Jessica Golbus, MD, highlights ways to boost cardiac rehabilitation participation

In a discussion with Contemporary OB/GYN, Jessica Golbus, MD, assistant professor at University of Michigan Health, highlighted findings from a recent American Heart Association (AHA) scientific statement addressing the gender gap in cardiac rehabiliation (CR) participation and proposing strategies to enhance engagement among women.^1,2

CR offers substantial benefits for both men and women, including reductions in cardiovascular morbidity and mortality, improved quality of life, and overall better health outcomes. Despite these well-established advantages, women remain significantly underrepresented in CR participation and completion rates.

Golbus explained that the AHA statement focuses on identifying barriers to CR participation specific to women and evaluating evidence-based strategies to overcome them. These barriers occur at multiple levels: individual, interpersonal or societal, and programmatic or health-system.

Individual challenges often include comorbidities such as arthritis that limit mobility, as well as logistical issues such as transportation and caregiving responsibilities. On a societal level, women may face gendered expectations and time constraints that deprioritize their own health needs. Health system barriers include lower referral rates and insufficient clinician engagement around CR’s importance for female patients.

One of the most effective yet underutilized strategies to improve CR participation is simply ensuring that referrals are made. Automatic referral systems, where eligible patients are referred based on diagnosis rather than clinician discretion, have been shown to significantly increase enrollment.

Equally important is direct communication between clinicians and patients. When physicians emphasize the benefits of CR during clinical visits, participation rates rise significantly. However, Golbus noted that clinicians are often less likely to discuss CR with women, possibly because of biases about age, comorbidities, or suitability for physical activity.

To address logistical and accessibility challenges, the AHA statement encourages exploring novel delivery methods such as virtual cardiac rehabilitation. These programs allow patients to exercise remotely while being monitored in real time by health care professionals.

Though most evidence on virtual CR applies to mixed populations, this approach may be particularly beneficial for women facing transportation difficulties or discomfort with traditional facility-based programs. Golbus emphasized the need for more research specifically focused on women’s outcomes in these digital models.

Ultimately, she urged clinicians to approach every patient with an open mind, ensuring that all women diagnosed with cardiovascular conditions are informed of and referred to cardiac rehabilitation. Through better referral systems, education, and flexible program delivery, the persistent gender gap in cardiac rehabilitation can be narrowed, improving heart health outcomes for women nationwide.

No relevant disclosures.

References

1. Women missing cardiac rehabilitation, despite key benefits. University of Michigan. November 3, 2025. Accessed November 7, 2025. https://www.eurekalert.org/news-releases/1104210.
2. Coutinho T, Khadanga S, Adedinsewo D, et al. Cardiac rehabilitation in women: A scientific statement from the American Heart Association. Circulation. 2025. doi:10.1161/CIR.0000000000001379