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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  

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 V̇O2peak, 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 V̇O2peak, 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。

结论

虽然在坚持 CRP 方面没有性别差异,但女性和男性对未完成的预测大多是独特的。年轻女性最有可能无法完成任务。从业者应提供针对特定性别的、量身定制的策略,以提高完成度,重点关注年轻女性,并提供适应卒中的 CRP,并密切关注糖尿病患者。

更新日期:2023-04-22
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