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Sex-Based Differences in Metabolic Equivalents (METs) After Cardiac Rehabilitation: A Systematic Review

Neel A Duggal, David A Scalzitti, Samuel Watkins, Oliver Hecht, Stephanie J Johnson, Joshua G Woolstenhulme

Purpose: The purpose of this systematic review is to investigate the differences in peak Metabolic Equivalents (METs) between men and women post myocardial infarction after participating in a Cardiac Rehabilitation (CR) program.

Methods: Four databases were systematically searched through August 2020. Search terms related to cardiac rehabilitation, treatment outcomes, and gender differences were used. Papers were considered relevant if they compared outcomes in cardiac rehabilitation between men and women. Information from the studies was extracted by two independent authors. Risk of bias was assessed using the Downs and Black instrument.

Results: A total of 12,786 records were identified from the search and 8 observational studies were included in the final review. Improvements in absolute METs during CR ranged from 1.1 to 2.0 for women and 0.8 to 2.5 for men. Seven studies reported a statistically significant increase in peak METs for both men and for women after outpatient CR. Three of these studies showed a greater increase in absolute METs in men compared to women that were statistically significant. Four studies showed no sex-based differences before and after. Several of these studies reported significant improvements in both men and women in other outcomes including cholesterol, blood glucose, and BMI.

Conclusion: Both men and women improve functional capacity from CR. The majority of studies reported that there were more men participating in CR programs than women. Given the underrepresentation of women in these studies, it is difficult to speculate if any differences in MET levels reported in these studies are a true representation of sex differences with respect to peak MET levels. Nonetheless, the statistically significant improvement in METs in both sexes suggests that women experience clinical benefit from CR and that efforts should be made for greater referral of women to CR programs.