Sex Differences and Correlates of the Utility of the Cardiopulmonary Exercise Test for Prescribing Exercise at Entry to Cardiac Rehabilitation

Susan Marzolini; Paul Oh; James E Peterman; Phillip Wallace; Azadeh Yadollahi; Fernando Rivera; Carolina Carvalho; Leonard A Kaminsky

doi:10.1016/j.cjca.2024.11.022

Sex Differences and Correlates of the Utility of the Cardiopulmonary Exercise Test for Prescribing Exercise at Entry to Cardiac Rehabilitation

Can J Cardiol. 2024 Nov 26:S0828-282X(24)01149-8. doi: 10.1016/j.cjca.2024.11.022. Online ahead of print.

Authors

Susan Marzolini¹, Paul Oh², James E Peterman³, Phillip Wallace², Azadeh Yadollahi², Fernando Rivera², Carolina Carvalho², Leonard A Kaminsky³

Affiliations

¹ KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
² KITE Research Institute, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada.
³ Fisher Institute of Health and Well-Being, Ball State University, Muncie, Indiana, USA.

PMID: 39603341
DOI: 10.1016/j.cjca.2024.11.022

Abstract

Background: Despite the importance of objective measures for prescribing aerobic exercise for mitigating cardiovascular risk in people with coronary artery disease (CAD), no study has examined sex differences in the utility of the cardiopulmonary exercise test (CPET) for developing the exercise prescription.

Methods: CPET results from 1352 women and 5875 men with CAD were analysed to determine if there was a sex difference in achieving maximal oxygen uptake (V˙O_2max) or an identifiable first ventilatory threshold (VT₁). Secondary outcomes were to determine correlates of not achieving V˙O_2max or VT₁ in all patients and in men and women separately.

Results: A greater proportion of men than women achieved V˙O_2max or VT₁ (89.7% vs 71.3%; P < 0.001) as well as specifically achieving V˙O_2max (40.2% vs 26.7%; P < 0.001) and VT₁ (88.0% vs 69.2%; P < 0.001). The most influential correlates of not achieving V˙O_2max or VT₁ were female sex (odds ratio 3.1, 95% confidence interval 2.6-3.7), age > 60 years, tested on treadmill vs cycle, depressive symptoms, and a secondary heart failure diagnosis. At entry to cardiac rehabilitation, these correlates were more prevalent in women than in men. Correlates differed by sex. The threshold for when age affected achieving V˙O_2max or VT₁ on the cycle CPET was earlier for women (> 50 years of age) than for men (> 70 years of age) with no difference on treadmill (> 80 years of age for both).

Conclusions: Although most patients achieved V˙O_2max or VT₁ on the CPET, women were 3 times less likely than men to achieve V˙O_2max or VT₁. Strategies to improve utility of CPETs for women, such as alternative exercise test protocols and investigation into underlying mechanisms for effects of depressive symptoms, should be conducted.