Sherry L Grace

• PhD, CRFC FAACVPR FCCS
• Professor (Full) at York University

Objective This systematic review aimed to evaluate the effectiveness of alternative exercises within a cardiac rehabilitation (CR) program compared to traditional gym-based exercises or usual care. The focus was on CR completion and outcomes in women. Introduction CR programs generally offer traditional gym-based exercises, including treadmill exe...

Aims Women are under-represented in cardiac rehabilitation (CR), especially in lower-income settings. This study tested Technology-bAsed Cardiac rehabilitation Therapy (TaCT) on functional capacity, risk factors, quality of life (QoL; MacNew), heart-health behaviours (e.g. Global Physical Activity Questionnaire), cardiac symptoms (e.g. angina), and...

Background: High rehospitalization rates and limited access to cardiac rehabilitation characterize heart failure in South America. This study highlights the significant barriers faced by patients, including lack of energy, awareness, and accessibility. Despite these challenges, professional exercise supervision has reduced readmission rates by mor...

Patient education is a core component of cardiovascular rehabilitation (CR). Recent guidelines call for tailored materials to support women, given their unique needs and preferences. This study investigated women patient's perspectives of online CR educational materials (Cardiac College, Toronto). Through a cross-sectional design, a think-aloud pro...

Introduction Comprehensive, hybrid cardiac rehabilitation (CR) models have been scantly investigated in heart failure (HF) populations, particularly in low-resource settings. CO-CREATION-HF aims to evaluate the effectiveness of such a model compared to supervised exercise alone. Methods and analysis A 2 parallel-arm, multi-center randomized clinic...

Introduction The aim of this study was to pilot test a question prompt list (QPL) about cardiovascular disease (CVD) risk reduction after hypertensive pregnancy (HDP). Methods In a prospective cohort study of adult women who had HDP given the QPL before and surveyed after a physician visit, we assessed perceived person‐centred care, self‐efficacy...

A Cardiac College for Women curriculum was developed to address the dearth of women-focused cardiac rehabilitation (CR) education. This study investigated: (1) patient utilization of the education; (2) acceptability and applicability of the education; as well as (3) patient and CR providers’ experiences implementing it. This was a multi-site, mixed...

Objective To test the measurement properties of the revised version of the English Cardiac Rehabilitation Barriers Scale (CRBS-R), suitable for hybrid delivery, structural validity, internal reliability, as well as face, cross-cultural, construct and criterion validity were assessed. Design Cross-sectional study, where participants completed an on...

Background/Objectives: Access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to...

During the past century, there have been major developments in the medical and surgical treatment of cardiovascular disease (CVD). These advancements have resulted in more people surviving initial events and having reduced length of stay in hospital; consequently, there is an increasing number of people in need of ongoing and lifelong cardiovascula...

The access to cardiac rehabilitation (CR) is contingent upon physician referrals, yet these are often inadequate, particularly in low-resource settings. This multi-method study aimed to translate, culturally adapt, and validate the Portuguese version of the Provider Attitudes toward CR and Referral (PACRR-P) scale, as well as to identify key factor...

Background Cardiovascular disease prevalence in women is high globally, which leads to a great burden of disability, and it is their leading cause of death. Cardiovascular rehabilitation (CR) is an outpatient model of secondary preventive care proven to mitigate this burden; however, significantly fewer women access CR than men, and those that do a...

Background Cardiovascular rehabilitation (CR) is an outpatient model of secondary preventive care proven to mitigate the burden of cardiovascular disease (CVD). Despite their differential risk factor burden, context and often different forms of heart disease, CR programs generally do not provide women with needed secondary prevention information sp...

Aims Tailored education is recommended for cardiac patients, yet little is known about information needs in areas of the world where it is most needed. This study aims to assess (i) the measurement properties of the Information Needs in Cardiac Rehabilitation short version (INCR-S) scale and (ii) patient's information needs globally. Methods and r...

BACKGROUND Adherence to medication regimens is critical to effectively manage chronic diseases, prevent their complications, and reduce costs. Text messaging interventions, are a potentially cost-effective way to support chronic disease management in developing nations, owing to the increasing availability of mobile phones. OBJECTIVE To systematic...

Background The Provider Attitudes toward CR and Referral (PACRR) scale was translated into Simplified Chinese and psychometric validation ensued. Methods Brislin's Translation Model was applied, with two independent forward translations followed by back-translation. Experts assessed the face, content and cross-cultural validity of items, and item...

