Effects of a 3-month women-focused maintenance cardiovascular rehabilitation program on attendance and perceived barriers: preliminary results of an ongoing RCT

Abstract Background Women are less likely to enrol and attend phase II cardiovascular rehabilitation (CR) due to well-known barriers. Maintenance CR offers supervised continuity, but similar barriers likely persist. Whether tailoring a maintenance CR program to women's specific needs impacts long-term adherence and health outcomes remains unknown. Purpose To compare preliminary 3-month results of a women-tailored maintenance CR program versus maintenance CR standard-care on exercise sessions adherence and perceived barriers. Methods This ongoing single-blind RCT (1:1) compares a 6-month women-focused maintenance CR program (barrier-focused, individualized counselling and education) with a standard-care maintenance CR (supervised exercise sessions, 2-3 times/week, 60 min). Preliminary 3-months results on adherence to exercise (sessions attended/predicted), perceived barriers (CRBS questionnaire) and motivation (BREQ-2 questionnaire) are addressed. Demographic, clinical history and physical activity (accelerometer) were collected. For between-group comparisons independent sample t-tests (or non-parametric alternative) and chi-square were performed. The intervention’s effect on attendance was evaluated using a Generalized Estimating Equations (GEE) model for repeated measures. Results Twenty out of 38 women completed 3-month assessments (11 women-tailored group, WTG; 9 standard-care group, SCG). Baseline characteristics (table 1) were well-balanced between groups. Most frequent barriers at 3 months (travel, other health problems and family responsibilities) mirrored baseline. For perceived barriers, GEE analysis (table 2) indicated no significant intervention effect (Group x Time interaction: p=.284). However, having a partner (B=-0.49, p.001) and participating in phase II CR (B=-0.20, p=.034) were both associated with significantly lower perceived barriers. A higher behavioural regulation score (BREQ-2) was also associated with fewer barriers (p=.050). Regarding attendance, patterns differed significantly between groups over time (Group x Time interaction: p=.037). Adjusted GEE analysis (table 3) revealed that the WTG displayed significantly higher attendance in the 1st month compared to SCG (B=15.38, p=.040). While the SCG exhibited significant declines in attendance at the 2nd month (B=-13.06, p.001) and 3rd month (B=-11.45, p=.014) relative to baseline, the intervention mitigated these initial drops. Age was a significant positive predictor of attendance (B=0.90, p=.002), whereas baseline barriers and motivation were not associated with participation. Conclusions Preliminary findings of this ongoing RCT suggest that a women-focused program significantly improves attendance trajectories, even after controlling potential confounders. This suggests that individualizing counselling based on women’s specific needs is effective for enhancing adherence in maintenance CR, helping to mitigate the attendance decline typically observed over time.For image description, please refer to the figure legend and surrounding text. For image description, please refer to the figure legend and surrounding text.