A recent study by UHN KITE Research Institute scientists has highlighted the disproportionate impact of post-stroke depressive symptoms on women compared to men upon entry to cardiac rehabilitation programs. Their findings underscore how rehabilitation programs can tailor their strategies to optimize outcomes for patients.
Cardiac rehabilitation programs have been increasingly recognized for their benefits to individuals following stroke. Participation in exercise-based rehabilitation programs has been found to reduce mortality, recurrent stroke and rehospitalisation.
These programs are also well-suited for addressing and managing post-stroke depressive symptoms (PSDS) due to their comprehensive approach offering exercise training, lifestyle modification support, psychosocial support, nutrition counseling and education, as well as pre-screening for depressive symptoms.
“PSDS is among the most common neuropsychiatric effects of stroke and has significant implications for recovery and quality of life,” says Dr. Susan Marzolini, KITE Scientist and senior author of the study. “It is critical to understand sex-related differences in PSDS as it can pose a greater burden on women compared to men.”
In stroke recovery, men and women experience differences in symptom presentation, rehabilitation needs, psychological impact, coping strategies and access to healthcare services. PSDS may have a greater impact on women post-stroke due to greater functional impairment, fatigue and pain as well as lower quality of life experienced by women compared to men. Understanding risk factors and sex differences in PSDS helps researchers understand how to better tailor treatment approaches that can improve stroke outcomes following cardiac rehabilitation programs.
Researchers analyzed data from over 1300 stroke patients enrolled in a cardiac rehabilitation program at the Toronto Rehabilitation Institute at UHN and found that a higher proportion of women experienced PSDS compared to men.
Their findings also revealed unique factors associated with PSDS among women and men. The most common factor associated with PSDS in women was obesity. Additionally, a significant proportion of women aged 51-70 years experienced PSDS, potentially influenced by menopausal transitions, caregiving demands, and social factors such as marital status and living arrangements. Interventions within cardiac rehabilitation programs targeting obesity through diet and nutrition counseling, as well as efforts to improve social connectedness, may help mitigate PSDS in women post-stroke.
On the other hand, unemployment emerged as a common factor associated with PSDS in men as well as sleep apnea and a chronic lung condition known as chronic obstructive pulmonary disease. This highlighted the need for cardiac rehabilitation interventions to assist in finding employment opportunities, providing financial support resources and helping improve continuous positive airway pressure (CPAP) compliance in men post-stroke.
“By recognizing the unique factors influencing PSDS in women and men, we can better tailor interventions within cardiac rehabilitation programs to alleviate the burden of post-stroke depression,” says Xiao Wei (Olivia) Du, a previous graduate student in Dr. Marzolini’s lab and first author of this study. “By understanding and targeting the specific needs of individuals, these rehabilitation programs can play a pivotal role in promoting holistic post-stroke care and improve the outcomes for stroke survivors.”
Future research should focus on understanding the effects of cardiac rehabilitation on PSDS.
This work was supported by the Heart and Stroke Foundation of Canada Seed/Catalyst grant, the Frederick Banting and Charles Best Canada Graduate Scholarship-Master’s Scholarship from the Canadian Institutes of Health Research and UHN Foundation. Dr. Marzolini is also an Associate Professor in the Rehabilitation Sciences Institute and the Faculty of Kinesiology & Physical Education at the University of Toronto.
Du X, Brooks D, Oh P, Marzolini S. Sex Differences in Depressive Symptoms in 1308 Patients Post-Stroke at Entry to Cardiac Rehabilitation. J Cardiopulm Rehabil Prev. 2024 Feb 2. doi: 10.1097/HCR.0000000000000848.
Women are disproportionately affected by depressive symptoms compared to men and are less likely to enroll in cardiac rehabilitation programs following stroke. It is critical to understand the sex-related differences in post-stroke depressive symptoms to tailor recovery and care strategies.