Objectives There are substantial variations in entry criteria for heart failure (HF) clinics, leading to variations in whom providers refer for these life-saving services. This study investigated actual versus ideal HF clinic inclusion or exclusion criteria and how that related to referring providers' perspectives of ideal criteria. Design, settin...

Clinical guidelines recommend influenza vaccination for cardiac patients, and COVID-19 vaccination is also beneficial given their increased risk. Patient education regarding vaccination was developed for cardiac rehabilitation (CR); impact on knowledge and attitudes were evaluated. A single-group pre-post design was applied at a Spanish CR program...

Background Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear. Objective This meta-analysis aimed to evaluate th...

BACKGROUND Psychological distress is recognized as an independent risk factor for cardiovascular diseases (CVDs), contributing to increased morbidity and mortality. While eHealth is increasingly used to deliver psychological interventions, their effectiveness for patients with CVDs remains unclear. OBJECTIVE This meta-analysis aimed to evaluate th...

Importance While effective, cardiovascular rehabilitation (CR) as traditionally delivered is not well implemented in lower-resource settings. Objective To test the noninferiority of hybrid CR compared with traditional CR in terms of cardiovascular events. Design, Setting, and Participants This pragmatic, multicenter, parallel arm, open-label rand...

This final chapter of the Canadian Women’s Heart Health Alliance “ATLAS on the Epidemiology, Diagnosis, and Management of Cardiovascular Disease in Women” presents ATLAS highlights from the perspective of current status, challenges, and opportunities in cardiovascular care for women. We conclude with 12 specific recommendations for actionable next...

Background Cardiac rehabilitation (CR) is a proven model of secondary prevention, but new sites, providing quality care, are needed in low-resource settings. This study (1) described the development of International Council of Cardiovascular Prevention and Rehabilitation’s (ICCPR) Program Certification and (2a) tested its implementation, considerin...

Objective To translate and culturally adapt the Information Needs in Cardiac Rehabilitation (INCR) questionnaire into Korean and perform psychometric validation. Methods The original English version of the INCR, in which patients are asked to rate the importance of 55 topics, was translated into Korean (INCR-K) and culturally adapted. The INCR-K wa...

Background Women are less likely than men to use cardiac rehabilitation (CR); thus, women-focused (W-F) CR was developed. Implementation of W-F CR globally was investigated, as well as barriers and enablers to its delivery. Methods In this cross-sectional study, a survey was administered to CR programs via Research Electronic Data Capture (REDCap)...

Background: Cardiac rehabilitation (CR) programs are underutilized globally, especially by women. In this study we investigated sex differences in CR barriers across all world regions, to our knowledge for the first time, the characteristics associated with greater barriers women, and women’s greatest barriers according to enrollment status. Method...

Background Heart failure (HF) care providers are gatekeepers for patients to appropriately access lifesaving HF clinics. Objective The aim of this study was to investigate referring providers' perceptions regarding referral to HF clinics, including the impact of provider specialty and the coronavirus disease pandemic. Methods An exploratory, sequ...

Cardiovascular disease is a leading cause of death, morbidity, disability, and reduced health-related quality of life, as well as economic burden worldwide, with some 80% of disease burden occurring in the low- and middle-income country (LMIC) settings. With increasing numbers of people living longer with symptomatic disease, the effectiveness and...

Objective: This review will evaluate the effectiveness of alternative versus traditional forms of exercise on cardiac rehabilitation program utilization and other outcomes in women with or at high risk of cardiovascular disease. Introduction: Exercise-based cardiac rehabilitation programs improve health outcomes in women with or at high risk of...

The International Council of Cardiovascular Prevention and Rehabilitation developed an International Cardiac Rehabilitation (CR) Registry (ICRR) to support CR programs in low-resource settings to optimize care provision and patient outcomes. This study assessed implementation of the ICRR, site data steward experience with on-boarding and data entry...

Background Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally. Methods In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-atte...

Background: Despite the epidemic of cardiovascular disease and the benefits of cardiac rehabilitation (CR), availability is known to be insufficient. However, this had not been quantified before the International Council of Cardiovascular Prevention and Rehabilitation’s (ICCPR) Global Audit. This presentation will summarize the results of the Globa...

