Toronto, March 9:  Women with cardiovascular problems today need flexible options for lifestyle programmes that fit their busy schedules, say researchers.

"Women tend to prioritise others before themselves. The realities of modern life require women to address multiple family, community, social and work-related demands. As a result, many feel they do not have time for cardiac rehabilitation," said study senior author Jennifer Reed from the University of Ottawa in Canada.

Cardiovascular disease is the leading cause of death in women worldwide; in 2015 it accounted for one-third of all female deaths.

Following a cardiac event such as a heart attack, patients are advised to attend cardiac rehabilitation for exercise training, lifestyle education, smoking cessation and psychological support.

According to the study, published in the European Journal of Preventive Cardiology, these programmes improve fitness, quality of life, mental health and survival, and reduce the risk of further events.

However, approximately 10-20 per cent fewer women than men participate in cardiac rehabilitation, and women are more likely to drop out (35 per cent of women quit versus 29 per cent of men), the researchers said.

In contrast, women are high users of local exercise classes: many women attend at least 70 per cent of the sessions on offer.

For the results, the authors reviewed a decade of literature to identify what stops women with heart disease from attending cardiac rehabilitation, and the characteristics of local exercise programmes (not specifically targeting people with heart disease) that could overcome those hurdles.

According to the research team, multiple barriers to participation were identified. Some women view cardiac rehabilitation as a "men's club". Classes are at set times and incompatible with women's daily schedules.

Women do not enjoy the physical activity offered and it does not fit their needs: some find it too physically demanding, while others want it to be more challenging.

Women frequently lack social support and feel guilty for deserting their family, , the study said.

The researchers identified ways to modernise cardiac rehabilitation and make it more attractive to women:

Offer enjoyable physical activity such as Zumba, soccer, group walking, tai chi, qigong, technology-based balance exercises (e.g. Wii Fit), dancing, and Nordic walking, they said.

Older women may benefit from exercises to help them perform daily activities (e.g. dressing, reaching a cupboard, moving in and out of a chair or bed) and reduce their risk of falls, while younger women may prefer more challenging activities such as high-intensity interval training.

The researchers suggested to provide flexible class times that are compatible with women's busy schedules.

"Women's high participation in group exercise classes in their neighbourhood suggests that they enjoy the sense of community. Multi-site cardiac rehabilitation programmes can help to resolve transportation issues and bring a sense of belonging," Reed said.