{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T21:24:19Z","timestamp":1761168259520,"version":"build-2065373602"},"reference-count":42,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2025,1,9]],"date-time":"2025-01-09T00:00:00Z","timestamp":1736380800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"DOI":"10.13039\/100000050","name":"National Heart, Lung, and Blood Institute","doi-asserted-by":"publisher","award":["R33HL143305"],"award-info":[{"award-number":["R33HL143305"]}],"id":[{"id":"10.13039\/100000050","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000057","name":"National Institute on General Medical Sciences","doi-asserted-by":"crossref","award":["R01DA059562, U54DA036114-09"],"award-info":[{"award-number":["R01DA059562, U54DA036114-09"]}],"id":[{"id":"10.13039\/100000057","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,10,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Those with established symptomatic cardiopulmonary disease should attend secondary prevention programs. Attendance at these programs is known to differ by sex and smoking status, with females and those who smoke being less likely to attend. However, little is known about whether the risk factors of being female and smoking are cumulative, and how outcomes from secondary prevention differ by these subgroups. Accordingly, we sought to examine patient characteristics at entry and outcomes of those attending pulmonary (PR) and cardiac rehabilitation (CR) by sex and smoking status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Methods<\/jats:title>\n                    <jats:p>Data were from patients enrolled in programs participating in a national registry between 2013 and 2021 (PR) or 2012 and 2021 (CR). Variables examined included: age, sex, race, educational attainment, insurance coverage, qualifying diagnosis, BMI, number of PR\/CR sessions attended, baseline, and change in, psychosocial (depression and anxiety symptoms) and physical function and fitness measures (6-minute walk distance [6MWD]\/metabolic equivalents [METs]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Analyses included 41\u00a0087 PR and 447\u00a0921 CR patients. Current smoking was reported in 14.3% (PR) and 8.4% (CR) of patients. Across PR\/CR, at baseline, current smoking and female sex were both associated with higher depression scores, lower fitness\/function measures, and fewer sessions. Both current smoking and female sex were significantly associated with less improvement in 6MWD, METs, and depression scores within CR.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Both sex and smoking status are important risk factors for those entering secondary prevention programs. Females who smoke have higher risk factors at entry, attend fewer sessions, and, within CR, improve less in fitness\/function.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>This study uses large national registries to replicate and expand upon prior findings that both female sex and current smoking are associated with higher-risk profiles when entering secondary prevention programs. Additionally, this study demonstrates that current smoking and female sex are also associated with less improvement during secondary prevention, especially within cardiac rehabilitation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntaf007","type":"journal-article","created":{"date-parts":[[2025,1,8]],"date-time":"2025-01-08T15:22:11Z","timestamp":1736349731000},"page":"1995-2002","source":"Crossref","is-referenced-by-count":1,"title":["Patient Characteristics and Outcomes by Sex and Smoking Status in Pulmonary and Cardiac Rehabilitation"],"prefix":"10.1093","volume":"27","author":[{"given":"Diann E","family":"Gaalema","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Texas Medical Branch ,\u00a0 Galveston, TX ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Biostatistics,\u00a0School of Public Health,\u00a0University of Alabama at Birmingham ,\u00a0 Birmingham, AL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Howard","sequence":"additional","affiliation":[{"name":"Department of Biostatistics,\u00a0School of Public Health,\u00a0University of Alabama at Birmingham ,\u00a0 Birmingham, AL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3673-7210","authenticated-orcid":false,"given":"Katherine E","family":"Menson","sequence":"additional","affiliation":[{"name":"Department of Medicine,\u00a0University of Vermont Larner College of Medicine , Burlington, VT ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,1,9]]},"reference":[{"issue":"12","key":"2025102119514022900_CIT0001","doi-asserted-by":"publisher","first-page":"892","DOI":"10.1056\/NEJMra001529","article-title":"Cardiac rehabilitation and secondary prevention of coronary heart disease","volume":"345","author":"Ades","year":"2001","journal-title":"N Engl J Med."