Background: While cardiovascular disease is a leading cause of death and disability in well-resourced countries, this noncommunicable disease is now accelerating rapidly in low-resourced countries. Secondary prevention is essential to decrease recurrence rates, reported to be as high as 30% in the first 12 months post-myocardial infarction. Cardiac...

Background: Cardiovascular rehabilitation (CVR) is a Level 1, Class A standard for comprehensive secondary prevention of cardiovascular disease. Despite well-established benefits, CVR delivery is lacking across the world. Reasons for this dearth have been studied globally, with one of the main issues being lack of programs in low-resource settings...

Cardiac rehabilitation (CR) utilization is low, particularly in Arabic-speaking countries. This study aimed to translate and psychometrically validate the CR Barriers Scale in Arabic (CRBS-A), as well as strategies to mitigate them. The CRBS was translated by two bilingual health professionals independently, followed by back-translation. Next, 19 h...

Objectives: Cardiac rehabilitation - programs comprehensively delivering outpatient secondary prevention - is under-available and under-studied in the resource-poor settings where it is needed most. This report summarizes the governance, participating sites, patient characteristics and outcomes, as well as knowledge translation activities during f...

Objective: This study evaluated the usefulness of a booklet as support material for counseling focused on self-efficacy and therapist interaction in the course of counseling in a hybrid CR program (i.e., supervised and unsupervised sessions) developed for low-resource settings. Methods: Counseling material was developed by a multidisciplinary te...

The objective of this cross-sectional study was to investigate health management, well-being, and pandemic-related perspectives of chronic disease patients in the context of stringent measures, and associated correlates. A self-report survey was administered during the Omicron wave lockdown in Shanghai, China. Items from the Somatic Symptom Scale (...

Background: COVID-19 control measure stringency, including testing, has been among the highest globally in China. Psychosocial impact on pandemic workers in Shanghai, and their pandemic-related attitudes were investigated. Methods: Participants in this cross-sectional study were healthcare providers (HCP) and other pandemic workers. A Mandarin o...

Background: Though heart failure patients benefit from multidisciplinary care in heart function clinics (HFCs), utilization is suboptimal and inequitable. This study investigated factors influencing referral and patient access to HFCs from multiple stakeholders' perspectives, namely policy-makers (PM), providers at HFCs and patients. Methods: In...

Cardiac Rehabilitation (CR) is a secondary prevention intervention proven to improve quality of life, yet with low participation. The Cardiac Rehabilitation Barriers Scale (CRBS) was developed to assess multi-level barriers to participation. This study aimed at the translation, and cross-cultural adaptation of the CRBS into the Greek language (CRBS...

Open in new tabDownload slide The benefits of cardiac rehabilitation have supported continually through Cochrane reviews since 2001. OR, odds ratio; RR, risk ratio; CI, confidence interval; CV, cardiovascular.

Women are underrepresented in cardiac rehabilitation (CR) despite the benefits, and this is exacerbated in lower‐resource settings where CR is insufficiently available. In this randomized controlled trial, the effectiveness of the Technology‐based Comprehensive Cardiac Rehabilitation Therapy (TaCT) electronic cardiac rehabilitation (eCR) interventi...

Background: Cardiac rehabilitation (CR) is scantly available in Iran, although it is the cost-benefit strategy in cardiac patients, It has not been established how CR is delivered within Iran. This study aimed to determine: (a) availability, density and unmet need for CR, and (b) nature of CR services in Iran by province. Materials and methods:...

Background Despite the benefits of cardiac rehabilitation (CR), it remains under-utilized, particularly by women. This study compared CR barriers between non-enrolling men and women in Iran, which has among the lowest gender equality globally. Methods In this cross-sectional study, CR barriers were assessed via phone interview in phase II non-atte...

Background: This study assessed cardiac rehabilitation (CR) barriers in heart failure (HF) patients for the first time, use of formal exercise supervision, and readmissions. Methods: This was a prospective study of HF in-patients at a private hospital. The CR Barriers Scale (CRBS), and International Physical Activity Questionnaire were administered...

This cross-sectional study investigated health management, well-being, and pandemic-related perspectives in Shanghainese adults ≥50 years at the early stages of COVID-19 using a self-report survey in March–April, 2020. Items from the SSS, PHQ-9 and GAD-7 were administered. A total of 1181 primarily married, retired females participated. Many partic...

