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Psychosocial Benefits of Cardiac Rehabilitation Among Women Compared With Men

Hazelton, Garrett PhD; Williams, Jennifer W. PhD; Wakefield, Jessica MA; Perlman, Adam MD, MPH; Kraus, William E. MD; Wolever, Ruth Q. PhD

Journal of Cardiopulmonary Rehabilitation and Prevention: January/February 2014 - Volume 34 - Issue 1 - p 21–28
doi: 10.1097/HCR.0000000000000034
Cardiac Rehabilitation

PURPOSE: Cardiac rehabilitation (CR) has been shown to reduce cardiac risk and improve the psychosocial functioning of participants. This study examines gender differences on several psychosocial indicators across the course of CR.

METHODS: Patients (N = 380; 67.9% men and 32.1% women) referred from local inpatient and outpatient settings at a southeastern US academic medical facility were assessed on reported levels of depression, anxiety, panic, anger, and relationship satisfaction, using the Burns Brief Mood Survey, at the start and conclusion of a CR program. Medical variables were also assessed but are not the focus of this report. Statistical analyses included 1-way, Kruskal-Wallis, and repeated-measures analysis of variance procedures, as well as χ2 analyses.

RESULTS: Women reported more psychosocial symptoms at pre-CR than men, and overall, both groups improved across CR. Women with significant depression, anxiety, and panic experienced clinically significant benefit across CR. Although the percentage of men reporting clinically significant levels of anger decreased significantly across CR, clinically significant levels of anger did not significantly change among women. In addition, women did not report benefits in relationship dissatisfaction.

CONCLUSION: This study provides further evidence that CR offers psychosocial benefit for women, as has been reported in several small clinical samples. Some notable gender differences on anger and relationship satisfaction were observed. Clinical attention may be warranted to facilitate improvement for symptoms of anger and relationship concerns among selected women who participate in CR.

Cardiac rehabilitation (CR) participants (N = 380) generally experienced psychosocial improvement from the start to conclusion of CR. However, a high percentage of women reported clinically relevant anger and relationship dissatisfaction that did not improve. Clinical attention and programming appear warranted to focus on symptoms of anger and relationship distress among women presenting for CR.

Department of Psychiatric Medicine, East Carolina University, Greenville, North Carolina (Dr Hazelton); Duke Integrative Medicine, Duke University Health System, Durham, North Carolina (Drs Hazelton, Perlman, and Wolever and Ms Wakefield); Carolina Psychological Services, Rocky Mount, North Carolina (Dr Williams); Divisions of General Internal Medicine (Dr Perlman) and Cardiology (Dr Kraus), Department of Medicine, and Department of Psychiatry and Behavioral Sciences (Dr Wolever), Duke University School of Medicine, Durham, North Carolina.

Correspondence: Ruth Q. Wolever, PhD, Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine 102904, Durham, NC 27710 (

The authors declare no conflicts of interest.

© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins