o značaju upućivanja žena na program KV rehabilitacije.

Abstract

Background / Aim.Gender as a risk factor for cardiovascular diseases has been t e subject of research in numerous studies.All of them warn of shortcomings in the diagnosis and treatment of women with coronary artery disease.The aim of the paper to determine whether there is a difference in the effects of cardiovascular rehabilitation on the tolerance of physical strain related to gender in examinees with coronary artery disease.Methods.

The study involved 684 patients, 506 (74.0%) men and 178 (26.0%) women.All respondents were referred to the cardiovascular rehabilitation program after surviving heart attack, percutaneous coronary intervention or surgical myocardial revascularization.During a three-week program of cardiovascular rehabilitation, patients were subjected to dosed and personalized physical training.At the beginning and at the end of rehabilitation, all patients were tested for physical strain.Results.The average strain level in men was significantly higher in the second test (t = 4.368; p <0.001).Also, the duration of the test was significantly longer in the second test (Z = 11.836;p <0.001).In women, the average strain level was significantly higher (t = 5.352; p <0.001), and the duration of the test as significantly longer in the second test (Z = 7.471; p <0.001).Conclusion.A three-week program of cardiovascular rehabilitation has led to an improvement in the tolerance of physical strain in both men and women.Our research has once again prove

rapy, co
onarography and, in particular, percutaneous coronary intervention have led to a decline in mortality of CAD (3).

Gender as a risk factor for CVD has been the subject of research in numerous studies.It is believed that almost ½ of women over the age of 20 and about 1/3 of men suffer from some cardiovascular diseases (4,5).The Framingham study has shown that CAD is more common in men, especially in relation to premenopausal women (6).On the other hand, recent studies warn of shortcomings in the diagnosis and treatment of women with CAD (7).A large meta-analysis done by Kim et al. indicated a higher incidence of complications and higher early mortality in women after percutaneous coronary intervention or surgical myocardial revascularization (8).

Cardiovascular rehabilitation is of paramount importance in the secondary prevention of cardiovascular events (9,10).This relates primarily to those patients who have suffered a heart attack, have had surgical revascularization of the myocardium and / or percutaneous coronary intervention.Cardiovascular rehabilitation does not only include dosed physical activity, but also adequate patient education, the struggle against modifying risk factors, psychosocial adaptation, and adequate cardioprotective, medication therapy (11).As such, cardiovascular rehabilitation has be n shown to have a great effect on the quality and duration of life (12,13).

The aim of the paper was to determine whether there is a difference in the effects of cardiovascular rehabilitation on the tolerance of physical strain related to gender in examinees with ischemic heart disease.


Methods

The study involved 684 patients, 506 (74.0%) men and 178 (26.0%) women.The


Results

The age structure of patients did not significantly differ between genders (m: 60.6 ± 9.81 vs: f: 61.54 ± 9.83, t = 1.102, p = 0.271).Myocardial infarction (MI) was more common in women than in men (χ2 = 6.283; p = 0.012).Men were more often subjected to coronary artery byp

(EST) we
e performed.Tolerance of strain on the first test between men and women is shown in Table III.The test lasted longer in men (Z = 2.621; p = 0.009) and men achieved a higher level of strain compared to women (t = 4.758; p <0.001).There was no significant difference in the double product before the test, double product standing for systolic blood pressure x heart rate.The double product after the test was higher in men (Z = 2.293; p = 0.022).The incidence of complex heart rhythm disorders or ST depression did not differ between the genders.After a three-week rehabilitation, the patients were again subjected to exercise stress test.The results obtained were almost identical to the first test.The average strain level was significantly higher among men (t = 5.123; p <0.001), as well as the duration of the test (t = 2.264; p <0.024).There wa

no signific
nt difference in the duration of the test and the double product before the test.The double product after the test was higher in men (Z = 2.549; p = 0.011).The incidence of complex arrhythmias or ST depression did not differ between genders (Table IV).At the end of the rehabilitation, we compared the results of the first and the second tests in order to determine whether there were differences in the effects of cardiovascular rehabilitation on the tole ance of physical strain in relation to the gender of the patients.

The average strain level in men was significantly higher in the second test (t = 4.368; p <0.001).The duration of the test was significantly longer in the second test (Z = 11.836;p <0.001).A double product before the test did not show a significant difference, but the double product after the test was significantly lower in the second test (Z = 2,311; p = 0.021).ST depression was more frequent in the second test (χ2 = 5.891; p = 0.015) (Table V).In women, the average strain level was significantly higher in the second test (t = 5.352; p <0.001).The duration of the test was also significantly in the second (Z = p <0.001).A double product before and after t/he test did not differ significantly.

The frequency of ST depression in the second test was significantly higher (χ2 = 6.369; p = 0.021) (Table VI).In patients with CABG the average strain level was significantly higher in the second test for both men and women (t=5,406; p<0,001 for men; t=1,926; p=0,060 for women).Also, the duration of test was significantly longer in the second test for both men and women (Z=10,025; p<0,001 for men; Z=2,953; p=0,003 for women).Significantly higher percentage of patients reached submaximal heart rate during the second exercise test for both genders with CABG (χ 2 =71,136; p<0,001 for men; χ 2 =24,874; p<0,001 for women) (Table VIII).A three-week program of cardiovascular rehabilitation has led to an improvement in the tolerance of physical strain in both men and women regardless of the type of revascularization

The Table IX shows the distribution of used drugs among men and women.It was found that women were significantly more likely to use clopidogrel (χ2 = 5.713; p = 0.007).The use of other drugs did not differ significantly by gender.The most commonly used drugs in both groups of patients were beta-blockers, acetyl-salicylic acid and statins.


Discussion

Cardiovascular ehabilitation is an essential part of the secondary prevention of cardiovascular events in patients with CAD (14).It has been proven that CVR significantly improves the quality of life, reduces mortality and significantly reduces the possibility of a re-coronary event (15)(16)(17).Also, CVR leads to the better lipid profile, weight loss, blood pressure reduction and reduction of cigarette consumption, anxiety and depression (18)(19).

However, less than half of patients are involved in cardiovascular rehabilitation prog ams (20,21).The reason for such low participation lies in the financial and psychosocial reasons, the lack of motivation and age, and the inadequate education on the benefits of CVR (22,23).On the other hand, patients are often not referred to the CVR by an authorized physician (24,25).The reason lies in inadequate education and not-wellinformed medical staff on the importance of CVR.

Most studies on the CVR emphasized that women participate

n cardiovas
ular rehabilitation programs in a significantly lower percentage than man.The reasons are numerous, looking after family members, transport problems and the existence of comorbidity (26)(27)(28).Also, it should be noted that women were significantly less directed to the CVR by physicians (29)(30)(31)(32).This again emphasizes a different attitude of the medical profession towards women in terms of adequate diagnostics, timely therapy and appropriate rehabilitation.Namely, numerous studies that compared the i