This cross-sectional study investigated health management, well-being, and pandemic-related perspectives in Shanghainese adults ≥50 years during early and strict COVID-19 control measures. A self-report survey was administered via Wenjuanxing between March-April/2020. Items from the Somatic Symptom Scale, Patient Health Questionnaire-9 and Generali...

Background COVID-19 control measure stringency including testing has been among the highest globally in China. Psychosocial impact on pandemic workers in Shanghai, and their pandemic-related attitudes were investigated. Methods Participants in this cross-sectional study were healthcare providers (HCP) and other support workers. A Mandarin self-rep...

Background: COVID-19 and associated controls may be particularly problematic in the context of chronic conditions. This study investigated health management, well-being, and pandemic-related perspectives in these patients in the context of stringent measures, and associated correlates. Methods: A self-report survey was administered via Wenjuanxing...

In China, despite the rapid increase in percutaneous coronary interventions (PCIs), cardiac rehabilitation (CR) is just burgeoning, leaving a need for comprehensive evidence-based education curricula. This pilot study assessed the acceptability of Simplified Chinese CR education delivered via booklets and videos on WeChat asynchronously and the imp...

Objective Cardiac rehabilitation (CR) is a comprehensive model of secondary preventive care. There is a wide variety in implementation characteristics globally, and hence quality control is paramount. Thus, the International Council of Cardiovascular Prevention and Rehabilitation was urged to develop a CR registry. The purpose of this study was to...

Women-focused cardiovascular rehabilitation (CR; phase II) aims to better engage women, and might result in better quality of life than traditional programs. This first clinical practice guideline by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) provides guidance on how to deliver women-focused programming. The w...

Introduction: Cardiac rehabilitation (CR) is an effective but underutilized intervention. Strategies have been identified to increase its use, but there is paucity of data testing them in low-resource settings. We sought to determine the effect of automatic referral post-coronary artery bypass graft (CABG) surgery on CR enrollment. Methods: This is...

Objective To investigate the effects of physical activity (PA) and tobacco use on adverse clinical outcomes after revascularisation for peripheral arterial disease (PAD), in the Western-Pacific region, where the cases of PAD and tobacco use are among the highest in the world. Design Retrospective cohort study Materials and Methods We used the Korea...

Investigating the mechanisms of behavior change interventions provides a more fulsome understanding of how and why interventions work (or don’t work). We assessed mechanisms of two interventions (mailouts alone, and mailouts plus telephone support, informed by the Health Action Process Approach (HAPA) and Habit Theory), designed to increase medicat...

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) is a proven method to reduce the risk of disease, but unfortunately in low-and middle-income countries (LMICs), it is either unavailable or done in small quantities. Purpose To compare traditional (1-month supervised) vs hybrid cardiac rehabilitation...

Purpose: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) developed an online Cardiovascular Rehabilitation Foundations Certification (CRFC; https://globalcardiacrehab.com/Certification) in October 2017, to build cardiac rehabilitation (CR) delivery capacity in low-resource settings based on their guidelines. Herein...

Contemporary myocardial infarction (MI) care and management has evolved dramatically since the 1950’s; yet outpatient rehabilitation remains underutilized. Deepening our understanding of the origins and history of cardiac rehabilitation highlights a contemporary shift required for policy and practice related to secondary prevention of coronary dise...

Cardiac rehabilitation (CR) is under-used, particularly in low-resource settings. There are few studies of barriers and facilitators to CR adherence in these settings, particularly considering multiple perspectives. In this multiple-method study, a cross-sectional survey including the Cardiac Rehabilitation Barriers Scale (each item scored on a fiv...

Background: Cardiac rehabilitation (CR) barriers are well-understood in high-resource settings. However, they are under-studied in low-resource settings, where access is even poorer and the context is significantly different, including two-tiered healthcare systems and greater socioeconomic challenges. Objective: To investigate differences in ch...

Background The aim of this systematic review was to investigate the effects of women-focused cardiac rehabilitation (CR) on patient outcomes and cost. Methods Medline, PubMed, Embase, PsycINFO, CINAHL, Web of Science, Scopus and Emcare were searched for articles from inception through to May 2020. Primary studies of any design were included, with...

Introduction: The International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) is developing a registry (ICRR) specifically for low-resource settings, where the burden of cardiovascular diseases is greatest and the need for program development highest. Herein we describe the development process, including the variable selection pro...

