Exercise a must for prevention and recovery from cardiac event, especially for women

By Debbie Cooper, Clinical Exercise Physiologist at Mount Hospital, WA

Cardiovascular disease continues to be a major health problem and the leading cause of death worldwide for both men and women. It has long been accepted that exercise-based cardiac rehabilitation programs to prevent or conducted after a cardiac event are effective in reducing mortality, improving outcomes of cardiovascular disease and quality of life.

The benefits of exercise for prevention, or management of cardiac disease include improved physical function, reduced blood pressure, stronger muscles and bones, improved circulation, increased energy levels, and improved mobility and balance. It also helps manage stress, anxiety, and depression.  

Whilst the benefits of exercise are well established, research has continually demonstrated that only 20-50% of eligible patients participate in any cardiac rehabilitation. Worst still it has been determined that for women, older patients, and minorities the referral and participation rate is much lower.  Women are particularly under-represented, with fewer than 15% of women participating, and have a much higher dropout rate than men.  

Evidence is now emerging that indicates risk factors such as physical inactivity, obesity, hypertension, diabetes mellitus and poor mental health have a greater impact on women’s cardiovascular health, leading to a higher risk of acute myocardial infarction (heart attack) compared to men. Women are also more likely to be physically inactive, and have lower cardiorespiratory fitness following an acute coronary event thus increasing the risk of dying in the first year following the event.
 
Participation barriers proposed by women have been shown to be complex and multifactorial and include lack of time, motivation, religious reasons, lack of family/social support, work conflicts, transport, distance, services offered, group format,  cost, negative experiences, and language barriers. Women are also significantly less likely to be referred for cardiac rehabilitation than men, with one study reporting on average only 39.6% women are referred, with men 1.5 times more likely to be referred.  Providing alternative modalities of cardiac rehabilitation such as female only sessions has failed to improve retention rates. 

Current cardiac rehabilitation guidelines promote moderate intensity continuous exercise (MICE); however, this may be perceived as less enjoyable thereby decreasing motivation and increasing dropout rates. High intensity interval training (HIIT) is becoming more popular, particularly for time poor individuals and is proving to be a safe alternative.  Given that women present with lower cardiorespiratory fitness maybe there is a need to integrate more robust exercise strategies, such as HIIT, to improve their cardiorespiratory fitness, a known strong predictor of future cardiovascular events. 

Women need more encouragement and support to participate in exercise programs. This starts with increasing referral rates by GPs and Specialists to exercise based programs for those who are at risk of or have experienced a recent cardiac event.