London, Cardiac rehabilitation is not a "men's club" anymore and modern women living with heart disease need flexible options for lifestyle programmes that fit their busy schedules, find researchers.

Enjoyable physical activity such as Zumba, group walking, tai chi, qigong, technology-based balance exercises (Wii Fit), dancing and Nordic walking are some of the modern lifestyle methods that can keep the heart in good shape for women.

"Women tend to prioritise others before themselves," said senior study author Dr Jennifer Reed of the University of Ottawa Heart Institute, Canada.

"The realities of modern life require women to address multiple family, community, social and work-related demands. As a result, many feel they do not have time for cardiac rehabilitation," Reed added.

Cardiovascular disease is the leading cause of death in women worldwide; in 2015, it accounted for one-third of all female deaths.

However, approximately 10-20 per cent fewer women than men participate in cardiac rehabilitation, and women are more likely to drop out (35 per cent of women quit versus 29 per cent of men).

In contrast, women are high users of local exercise classes: many women attend at least 70 per cent of the sessions on offer.

"We are experiencing a shift in family responsibilities towards more equality, but today's women with heart disease are still more likely to be a caregiver than men," said Sol Vidal-Almela of the University of Ottawa Heart Institute.

Multiple class options throughout the day may particularly benefit younger women who report lack of time, family and work commitments as barriers to attending cardiac rehabilitation, said the study published in the European Journal of Preventive Cardiology.

To reach this conclusion, the authors reviewed a decade of literature to identify what stops women with heart disease from attending cardiac rehabilitation.

Multiple barriers to participation were identified.

Some women view cardiac rehabilitation as a "men's club".

Classes are at set times and incompatible with women's daily schedules.

Women do not enjoy the physical activity offered and it does not fit their needs: some find it too physically demanding, while others want it to be more challenging.

Women frequently lack social support and feel guilty for deserting their family, said the study.

Older women may benefit from exercises to help them perform daily activities (dressing, reaching a cupboard, moving in and out of a chair or bed) and reduce their risk of falls, while younger women may prefer more challenging activities such as high-intensity interval training, the authors suggested.

"Women have been underrepresented in cardiovascular research. The assumption that findings from studies predominantly including males will be generalisable to females represents a barrier to the advancement of cardiac rehabilitation to meet the needs of women and men," elaborated Reed.