Effects of cardiac rehabilitation on female patients with heart disease: A systematic review and meta-analysis

In recent years, “women-focused cardiac rehabilitation” or “women-only cardiac rehabilitation” has been implemented to address low referral, participation, and adherence among women in conventional cardiac rehabilitation programs. This review examined the effects of women-focused cardiac rehabilitation on psychological and physical outcomes and program adherence. Randomized clinical trials with patients 18 years and older with cardiovascular disease that provided women-focused cardiac rehabilitation and assessed at least one of the outcomes of psychological impacts, physical impacts, or adherence were included. Literature searches were conducted in PubMed, Web of Science, and CiNii from inception to April 9, 2024. Meta-analyses were performed using “EZR” software. From 653 relevant studies identified, 16 studies were included. Women-focused cardiac rehabilitation significantly improved depressive symptoms (standardized mean difference = −0.40, 95 % confidence interval [−0.61, −0.19]) but had no significant effect on anxiety (standardized mean difference = −0.15, 95 % confidence interval [−0.55, 0.25]). Some studies suggested potential improvements in quality of life and 6-min walk distance, although effect sizes varied and many outcomes were not statistically significant. Tailored or supervised cardiac rehabilitation was also associated with high adherence to both exercise and educational programs in some studies. Due to the small number of studies per outcome, variability in intervention formats, and the overall high risk of bias, conclusions should be interpreted with caution. Women-focused cardiac rehabilitation may provide psychological benefits, particularly in reducing depressive symptoms, but further high-quality trials are needed to better understand its effects on physical outcomes and adherence.