Cardiac rehabilitation is a structured form of secondary prevention offered after conditions such as heart attack, coronary artery disease or other cardiovascular events. It typically combines physical activity, education, risk-factor management, medication support and psychological care. The goal is not only to help patients recover their physical capacity but also to reduce the likelihood of another cardiovascular event. Yet women are often less likely than men to begin or complete cardiac rehabilitation, and those living outside metropolitan areas can face additional barriers, including long travel distances, limited public transport, workforce shortages and a lack of programs designed around women’s experiences.

“The lack of women-focused programs are major barriers,” says Flinders University researcher Dr Joyce Ramos. “But home-based cardiac rehabilitation using telehealth and gender-tailored approaches may help address these challenges.” The CREW program was designed around this principle. Rather than requiring participants to attend repeated face-to-face sessions, it used a web-based format that allowed women to access educational material and rehabilitation support from home. Telehealth can reduce the practical burden of travel while maintaining contact with health professionals, an approach that may be particularly important in rural and remote regions where specialist services are widely dispersed.

The study included 40 women from rural or remote South Australia who had been referred to cardiac rehabilitation through the integrated Cardiovascular Clinical Network, known as iCCNet. Participants entered the study between November 2023 and November 2024 and were invited to use the CREW program. Its digital content consisted of four educational modules intended to strengthen self-management and help participants understand the factors influencing cardiovascular health. Completion was monitored through digital records, allowing researchers to assess how many women began the program and how many completed it.

The results indicated that 82.5 per cent of participants initiated cardiac rehabilitation, while 60 per cent completed the program. These figures are important because participation often declines between referral, enrolment and completion. A referral alone does not guarantee that a patient will receive the full benefits of rehabilitation. Completion can be affected by fatigue, pain, anxiety, family responsibilities, work demands, digital access and uncertainty about how rehabilitation fits into everyday life. The relatively high initiation rate in the CREW study suggests that a flexible, women-focused model may help reduce some of the obstacles that prevent patients from taking the first step.

Participants also reported high satisfaction with most elements of the program. Although satisfaction does not by itself demonstrate that a program improves long-term survival or prevents future cardiovascular events, it is a significant measure of feasibility and acceptability. Patients are more likely to engage with a health intervention when its format is understandable, accessible and relevant to their circumstances. A web-based platform may also give participants greater control over when and where they complete educational activities, which can be valuable for women balancing recovery with caregiving, employment or household responsibilities.

“ These findings highlighted the value of a women-focused approach to support women engage with their heart health,” says Dr Ramos. “They should also increase clinician awareness about the importance of recognising and addressing women’s unique needs throughout the cardiac rehabilitation journey.” Gender-sensitive rehabilitation does not mean assuming that every woman has the same needs. Instead, it recognises that cardiovascular disease can be shaped by differences in symptoms, life circumstances, social roles, communication preferences and access to care. A tailored program can provide space to address issues that may be overlooked in a general rehabilitation pathway, including confidence with physical activity, emotional recovery and the practical demands of managing health at home.

Researchers also conducted interviews with participating women and with clinicians responsible for delivering cardiac rehabilitation. These interviews added context to the digital participation data and explored how the program functioned in real-world conditions. The analysis identified several themes. Women described the program as empowering, particularly when it helped them develop knowledge and confidence in managing their cardiovascular health. Telehealth was viewed as a way to support participation by reducing travel and making rehabilitation more compatible with life in rural and remote communities. Clinicians, meanwhile, highlighted the potential of the model to respond to workforce and resource pressures within health systems.

The findings suggest that digital cardiac rehabilitation could extend specialist support without requiring every appointment to take place in a hospital or clinic. However, the researchers also identified opportunities to improve the program. Recommendations emerging from the interviews included enhancing program content and refining delivery so that it better reflects the experiences of women and the operational realities of clinicians. Digital programs must also account for differences in internet connectivity, technology confidence, health literacy and access to devices. A web-based intervention can remove geographic barriers, but it cannot eliminate every form of inequality unless technical and clinical support are built into its design.