},{"issue":"8","key":"2025102119514022900_CIT0002","doi-asserted-by":"publisher","first-page":"e13","DOI":"10.1164\/rccm.201309-1634ST","article-title":"An official American Thoracic Society\/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation","volume":"188","author":"Spruit","year":"2013","journal-title":"Am J Respir Crit Care Med."},{"issue":"9","key":"2025102119514022900_CIT0003","doi-asserted-by":"publisher","first-page":"830","DOI":"10.1056\/NEJMra2302291","article-title":"Cardiac rehabilitation - challenges, advances, and the road ahead","volume":"390","author":"Thomas","year":"2024","journal-title":"N Engl J Med."},{"issue":"18","key":"2025102119514022900_CIT0004","doi-asserted-by":"publisher","first-page":"1813","DOI":"10.1001\/jama.2020.4437","article-title":"Association between initiation of pulmonary rehabilitation after hospitalization for COPD and 1-year survival among medicare beneficiaries","volume":"323","author":"Lindenauer","year":"2020","journal-title":"JAMA."},{"issue":"9","key":"2025102119514022900_CIT0005","doi-asserted-by":"publisher","first-page":"1015","DOI":"10.1164\/rccm.202012-4389OC","article-title":"Association between initiation of pulmonary rehabilitation and rehospitalizations in patients hospitalized with chronic obstructive pulmonary disease","volume":"204","author":"Stefan","year":"2021","journal-title":"Am J Respir Crit Care Med."},{"issue":"7","key":"2025102119514022900_CIT0006","doi-asserted-by":"publisher","first-page":"CD001800","DOI":"10.1002\/14651858.CD001800.pub2","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease","author":"Heran","year":"2011","journal-title":"Cochrane Database Syst Rev."},{"issue":"6","key":"2025102119514022900_CIT0007","doi-asserted-by":"publisher","first-page":"452","DOI":"10.1093\/eurheartj\/ehac747","article-title":"Exercise-based cardiac rehabilitation for coronary heart disease: a meta-analysis","volume":"44","author":"Dibben","year":"2023","journal-title":"Eur Heart J."},{"issue":"7","key":"2025102119514022900_CIT0008","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1111\/resp.14486","article-title":"Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary","volume":"207","author":"Agusti","year":"2023","journal-title":"Respirology."},{"issue":"9","key":"2025102119514022900_CIT0009","doi-asserted-by":"publisher","first-page":"e9","DOI":"10.1161\/CIR.0000000000001168","article-title":"2023 AHA\/ACC\/ACCP\/ASPC\/NLA\/PCNA guideline for the management of patients with chronic coronary disease: a report of the American Heart Association\/American College of Cardiology Joint Committee on clinical practice guidelines","volume":"148","author":"Virani","year":"2023","journal-title":"Circulation."},{"year":"2024","key":"2025102119514022900_CIT0010"},{"year":"2024","key":"2025102119514022900_CIT0011"},{"issue":"5","key":"2025102119514022900_CIT0012","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1164\/rccm.200607-896OC","article-title":"Regular physical activity modifies smoking-related lung function decline and reduces risk of chronic obstructive pulmonary disease: a population-based cohort study","volume":"175","author":"Garcia-Aymerich","year":"2007","journal-title":"Am J Respir Crit Care Med."},{"issue":"3","key":"2025102119514022900_CIT0013","doi-asserted-by":"publisher","first-page":"192","DOI":"10.1097\/HCR.0000000000000735","article-title":"Strategies to improve enrollment and participation in pulmonary rehabilitation following a hospitalization for COPD: results of a national survey","volume":"43","author":"Kotejoshyer","year":"2023","journal-title":"J Cardiopulm Rehabil Prev."},{"key":"2025102119514022900_CIT0014","volume-title":"Guidelines for Pulmonary Rehabilitation Programs","author":"Bauldoff","year":"2020","edition":"5th ed"},{"key":"2025102119514022900_CIT0015","doi-asserted-by":"publisher","first-page":"391","DOI":"10.2147\/COPD.S100254","article-title":"Determinants of successful completion of pulmonary rehabilitation in COPD","volume":"11","author":"Brown","year":"2016","journal-title":"Int J Chron Obstruct Pulmon Dis."