Sex differences and predictors of completion of a 6-month exercise-based cardiac rehabilitation program in 1,536 people following stroke,Journal of Stroke & Cerebrovascular Diseases

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Sex differences and predictors of completion of a 6-month exercise-based cardiac rehabilitation program in 1,536 people following stroke
Journal of Stroke & Cerebrovascular Diseases ( IF 2.0 ) Pub Date : 2023-04-21 , DOI: 10.1016/j.jstrokecerebrovasdis.2023.107129
Susan Marzolini ₁ , Juliana Nunes da Silva ₂ , Alessia Capone ₃ , Danielle Barry-Hickey ₄ , Aleksandra Pikula ₅ , Shannon L MacDonald ₆ , Sarah Munce ₇ , David Mastrangelo ₄ , Paul Oh ₁

Affiliation

KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Department of Exercise Sciences, Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.
Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Neurovascular Unit, University Health Network Toronto Western Hospital, Toronto, ON, Canada; Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Department of Medicine, Division of Neurology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Sinai Health, Toronto, ON, Canada.
KITE Research Institute, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management & Evaluation, University of Toronto, Toronto, ON, Canada.

Objective

To retrospectively examine sex-differences and predictors of completion in consecutively-referred patients to a 6-month exercise-based cardiac rehabilitation program (CRP) from 2006 to 2017.

Materials/methods

People with hemiplegic gait participated in stroke-adapted-CRP; otherwise, traditional-CRP. Reasons for non-completion were ascertained by interview. Regression-analyses were conducted to determine non-completion in all patients and women and men separately.

Results

There were 1536 patients (30.3% women), mean age 64.5 ± 12.5 with 23% initiating the stroke-adapted-CRP. Overall, 75.1% completed the CRP (87.3% stroke-adapted-CRP vs 71.5% traditional-CRP; p < .001). There was no difference in completion between women and men (74.5% vs 75.4%; p=0.7), or in attendance to pre-scheduled sessions (p=0.6) or reasons for non-completion (p > .05, all). The only sex difference in completion by age (decade) occurred in those <41 years (59% women vs 85% men; p=.02). Baseline predictors of non-completion among all patients included not being enrolled in the stroke-adapted-CRP, lower V̇O_2peak, smoking, diabetes (prescribed insulin) and depression but not sex (p=.5) or age (p=.15). Unique predictors in women vs men were younger age, lower V̇O_2peak, smoking, diabetes (prescribed insulin), depression, and cancer diagnoses. Unique to men was having >1 stroke and diabetes (any anti-diabetes medication). The strongest predictor of non-completion among all models was not being enrolled in stroke-adapted-CRP.

Conclusions

While there were no sex-differences in adherence to the CRP, women and men have mostly unique predictors of non-completion. Younger women are at greatest risk for non-completion. Practitioners should provide sex-specific, tailored strategies for enhancing completion with a focus on younger women and offering a stroke-adapted-CRP with close attention to those with diabetes.

中文翻译：

1,536 名中风后患者完成为期 6 个月的基于运动的心脏康复计划的性别差异和预测因素

客观的

回顾性检查 2006 年至 2017 年连续转介患者参加为期 6 个月的基于运动的心脏康复计划 (CRP) 的性别差异和完成预测因素。

材料/方法

患有偏瘫步态的人参加了卒中适应性 CRP；否则，传统 CRP。未完成的原因通过面谈确定。进行回归分析以确定所有患者以及女性和男性的未完成情况。

结果

共有 1536 名患者（30.3% 为女性），平均年龄为 64.5 ± 12.5 岁，其中 23% 开始了卒中适应性 CRP。总体而言，75.1% 的患者完成了 CRP（87.3% 的卒中适应性 CRP 与 71.5% 的传统 CRP；p < .001）。女性和男性在完成（74.5% 对 75.4%； p =0.7）或参加预先安排的会议（p =0.6）或未完成的原因（p > .05，全部）方面没有差异。按年龄（十年）完成的唯一性别差异发生在 41 岁以下（59% 女性对 85% 男性；p =.02）。所有患者未完成的基线预测因素包括未参加卒中适应性 CRP、较低的 V̇O _2peak、吸烟、糖尿病（处方胰岛素）和抑郁症，但不包括性别（p =.5) 或年龄 ( p =.15)。女性与男性的独特预测因素是年龄较小、V̇O _2peak较低、吸烟、糖尿病（处方胰岛素）、抑郁症和癌症诊断。男性的独特之处在于患有 >1 次中风和糖尿病（任何抗糖尿病药物）。所有模型中未完成的最强预测因素是未参加卒中适应性 CRP。