The study does not establish that CREW produces better clinical outcomes than conventional cardiac rehabilitation, and its relatively small sample means the results should be interpreted as evidence of feasibility rather than definitive proof of effectiveness. Further research will be needed to determine whether the program improves physical fitness, medication adherence, cardiovascular risk factors, quality of life and long-term participation. Larger studies could also assess whether the approach is effective across different rural populations and whether it can be incorporated sustainably into routine health services. Even so, the combination of digital completion data and interviews provides a useful picture of how a women-focused model may work beyond the metropolitan health system.

The research, titled “Feasibility and Acceptability of the Cardiac Rehabilitation Especially for Women (CREW) Web-Based Program in Rural and Remote Communities: A Mixed-Method Study,” was conducted by Orathai Suebkinorn, Alline Beleigoli, Robyn Clark, Lemlem Gebremichael, Norma Bulamu, Jeroen Hendriks, Jonathon Foote, Anita Lymn, Sherry Grace and Joyce Ramos on behalf of the Cardiac Rehabilitation Especially for Women Project Team. Published in Heart, Lung and Circulation on 3 August 2026, the study presents CREW as a promising response to persistent gender and geographic disparities in cardiac rehabilitation. Its central message is that recovery after cardiovascular disease may be strengthened when care is brought closer to patients’ homes and designed with women’s real-world needs in mind.

Subject of Research: People

Article Title: Feasibility and Acceptability of the Cardiac Rehabilitation Especially for Women (CREW) Web-Based Program in Rural and Remote Communities: A Mixed-Method Study

Web References: https://doi.org/10.1016/j.hlc.2026.06.021

References: Suebkinorn O, Beleigoli A, Clark R, Gebremichael L, Bulamu N, Hendriks J, Foote J, Lymn A, Grace S, Ramos J, on behalf of the Cardiac Rehabilitation Especially for Women (CREW) Project Team. “Feasibility and Acceptability of the Cardiac Rehabilitation Especially for Women (CREW) Web-Based Program in Rural and Remote Communities: A Mixed-Method Study.” Heart, Lung and Circulation. Published 3 August 2026. DOI: 10.1016/j.hlc.2026.06.021

Keywords: cardiac rehabilitation, women’s cardiovascular health, telehealth, digital health, rural healthcare, remote communities, cardiovascular disease, secondary prevention, gender-tailored care, CREW program

Stress urinary incontinence, characterized by involuntary leakage of urine during activities that increase abdominal pressure such as coughing or sneezing, frequently emerges or worsens following vaginal childbirth. This condition, a primary manifestation of pelvic floor dysfunction, affects an estimated 43 million women over the next two decades according to demographic projections. Importantly, untreated or inadequately managed incontinence can transition from a temporary inconvenience to a chronic health issue, significantly diminishing quality of life. For new mothers in particular, the physical and emotional toll is compounded by childcare responsibilities and work demands, making traditional physical therapy appointments challenging to attend.

The UCSF study undertook a randomized controlled trial involving 30 women approximately 1.5 years postpartum and averaging 37 years of age with a median of two childbirths. Participants were assigned either to receive conventional in-person pelvic physical therapy or a telehealth-based protocol. Both cohorts underwent a structured four-week therapeutic intervention with follow-up assessments at five weeks and one year post-treatment. The researchers leveraged validated symptom tracking metrics to quantitatively evaluate improvements in urinary control, pelvic floor muscle function, and overall patient satisfaction.

Remarkably, the findings demonstrated statistically significant improvements in urinary incontinence symptoms for all participants, regardless of treatment modality. At the one-year follow-up, symptom scoring indicated sustained relief and improved pelvic health, underscoring the potential long-term benefits of both telehealth and physical sessions. Notably, satisfaction ratings indicated that telehealth was not only comparable in efficacy but also met or exceeded patient expectations in terms of convenience and support, addressing a critical gap in access to care.

Pelvic physical therapy traditionally entails hands-on evaluation and exercise regimens to strengthen the pelvic floor muscles, restore neuromuscular coordination, and improve urinary continence mechanisms. However, logistical hurdles such as transportation, clinic availability, and time commitments often restrict patient adherence, especially for postpartum women balancing newborn care. Telehealth circumvents these barriers by delivering tailored physical therapy sessions through interactive video platforms, enabling therapists to guide exercises and monitor progress remotely. This modality exploits advancements in digital health technology, including wearable sensors and app-based monitoring, to ensure personalized and precise treatment adherence.