},{"issue":"1","key":"2025102119514022900_CIT0016","doi-asserted-by":"publisher","first-page":"00509","DOI":"10.1183\/23120541.00509-2020","article-title":"Predictors of pulmonary rehabilitation completion in the UK","volume":"7","author":"Stone","year":"2021","journal-title":"ERJ Open Res"},{"issue":"3","key":"2025102119514022900_CIT0017","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1164\/ajrccm.153.3.8630580","article-title":"Nutritional status and mortality in chronic obstructive pulmonary disease","volume":"153","author":"Gray-Donald","year":"1996","journal-title":"Am J Respir Crit Care Med."},{"key":"2025102119514022900_CIT0018","doi-asserted-by":"publisher","first-page":"106245","DOI":"10.1016\/j.ypmed.2020.106245","article-title":"Current smoking as a marker of a high-risk behavioral profile after myocardial infarction","volume":"140","author":"Gaalema","year":"2020","journal-title":"Prev Med."},{"issue":"11","key":"2025102119514022900_CIT0019","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1080\/14779072.2023.2282026","article-title":"Clinical challenges facing patient participation in cardiac rehabilitation: cigarette smoking","volume":"21","author":"Gaalema","year":"2023","journal-title":"Expert Rev Cardiovasc Ther."},{"key":"2025102119514022900_CIT0020","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.ypmed.2015.04.009","article-title":"Smoking and cardiac rehabilitation participation: associations with referral, attendance and adherence","volume":"80","author":"Gaalema","year":"2015","journal-title":"Prev Med."},{"issue":"2","key":"2025102119514022900_CIT0021","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1097\/HCR.0000000000000225","article-title":"Patient characteristics predictive of cardiac rehabilitation adherence","volume":"37","author":"Gaalema","year":"2017","journal-title":"J Cardiopulm Rehabil Prev."},{"key":"2025102119514022900_CIT0022","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s13102-019-0135-7","article-title":"Correction to: factors associated with non-attendance at exercise-based cardiac rehabilitation","volume":"11","author":"Borg","year":"2019","journal-title":"BMC Sports Sci Med Rehabil"},{"issue":"8","key":"2025102119514022900_CIT0023","doi-asserted-by":"publisher","first-page":"855","DOI":"10.1111\/crj.13373","article-title":"The effect of pulmonary rehabilitation on smoking and health outcomes in COPD patients","volume":"15","author":"Sahin","year":"2021","journal-title":"Clin Respir J"},{"issue":"5","key":"2025102119514022900_CIT0024","doi-asserted-by":"publisher","first-page":"912","DOI":"10.1080\/02770903.2022.2109163","article-title":"Factors affecting the success of pulmonary rehabilitation in asthma","volume":"60","author":"Satar","year":"2023","journal-title":"J Asthma."},{"issue":"1-2","key":"2025102119514022900_CIT0025","doi-asserted-by":"publisher","first-page":"171","DOI":"10.3109\/14659891.2013.765515","article-title":"The association of tobacco use and gender to cardiac rehabilitation outcomes: a preliminary investigation","volume":"19","author":"Weinberger","year":"2014","journal-title":"J Subst Use"},{"issue":"4","key":"2025102119514022900_CIT0026","doi-asserted-by":"publisher","first-page":"00264","DOI":"10.1183\/23120541.00264-2019","article-title":"Prevalence of comorbidities and impact on pulmonary rehabilitation outcomes","volume":"5","author":"Butler","year":"2019","journal-title":"ERJ Open Res"},{"key":"2025102119514022900_CIT0027","doi-asserted-by":"publisher","first-page":"101233","DOI":"10.1016\/j.arr.2020.101233","article-title":"Frailty is highly prevalent in specific cardiovascular diseases and females, but significantly worsens prognosis in all affected patients: a systematic review","volume":"66","author":"Marinus","year":"2021","journal-title":"Ageing Res Rev."},{"issue":"2","key":"2025102119514022900_CIT0028","doi-asserted-by":"publisher","first-page":"CD003793","DOI":"10.1002\/14651858.CD003793.pub3","article-title":"Pulmonary rehabilitation for chronic obstructive pulmonary disease","volume":"2015","author":"McCarthy","year":"2015","journal-title":"Cochrane Database Syst Rev."},{"issue":"12","key":"2025102119514022900_CIT0029","doi-asserted-by":"publisher","first-page":"CD005305","DOI":"10.1002\/14651858.CD005305.pub4","article-title":"Pulmonary rehabilitation following exacerbations of chronic obstructive pulmonary disease","volume":"12","author":"Puhan","year":"2016","journal-title":"Cochrane Database Syst Rev."},{"issue":"3","key":"2025102119514022900_CIT0030","doi-asserted-by":"publisher","first-page":"163","DOI":"10.1097\/HCR.0000000000000657","article-title":"Benchmarking depressive symptoms in cardiac rehabilitation","volume":"42","author":"Middleton","year":"2022","journal-title":"J Cardiopulm Rehabil Prev."