Gender-specific differences in cardiac rehabilitation outcomes among obese patients after myocardial infarction

Abstract

Aim: To assess gender-specific differences in the effectiveness of cardiac rehabilitation among obese patients after a first myocardial infarction and to identify factors influencing functional recovery. Materials and Methods: A prospective observational study was conducted between 2020 and 2024 at City Hospital No. 1 in Mykolaiv, Ukraine. The main group included 100 inpatients with stage I obesity (BMI 30.0–34.9 kg/m²) who experienced a first acute myocardial infarction, while the control group consisted of 100 normal-weight patients (BMI 18.0–24.9 kg/m²) with comparable clinical and anamnestic characteristics. All patients received standardised revascularisation, pharmacotherapy, and a comprehensive rehabilitation programme comprising physical training, dietary modification, psychological support, and education. Functional status was assessed using left ventricular ejection fraction (LVEF) and the 6-minute walk test. The follow-up duration was 6 months. Statistical analysis included variance and correlation analyses. Results: Obese women more frequently presented with atypical myocardial infarction symptoms and had higher rates of acute heart failure and arrhythmias. At discharge, obese women demonstrated higher VAI values and lower exercise tolerance than obese men and normal-weight women (p < 0.05). After rehabilitation, both groups showed improvement; however, obese women exhibited slower recovery of exercise tolerance and a 15% lower increment in LVEF than men. Clinically significant improvement in the 6-minute walk distance was observed less frequently in obese women. Conclusions: Obesity adversely affects post-infarction recovery, and gender-specific factors may modify rehabilitation outcomes. Obese women demonstrated delayed functional recovery and a smaller improvement in cardiac function. Gender-sensitive rehabilitation strategies and targeted secondary prevention programmes may help optimise outcomes in this high-risk population.