Dr. Jennifer Kinder, lead author and associate professor at UCSF’s Department of Physical Therapy and Rehabilitation Science, emphasized the significance of this research in expanding equitable healthcare access. “Our results validate telehealth as a feasible and effective treatment pathway for stress urinary incontinence, particularly valuable for postpartum mothers confronting competing demands. This work heralds a transformative shift toward integrating digital health into women’s pelvic floor rehabilitation, promoting both affordability and accessibility,” she stated. This endorsement from a women’s health specialist highlights the broader implications for incorporating telemedicine in specialized physical rehabilitation disciplines.

The trial’s methodological rigor, including randomization and longitudinal monitoring, lends weight to its conclusions. However, acknowledging limitations such as the modest sample size and specific demographic characteristics, the authors advocate for larger-scale, multi-center trials to corroborate these promising initial outcomes. Furthermore, technological literacy and internet connectivity remain practical considerations for widespread telehealth implementation, necessitating intersectoral collaboration to refine user-friendly platforms and infrastructure.

Clinically, this study contributes to a growing body of evidence endorsing telehealth applications beyond general medicine into targeted rehabilitative therapies. It challenges conventional paradigms by demonstrating that remote interventions can replicate the core benefits of tactile therapeutic engagement. Given the prevalence of postpartum urinary incontinence and its economic burdens on healthcare systems, integrating telehealth may optimize resource allocation, reduce patient costs, and alleviate systemic strain while maintaining therapeutic efficacy.

The study also sheds light on the pathophysiology of stress urinary incontinence and the mechanisms by which pelvic physical therapy ameliorates symptoms. Pelvic floor muscles play a crucial role in supporting the bladder and urethra; childbirth can overstretch or damage these tissues, impairing their function. Focused exercises improve muscle tone, coordination, and reflexive contraction during activities that increase intra-abdominal pressure. The researchers highlight that telehealth facilitates consistent performance and adherence of these exercises through real-time feedback and motivational support, aspects traditionally achieved through direct physical interaction.

In the broader context of digital health evolution, this research epitomizes how leveraging telecommunication technologies can democratize specialized healthcare services. It aligns with health policy goals targeting expanded rural and underserved area coverage, where limited specialist availability exacerbates treatment disparities. Additionally, the emotional and psychological benefits of receiving therapy in a familiar home environment may enhance receptivity and engagement, factors critical in chronic condition management.

UCSF’s commitment to integrating cutting-edge research with community-oriented medical solutions is exemplified in this study. Co-authored by experts including Wendy Katzman, PT, DPTSc, and Victor Cheuy, PhD, alongside collaborative contributions from the University of the Pacific and Mount Saint Mary’s University, the work reflects a multidisciplinary approach vital for complex health challenges. Funding support from Notre Dame de Namur University and supplemental travel funds from UCSF underscore institutional investment in advancing women’s health innovation.

As this seminal study ushers in new horizons for postpartum pelvic floor rehabilitation, it invites further exploration into optimizing telehealth protocols, integrating objective digital biomarkers, and personalizing interventions to individual patient profiles. Continued research and technological development will be essential to ensuring telehealth not only matches but eventually surpasses traditional care paradigms, transforming the landscape of women’s health and beyond.

Subject of Research: Stress urinary incontinence treatment comparing telehealth and in-person pelvic physical therapy in postpartum women

Article Title: Feasibility and Acceptability of a Protocol-Based Telehealth Pelvic Physical Therapy for Stress Urinary Incontinence Postpartum

News Publication Date: April 2025

Web References:
Journal of Women’s and Pelvic Physical Therapy

References: Provided within study publication

Keywords: Stress urinary incontinence, pelvic floor dysfunction, telehealth, physical therapy, postpartum care, digital health, women’s health, pelvic rehabilitation, remote therapy, maternal health, musculoskeletal therapy, patient satisfaction