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Response to Exercise Training During Cardiac Rehabilitation Differs by Sex

Women show significantly lower training responses to participating in cardiac rehabilitation (CR) when aerobic capacity was directly measured compared with men (+13% vs +17%). These differences were not present if reported using estimated peak METs (+33% vs +31%). No improvement in aerobic capacity was seen in 18% of patients (24% women, 16% men) completing CR. Purpose: Directly measured peak aerobic capacity or oxygen uptake (V˙o2 peak ) is a powerful predictor of prognosis in individuals with cardiovascular disease. Women enter phase 2 cardiac rehabilitation (CR) with lower V˙o2 peak and their response to training, compared with men, is equivocal. We analyzed V˙o2 peak at entry and exit in patients participating in CR and improvements by diagnosis to assess training response. We also identified sex differences that may influence change in V˙o2 peak . Methods: The cohort included consecutive patients enrolled in CR between January 1996 and December 2015 who performed entry exercise tolerance tests. Data collected included demographics, index diagnosis, V˙o2 peak , and exercise training response. Results: The cohort consisted of 3925 patients (24% female). There was a significant interaction between baseline V˙o2 peak and diagnosis (P < .001), with percutaneous coronary intervention and myocardial infarction greater than other diagnoses. Surgical patients demonstrated greater improvement in V˙o2 peak than nonsurgical diagnoses (n = 1789; P < .001). Women had lower V˙o2 peak than men for all diagnoses (P < .02) and demonstrated less improvement (13 vs 17%, P < .001). Percent improvement using estimated metabolic equivalents of task (METs) were similar for women and men (33 vs 31%, P = NS). Despite overall increases in V˙o2 peak , 18% of patients (24% women, 16% men) failed to demonstrate any improvement (exit V˙o2 peak ≤ entry V˙o2 peak ). Conclusions: While there were no differences in training effect estimated by METs, directly measured V˙o2 peak showed a significantly lower training response for women despite adjusting for covariates. In addition, 18% of patients did not see any improvement in V˙o2 peak . Alternatives to traditional CR exercise programming need to be considered.