Sex Differences in Exercise Capacity and Outcomes Following Outpatient Cardiac Rehabilitation

Area of Science:

• Cardiology
• Exercise Physiology
• Public Health

Background:

• Cardiac rehabilitation (CR) enhances exercise capacity (VO₂peak) and reduces major adverse cardiovascular events (MACEs).
• Women often show less improvement in VO₂peak after CR compared to men.
• Identifying sex-specific predictors is essential for optimizing CR outcomes.

Purpose of the Study:

• To investigate sex-based differences in clinical predictors for VO₂peak improvement.
• To examine sex-specific predictors for the odds of experiencing MACEs post-CR.

Main Methods:

• Analysis of consecutive patients undergoing cardiopulmonary exercise testing before and after CR (1999-2017).
• Comparison of sex differences in peak exercise metrics following CR.
• Logistic regression models to identify predictors of VO₂peak improvement and MACEs in men and women.

Main Results:

• Men demonstrated greater VO₂peak increases than women post-CR.
• In men, predictors of VO₂peak improvement included CR attendance and pre-CR VO₂peak; predictors of lower MACE odds included more CR sessions and surgical indication.
• For women, clinical factors showed no significant predictive power for VO₂peak improvement or MACEs, except for diabetes.

Conclusions:

• Clinical predictors influencing VO₂peak improvement and MACE risk after CR are distinct between sexes.
• These findings highlight the need for sex-specific approaches in cardiac rehabilitation strategies.