},{"key":"2025102119514022900_CIT0031","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.pcad.2022.01.007","article-title":"Cardiac rehabilitation in women, challenges and opportunities","volume":"70","author":"Sawan","year":"2022","journal-title":"Prog Cardiovasc Dis."},{"issue":"5","key":"2025102119514022900_CIT0032","doi-asserted-by":"publisher","first-page":"319","DOI":"10.1097\/HCR.0000000000000536","article-title":"Response to exercise training during cardiac rehabilitation differs by sex","volume":"40","author":"Rengo","year":"2020","journal-title":"J Cardiopulm Rehabil Prev."},{"issue":"5","key":"2025102119514022900_CIT0033","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1097\/HCR.0000000000000275","article-title":"Differential pulmonary rehabilitation outcomes in patients with and without COPD: ROLE OF GENDER","volume":"37","author":"Nguyen","year":"2017","journal-title":"J Cardiopulm Rehabil Prev."},{"key":"2025102119514022900_CIT0034","doi-asserted-by":"publisher","first-page":"106533","DOI":"10.1016\/j.rmed.2021.106533","article-title":"The effect of pulmonary rehabilitation on physical performance and health related quality of life in patients with chronic lung disease","volume":"186","author":"Vinan-Vega","year":"2021","journal-title":"Respir Med."},{"author":"AACVPR","key":"2025102119514022900_CIT0035"},{"issue":"1","key":"2025102119514022900_CIT0036","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1513\/AnnalsATS.201805-332OC","article-title":"Participation in pulmonary rehabilitation after hospitalization for chronic obstructive pulmonary disease among medicare beneficiaries","volume":"16","author":"Spitzer","year":"2019","journal-title":"Ann Am Thorac Soc"},{"issue":"5","key":"2025102119514022900_CIT0037","doi-asserted-by":"publisher","first-page":"740","DOI":"10.1513\/AnnalsATS.202307-601OC","article-title":"Pulmonary rehabilitation utilization in older adults with chronic obstructive pulmonary disease, 2013-2019","volume":"21","author":"Bhatt","year":"2024","journal-title":"Ann Am Thorac Soc"},{"issue":"6","key":"2025102119514022900_CIT0038","doi-asserted-by":"publisher","first-page":"610","DOI":"10.1080\/15412555.2017.1379070","article-title":"Social determinants of adherence to pulmonary rehabilitation for chronic obstructive pulmonary disease","volume":"14","author":"Oates","year":"2017","journal-title":"COPD"},{"issue":"2","key":"2025102119514022900_CIT0039","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1378\/chest.128.2.673","article-title":"The effects of short-term and long-term pulmonary rehabilitation on functional capacity, perceived dyspnea, and quality of life","volume":"128","author":"Verrill","year":"2005","journal-title":"Chest."},{"issue":"10190","key":"2025102119514022900_CIT0040","doi-asserted-by":"publisher","first-page":"2535","DOI":"10.1016\/S0140-6736(19)30648-8","article-title":"Disrupting gender norms in health systems: making the case for change","volume":"393","author":"Hay","year":"2019","journal-title":"Lancet."},{"key":"2025102119514022900_CIT0041","doi-asserted-by":"publisher","first-page":"20.176","DOI":"10.7812\/TPP\/20.176","article-title":"Insurance barriers, gendering, and access: interviews with Central North Carolinian women about their health care experiences","volume":"25","author":"Cardoso","year":"2021","journal-title":"Perm J"},{"issue":"8","key":"2025102119514022900_CIT0042","doi-asserted-by":"publisher","first-page":"1438","DOI":"10.1111\/add.13290","article-title":"Depression motivates quit attempts but predicts relapse: differential findings for gender from the International Tobacco Control Study","volume":"111","author":"Cooper","year":"2016","journal-title":"Addiction."}],"container-title":["Nicotine and Tobacco Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ntr\/advance-article-pdf\/doi\/10.1093\/ntr\/ntaf007\/61397920\/ntaf007.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/11\/1995\/61397920\/ntaf007.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ntr\/article-pdf\/27\/11\/1995\/61397920\/ntaf007.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T23:51:50Z","timestamp":1761090710000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ntr\/article\/27\/11\/1995\/7950744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,9]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,1,9]]},"published-print":{"date-parts":[[2025,10,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ntr\/ntaf007","relation":{},"ISSN":["1469-994X"],"issn-type":[{"type":"electronic","value":"1469-994X"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,1,9]]}}}