Background This study aimed to establish availability and characteristics of cardiac rehabilitation (CR) in Latin America and the Caribbean (LAC), where cardiovascular disease is highly prevalent. Methods In this cross-sectional sub-analysis focusing on the 35 LAC countries, local cardiovascular societies identified CR programs globally. An online...

This study compared characteristics and program utilization in women electing to participate in mixed-sex, women-only, or home-based cardiac rehabilitation (CR). In this retrospective cohort study, electronic records of CR participants in Toronto who were offered the choice of program model between January 2017-February 2020 were analyzed. There we...

Background Despite women’s greater need for cardiac rehabilitation (CR), they are less likely to utilize it. Innovative CR models have been developed to better meet women’s needs, yet there is little controlled, comparative data assessing the effects of these models for women. This study compared outcomes in women electing to participate in mixed-s...

Cardiovascular rehabilitation (CR) is an effective secondary preventive model of care. However, the use of CR is insufficient, and the reasons for this are not well-characterized in East- Central Europe. This prospective observational study psychometrically validated the recently translated Cardiac Rehabilitation Barriers Scale for the Czech langua...

Ballistocardiogram (BCG) is an emerging tool with the potential to monitor heart failure (HF) patients. A close association of the weight to the BCG as an intermediate signal source requires a careful design, where events such as saturation of the weight signal can result in the loss of the BCG. This work closely examined the factors around the wei...

Background: There are few studies on the impact of cardiac rehabilitation (CR) in the Eastern Mediterranean Region (EMR), where the burden of risk factors and context is somewhat different from Western countries where much of the evidence is derived. Methods: This was a retrospective, observational study of patients referred to Heart Hospital's C...

Background There is wide variability in cardiac rehabilitation (CR) dose (ie, number of sessions) delivered, and no evidence‐based recommendations regarding what dose to prescribe. We aimed to test what CR dose impacts major adverse cardiovascular events (MACEs). Methods and Results This is an historical cohort study of all patients who had corona...

Background Women do not participate in cardiac rehabilitation (CR) to the same degree as men; women-focused CR may address this. This systematic review investigated the: (1) nature, (2) availability, as well as (3a) utilization of, and (b) satisfaction with women-focused CR. Methods Medline, Pubmed, Embase, PsycINFO, CINAHL, Web of Science, Scopus...

Purpose of Review Cardiac rehabilitation (CR) is grossly under-utilized. This review summarizes current knowledge about degree of CR utilization, reasons for under-utilization, and strategies to increase use. Recent Findings ICCPR’s global CR audit quantified for the first time the number of additional CR spots needed per year to treat indicated p...

Background: Cardiac rehabilitation (CR) is a proven model of secondary prevention in which patient education is a core component. Objectives: to translate and culturally-adapt CR patient education for Mandarin-speaking patients living in China as well as immigrants, and offer recommendation for best practices in adaptation for both. Methods: t...

Phase III/IV cardiac rehabilitation (CR) is recommended to promote maintenance of benefits achieved during Phase II; there has been no meta-analysis to test this to date. This study determined the effects of maintenance CR on any outcome, with consideration of sex. Seven databases were searched from inception-January 2020. Randomized controlled tri...

Objectives To assess the effectiveness of cardiac rehabilitation (CR) in low- and middle-income countries (LMICs), given previous reviews have included scant trials from these settings and the great need there. Methods Six electronic databases (PubMed, Medline, Embase, CINAHL, Cochrane Library, and APA PsycINFO) were searched from inception-May 20...

Background: The aims of this study were to establish cardiac rehabilitation (CR) availability and density, as well as the nature of programs in South-East Asian Region (SEAR) countries, and to compare this with other regions globally. Methods: In 2016/2017, the International Council of Cardiovascular Prevention and Rehabilitation engaged cardiac...

Objective: Cardiovascular diseases are among the leading causes of morbidity in China and around the world. Cardiac rehabilitation (CR) effectively mitigates this burden; however, utilization is low. CR barriers in China have not been well characterized; this study sought to translate, cross-culturally adapt, and psychometrically validate the CR B...

Background: We investigated impacts of COVID-19 on cardiac rehabilitation (CR) delivery around the globe, including virtual delivery, as well as effects on providers and patients. Methods: In this cross-sectional study, a piloted survey was administered to CR programs globally via REDCap from April to June 2020. The 50 members of the Internation...