The nature, scope and type of exercise and physical activity undertaken by Middle Eastern women post-coronary artery disease diagnosis: a scoping review

Heart disease remains the leading cause of death for people around the world, affecting men and women alike, though it often presents differently and carries a heavier toll for women. A major way to prevent this disease or manage it after a diagnosis is through physical activity. Health guidelines generally recommend that adults engage in at least 150 minutes of moderate movement, such as brisk walking, or 75 minutes of vigorous activity every week. Yet, in many Middle Eastern countries, a significant portion of the population does not reach these levels, with women often being less active than men. This gap is frequently attributed to cultural and religious factors that limit access to suitable exercise spaces or require specific attire, making movement more difficult. When a woman is diagnosed with coronary artery disease, a condition where the heart's blood vessels become narrowed, doctors typically advise increased movement as part of the recovery plan. However, until recently, very little was known about whether women in the Middle East were actually following this advice or what specific challenges they faced in trying to do so.

To fill this gap in knowledge, researchers conducted a broad review of existing studies to understand the reality of exercise for women in the Middle East after they have been diagnosed with heart disease. The team searched through thousands of scientific records from medical and sports databases, looking for any research published in English between 2009 and early 2026 that focused specifically on women from the region. After carefully screening the titles, abstracts, and full texts of the findings, they narrowed the pool down to twelve studies that met their strict criteria. These included a mix of surveys, interviews, and clinical audits from countries across the Middle East and North Africa. The researchers then analyzed the data to see how much exercise these women were doing, whether they were joining structured heart rehabilitation programs, and what helped or hindered their efforts to stay active.

The review painted a clear picture of a population that is largely inactive despite a serious health diagnosis. The studies found that most women with heart disease in the region were not meeting the recommended weekly amounts of physical activity. While one large audit suggested that nearly all women in that specific sample were active, the researchers noted that this was an outlier; in the vast majority of other studies, fewer than half of the women were exercising enough. When they did move, it was often just walking, and even then, the duration was frequently too short to provide the full health benefits doctors recommend. For instance, some women walked for about two hours a week, which falls well short of the standard goal. The evidence suggests that simply having a diagnosis does not automatically lead to a more active lifestyle for these women, and the gap between medical advice and daily reality remains wide.

A critical part of the recovery process for heart disease is cardiac rehabilitation, which are structured programs designed to help patients regain strength and learn how to manage their condition. These programs often include supervised exercise, education, and support from a team of health professionals. The review found that women in the Middle East were rarely being referred to these programs, and even when they were, very few actually signed up or finished them. One study showed that less than half of the women who were eligible were even sent to a rehabilitation center. Of those who were referred, only about a third enrolled, and just under a third of those who started actually completed the full course. The researchers observed that women living far from the centers were particularly unlikely to be referred, suggesting that healthcare providers might assume transportation would be too difficult for them. When a hybrid option was offered—combining a few hospital visits with phone support and home exercises—women who lived far away were much more likely to participate, indicating that flexibility in how these programs are delivered could make a significant difference.

The reasons behind this low participation are deeply rooted in the social and cultural fabric of the region. The studies highlighted that family responsibilities often take precedence over a woman's own health, with many feeling they simply do not have the time to exercise. Cultural norms also play a powerful role; some women reported needing permission from a husband or male relative to go to a gym, while others found that traditional loose clothing made outdoor activities like walking difficult or impractical. The heat of the climate and a general lack of knowledge about the specific benefits of exercise for heart disease were also cited as barriers. Conversely, when women did find ways to be active, it was often because they had strong support from family and friends, or because they lived in areas where the government provided free or affordable access to parks and gyms. The researchers noted that education was a powerful tool; when women were taught about the importance of rehabilitation, their participation rates went up.

Ultimately, this review reveals that while the medical need for physical activity is well understood, the practical application for women in the Middle East is still in its early stages. The available information is scarce, and the existing data suggests that these women are not getting the same level of support or opportunity to move as their male counterparts. The authors conclude that there is an urgent need for more research that focuses specifically on the experiences of Arab women, rather than grouping them with men or other ethnicities. To improve heart health outcomes, the medical community needs to design programs that respect cultural values, address the specific barriers women face, and provide the kind of education and encouragement that can turn a diagnosis into a catalyst for a healthier, more active life.