Sex differences in mental health, independence, quality of life, and aerobic endurance throughout exercise-based cardiac rehabilitation

Abstract Introduction Sex differences in hormones, body composition, and behavior are known to influence performance and adherence in exercise-based cardiac rehabilitation (EBCR) programs. The quality and quantity of participation in EBCR programs in turn can have an impact on the psychological and physiological outcomes of EBCR. Purpose Investigating the association between mental health, independence, quality of life, aerobic endurance and sex to optimize rehabilitation strategies. Methods Data of patients referred for structured inpatient EBCR in Switzerland between December 2022 and June 2024 were examined in a retrospective monocentric cohort study. Patients were eligible for inclusion on completion of all four assessemnts at two time points, admission and discharge: aerobic endurance (six-minute walk test (6MWT)), health related quality of life (MacNewHeart (MNH)), independence (functional independence measure (FIM)), and mental health (hospital anxiety depression scale, total score (HADS)). Pearson's correlation coefficient was calculated to assess correlations between 6MWT, MNH, FIM and HADS for admission, discharge, and difference. Additionally, we performed linear regressions for difference in 6MWT, MNH, FIM and HADS score and adjusted for age and sex. Results In total, we included 503 patients with a median EBCR stay of 20.0 days quartiles 20.0–27.0. The cohort had a median age of 65.0 years quartiles 58.0–72.0, a median BMI of 25.6 kg/m2 quartiles 23.3–28.9 and was predominantly male (77.7%). Median values stratified by sex are reported in Figure 1. Linear regression analysis showed that sex was a significant predictor for difference in MNH (β = -5.34, 95%CI: -9.50, -1.18, p = .012). Women had a greater difference in MNH (median difference 28.5 quartiles 5.8–41.2 points than men (median difference 22.0 quartiles 9.0–36.0. Significant correlations were found between difference in 6MWT and MNH (r = 0.24, 95%CI: 0.15, 0.32, p .001). There were also significant correlations between 6MWT and FIM for admission (r = 0.34, 95%CI: 0.26, 0.42, p .001) and discharge (0.28 0.20, 0.36, p 0.001) as well as MNH and HADS at admission (r = -0.45, 95%CI: -0.51, -0.37, p .001) and discharge (r = -0.52, 95%CI: -0.58, -0.46, p .001). No significant correlations between difference in 6MWT and FIM and difference in MNH and HADST were found. Conclusion There was a similar change for both men and women in aerobic endurance (6MWT), independence (FIM) and mental health (HADS) after ECBR. For health-related quality of life (MNH), women revealed a greater change than men throughout ECBR. Further these results showed that a positive change in aerobic endurance has a weak correlation on health-related quality of life change.