Sex-specific inclusion of patients with cardiovascular disease in exercise research in Canada: a rapid review
Bibliographic record
Abstract
Abstract Background In the past decade, global recommendations have been released to address the under-representation of females in science, such as the guidelines for sex and gender considerations in research released by the Canadian Institute of Health Research (CIHR) in 2010. Cardiovascular disease (CVD) is the leading cause of mortality globally and the second most frequent cause of death in Canada. Exercise-based cardiac rehabilitation (CR) is a class 1 recommendation for the management of CVD, yet lower enrollment and adherence rates to CR for females compared to males have been reported. To date, the proportion of females compared to males with CVD included in exercise-based clinical trials is unknown. CR strategies are currently based on data from predominately males and imposed upon females, limiting our ability to optimize these programs for females. Purpose We performed a rapid review to assess the proportion of females and males with CVD included in exercise-related research in Canada. Methods Randomized trials assessing any structured exercise program (≥4weeks) in adults with CVD were included. A peer-reviewed search was conducted on February 28, 2024 in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials for Canadian trials examining exercise for managing CVD. Chi-square and Pearson’s tests were used to evaluate sex-specific inclusion. Results The search identified 12,290 relevant studies, of which 213 full-text articles were assessed for eligibility, and 30 papers were retrieved. A total of 2,339 participants were included in the analysis, of which 48% had coronary heart disease, and 56% of studies were conducted in Ontario, Canada. Over a decade since the CIHR recommendations were released, fewer females than males were included in exercise studies (n = 792 [34%] vs. n = 1,547 [66%]; P<0.001). Their participation in trials has not increased over the past 10 years (range: 11-56%; r=0.59; P=0.056). Interventions ranged from 1-5x/wk for 12-26wk at moderate-to-vigorous-intensity (23-60min/session) predominantly including standard CR programs (combined aerobic and resistance exercise; n=19 studies). Conclusion Despite recommendations aiming for sex equality, we found that females with CVD represented only 34% of patients included in Canadian exercise trials. Targeted strategies such as identifying and addressing sex-specific exercise barriers may enhance the inclusion of females in exercise research.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.030 | 0.111 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.011 | 0.008 |
| Bibliometrics | 0.027 | 0.027 |
| Science and technology studies | 0.002 | 0.002 |
| Scholarly communication | 0.007 | 0.004 |
| Open science | 0.003 | 0.003 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.006 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".