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On-site attendance to prescheduled cardiac rehabilitation visits has been shown to be associated with improved outcomes following cardiac rehabilitation. The extent to which on-site programmatic attendance represents a healthy-adherer effect remains unknown.This retrospective cohort study consisted of 17,000 consecutively referred patients to a cardiac rehabilitation program in Ontario, Canada. On-site attendance at prescheduled visits was our primary exposure variable. The primary outcome was all-cause death or hospitalization at two years following the expected program completion date, irrespective of drop-out. Secondary outcomes included adherence to statins, health-seeking preventative health visits, and changes in clinical risk-profiles. Cox proportional hazards adjusted for baseline sociodemographic, clinical and comorbid characteristics.Among the 12,440 patients who attended at least one prescheduled on-site visit, on-site attendance was inversely correlated with baseline smoking rates and body mass index at program entry. After adjustment for baseline factors, the risk of death or hospitalization progressively fell with incremental increases in on-site attendance (adjusted hazard ratio for each 10% increase in on-site attendance: 0.96; 95% confidence interval: 0.93-0.99, p = 0.007). Such associations were driven predominantly by differences in non-cardiovascular hospitalizations. Incremental increases in on-site attendance were associated with improvements in cardiopulmonary fitness and body mass index (both p 0.001), better attendance of preventative care physician visits (p 0.001) and higher medication adherence to statins (p = 0.007).Associations between on-site attendance at cardiac rehabilitation and outcomes may represent a healthy-adherer effect. Future research must evaluate the clinical utility of on-site attendance as a behavioral health-adherence metric for cardiac rehabilitation monitoring and surveillance.

Cardiovascular disease continues to be among the leading causes of morbidity and mortality among men and women globally. However, research suggests that women are significantly underrepresented in cardiac rehabilitation (CR), programmes which are shown to reduce recurrent cardiac events and related premature death. However, sex differences in referral rates have not been systematically and quantitatively reviewed. Hence, the objective of the study was to assess whether a significant sex difference exists.We searched Scopus, MEDLINE, CINAHL, PsycINFO, PubMed, and The Cochrane Library databases for studies reporting CR referral rates in women and men published between July 2000 and July 2011. Titles and abstracts were screened, and the selected full-text articles were independently screened based on predefined inclusion/exclusion criteria. Included articles were assessed for quality using STROBE.Of 623 screened articles, 19 observational studies reporting data for 241,613 participants (80,505 women) met the inclusion criteria. In the pooled analysis, women (39.6%) were significantly less likely to be referred to CR compared to men (49.4%; odds ratio 0.68, 95% confidence interval 0.62-0.74). Heterogeneity was considered significant (I (2 )= 90%). There was no change in significant findings when subgroup analyses were conducted, examining fee for service vs. no fee, high-quality studies vs. others, or studies pooled by different study methodologies.CR referral remains low for all patients, but is significantly lower for women than men. Evidence-based interventions to increase referral for all patients, including women, need to be instituted. It is time to ensure broader implementation of these strategies.

Resistance training (RT) has only a permissive role as an adjunct to aerobic training (AT) in cardiac rehabilitation.To compare the effect of AT with combined RT and AT (CT) we searched MEDLINE, Cochrane Controlled Trials Register, EMBASE, PreMedline, SPORT DISCUS, CINAHL (from the earliest date available to October 2009) for randomized controlled trials (RCTs), examining effects of CT versus AT on body composition, cardiovascular fitness (VO(2peak)), strength, and quality-of-life (QOL) in coronary artery disease (CAD) (excluding heart failure). Two reviewers selected studies independently.Twelve studies met the study criteria (229 AT patients, 275 CT patients). Compared with AT, CT decreased percent body fat by -2.3% (WMD (weighted mean difference); 95% CI: -3.59 to -1.02), decreased trunk fat (SMD (standardized mean difference): -0.56; 95% CI: -0.96 to -0.15) and increased fat-free mass by 0.9 kg (WMD; 95% CI: 0.39 to 1.36) in three studies (n = 106). Similarly CT was associated with larger increases in lower body strength (seven studies, n = 225, SMD: 0.77; 95% CI: 0.49 to 1.04) and upper body strength (eight studies, n = 262, SMD: 1.07; 95% CI: 0.76 to 1.38). Compared to AT, CT improved peak work capacity (three studies, n = 92, SMD: 0.88; 95% CI: 0.45 to 1.31) and there was a trend for CT to increase VO(2peak) by 0.41 ml/kg/min (nine studies, n = 399, WMD; 95% CI: -0.05 to 0.88). Qualitative analysis of QOL data favors CT. Study withdrawals were similar for AT (14.2% ± 13.2) and CT (11.5% ± 15.5). No serious adverse events were reported.CT is more effective than AT in improving body composition, strength, and some indicators of cardiovascular fitness, and does not compromise study completion or safety when compared to AT.