Smith JR; Department of Cardiovascular Medicine Mayo Clinic
Rochester MN. USA
Medina-Inojosa JR; Chacin Suarez AS; Taylor JL; et al

Journal of the American Heart Association. 15(14):e044403, 2026 Jul 21.

BACKGROUND: Cardiac rehabilitation (CR) leads to increased exercise
capacity (VO2peak) and risk reduction of major adverse cardiovascular
events (MACEs). Women exhibit blunted VO2peak improvements following CR.
The purpose was to examine sex differences in the clinical predictors of
VO2peak improvement and odds of MACEs following CR.

METHODS: From 1999 to 2017, all consecutive patients undergoing
cardiopulmonary exercise testing before and after CR were included. Sex
differences in peak exercise metrics in response to CR were compared.
Multiple logistic regression models were fit to assess clinical predictors
of VO2peak improvement (defined as >0% from pre-CR) and MACEs following CR
for men and women.

RESULTS: A total of 513 men and 158 women were included. Men had greater
increases in VO2peak than women following CR (P=0.001). For men,
independent predictors of VO2peak improvement following CR included higher
CR session attendance (odds ratio [OR], 1.04 [95% CI, 1.02-1.06]),
peripheral artery disease (OR, 0.47 [95% CI, 0.25-0.86]), and pre-CR
VO2peak (OR, 0.98 [95% CI, 0.97-0.99]) (all, P<0.02). Independent
predictors of lower odds of MACEs following CR in men included higher
number of CR sessions (OR, 0.97 [95% CI, 0.95-0.99]), pre-CR VO2peak (OR,
0.98 [95% CI, 0.97-0.99]), surgical CR indication (OR, 0.34 [95% CI,
0.18-0.68]), and no history of peripheral artery disease (OR, 2.94 [95%
CI, 1.60-5.38]) (all, P<0.02). For women, the selected clinical
characteristics were not statistically significant independent predictors
of VO2peak improvement or odds of MACEs (except for diabetes) following
CR.

CONCLUSIONS: These findings suggest that clinical predictors of VO2peak
improvement and odds of MACEs following CR are sex specific.