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.
J Stroke Cerebrovasc Dis. 2023 Jun;32(6):107129. doi: 10.1016/j.jstrokecerebrovasdis.2023.107129. Epub 2023 Apr 21.
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.
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, 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, 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.
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.
回顾性分析 2006 年至 2017 年间连续转诊至 6 个月运动为基础的心脏康复项目（CRP）的患者中，性别差异及完成情况的预测因素。
材料/方法：有偏瘫步态的患者参加卒中适应型 CRP，否则参加传统 CRP。通过访谈确定未完成的原因。对所有患者以及女性和男性分别进行回归分析，以确定未完成的原因。
共有 1536 名患者（30.3%为女性），平均年龄为 64.5±12.5 岁，其中 23%开始接受卒中适应型 CRP。总体而言，75.1%的患者完成了 CRP（卒中适应型 CRP 为 87.3%，传统 CRP 为 71.5%；p<0.001）。女性和男性之间的完成率没有差异（74.5%对 75.4%；p=0.7），也没有差异在预定的会议出席率（p=0.6）或未完成的原因（p>0.05，均）。仅在年龄（十年）方面，<41 岁的患者中，女性的完成率（59%）与男性（85%）相比存在差异（p=0.02）。所有患者中未完成 CRP 的预测因素包括未参加卒中适应型 CRP、较低的 V̇O、吸烟、糖尿病（胰岛素治疗）和抑郁，但与性别（p=0.5）或年龄（p=0.15）无关。女性与男性相比，完成率的独特预测因素是年龄较小、较低的 V̇O、吸烟、糖尿病（胰岛素治疗）、抑郁和癌症诊断。男性唯一的预测因素是有>1 次卒中发作和糖尿病（任何抗糖尿病药物）。所有模型中，未参加卒中适应型 CRP 是未完成 CRP 的最强预测因素。
尽管 CRP 治疗的依从性没有性别差异，但女性和男性完成率的预测因素大多不同。年轻女性最有可能无法完成 CRP。临床医生应针对女性提供特定的、量身定制的策略，以提高完成率，重点关注年轻女性，并提供卒中适应型 CRP，并密切关注患有糖尿病的患者。
