Underrepresented groups

Special consideration should be made for the elderly, women and minority ethnic groups to ensure that their particular needs are met. These groups tend to be under-represented in CR, but systematic reviews show that both the elderly and women benefit from exercise-based CR (SIGN, 2002; Jolliffe, et al., 2004).

The importance of considering the elderly is even more relevant now, as almost a half of all MIs occur in those over 70 years of age, and this is projected to rise further as the number of older patients in the total population increases (Rask-Madsen, et al., 1997). CR may provide a chance to improve the quality of life in appropriately referred elderly patients. Thow, et al. (2000) found that women are poorly represented in CR and suggest that in order to improve uptake and adherence in CR, different strategies, including changes to CR programme structure, gender-specific information, environment and implementing behavioural change, are required to address the specific needs of this group.

In trials of CR the ethnic background of patients is seldom reported, but it is likely that trial participants are mainly white Caucasian, though there is no evidence to suggest that outcomes are less favourable for other ethnic groups (Beswick, et al., 2004). Beswick, et al. (2004) further suggest that specific interventions to encourage attendance of these groups could be individualised classes, buddy systems and inclusion in the programme of a significant other. It is generally acknowledged that CR should be all inclusive, with no barriers to inclusion. Strategies should be developed to recruit these previously excluded groups.

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