Exercise and rehabilitation in women. Indications and outcomes

Women have been shown to improve their cardiovascular risk profiles with increasing levels of physical activity and physical fitness. All-cause mortality is lower among more fit women, but reductions in cardiovascular death rates have not been established, owing to the limited number and size of existing studies. Because older women are at greater risk for cardiac events and are the least likely to engage in regular physical activity, concerted effort should be made to increase the proportion of older women who participate in regular physical activity. Attention to concerns raised by older, sedentary women and development of personalized programs that proceed gradually in intensity and duration and avoid high-impact activities should improve the likelihood of initiation and continuation of greater activity levels. Cardiac rehabilitation programs are under-used by women. Personal and social barriers have been identified as well as the potential for referral bias. Reduction in cardiovascular risk levels and improvements in exercise capacity have been demonstrated for women who do participate. Approaches that meet the needs of older women may require considerable alteration from the standard program established for middle-aged men. Yet women may have the most to gain from participation in multidisciplinary, personalized rehabilitation programs.