The biggest barrier to enrollment and participation in cardiac rehabilitation (CR) among women globally is lack of awareness, an international cross-sectional study suggests.
That barrier prevented even women referred to CR from participating, according to the study, which included 2163 patients (42% women) from 16 countries across all World Health Organization regions. Other major barriers for referred women who did not participate included the program’s failure to contact them after referral, cost and finding exercise tiring or painful.
The researchers also found that among women who did enroll in CR after referral, the greatest barriers to session adherence were distance, travel, family responsibilities, and difficulties in accessing sessions that require attendance in person.
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“We tested some mitigation responses for each barrier in this study and patients particularly women rated them as highly useful,” study author Sherry L. Grace, PhD, professor at York University and University Health Network, Toronto, Ontario & Canada. “We have further research, a randomized trial, underway now to test if this can actually result in more CR participation.”
The study was published online September 24 in the Canadian Journal of Cardiology.
Significant Regional Differences
The investigators administered the English, Simplified Chinese, Arabic, Portuguese, or Korean version of the Cardiac Rehabilitation Barriers Scale (CRBS, a 5-point Likert scale, with higher scores indicating more barriers) to 2163 patients indicated for CR from October 2021 to March 2023. Members of the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) community facilitated participant recruitment. Mitigation strategies were offered and rated.
Globally, there was no sex difference in total CR barriers or subscales. But there were significant differences in total barriers in women regionally. Women’s barriers were greater in the Western Pacific (mean CRBS score, 2.6) and South East Asia (mean CRBS score, 2.5). Lack of CR awareness was the greatest barrier in both regions. The Eastern Mediterranean region was the only region in which men reported greater total barriers.
In Brazil, women reported significantly greater barriers related to logistical factors and comorbidities or functional status, compared with men. Brazilian women reported fewer barriers related to work or time conflicts. The findings were similar for the Western Pacific region.
