Love in Motion:

Improving Women’s Heart Health Through Physical Activity

8 minute read

February is American Heart Month, and as we close out this month, what better way to raise awareness than by gaining a deeper understanding of the silent killer for women: heart disease.  Coronary heart disease, often to refer to as ‘heart disease’ is the number one leading cause of deaths for women, yet about 60% of women are unaware of this fact.(1) Coronary Heart disease falls under the umbrella term of Cardiovascular Disease, which can lead to stroke, heart failure, heart attack and peripheral artery disease.(2) A study performed in 2016 by Garcia, M. et al, reported that women, particularly young women, are less likely to receive preventive care and guidance concerning cardiovascular health.(3) If medications are prescribed, treatment will be less aggressive. As we close out February, this is a good time to understand the risk factors and treatments guidelines for heart disease.  

Before we dive in: Did you know the most common recommendation, supported by the data, for reducing and preventing heart disease is lifestyle improvement, including improving your physical activity? We will discuss more on this topic, but remember you have significant control over reducing your risk for cardiovascular disease. 

Women and Men present differently: 

Heart disease can manifest different for women and men, which may contribute to why women are often undertreated.(4) Common signs for heart disease include: 

• Chest pain described as pressure, tightness, pain, squeezing or aching 

• Pain moving into the shoulder, neck, jaw or arm 

• Cold sweat 

• Shortness of breath

• Sudden dizziness

• Heartburn or indigestion 

• Nausea

For women, symptoms may present differently than for men. For instance, women may experience crushing chest pain, typically at rest, whereas men often experience chsest pain during activity that subsides with rest. Other common symptoms for women include abdominal pain, sleep disturbances, lack of energy and vomiting. (4)

Why does this different for women(4,5)? 

Hormonal changes, particularly during menopause or following surgical menopause due to a hysterectomy, significantly increase the risk of cardiovascular disease. Similarly, pregnancy-related concerns such as gestational diabetes, preterm labor/delivery, eclampsia and high blood pressure represent additional risk factor driven by hormones. Women exhibit differences in the structure and size of their hears compared to men in the context of cardiovascular disease.(4) Their vessels tend to be smaller, and the muscle walls are thinner. Women can face a heightened risk of coronary microvascular disease, which affects the smaller arteries of the heart. These factor contribute challenges in identify the disease and initiating a timely treatment.  

In additional the above risk factors above more risk factors for women are as follows: 

• Endometriosis 

• Autoimmune and inflammatory disease - i.e. Rheumatoid arthritis and systemic lupus erythematosus 

• Lack of physical activity 

• Mental health including - anxiety, stress and marital stress, depression and low social support 

• Overweight or obesity 

• Metabolic syndrome 

• Anemia 

• Smoking

• High blood pressure 

• Radiation and chemotherapy for breast cancer 

• Persistence weight gain >20% after 9 months from delivery/pregnancy

As mentioned above, improving your lifestyle can significant decrease your risk of cardiovascular disease. 

Prescribing medications is not necessarily the primary intervention; instead, you have a lot of control as the first line of defense through lifestyle, physical activity and diet. Below are the Top Ten primary prevention recommendations suggested by the American College of Cardiology/American Heart Association Task Force.(6)  

1.Promote a health lifestyle throughout life

By increasing your awareness through education, modifying behaviors,  finding resources, having support to remove barriers, ultilizing technology, and participating community, you can have positive benefits in creating a healthier long-term lifestyle. 

2. Identifying a team to help guide you and assist you in removing social determinants to find the best treatment 

Social determinants include: socioeconomic status, access to healthcare, health literacy, environmental factors, social support, cultural factors, and work/employment conditions.  By addressing these barriers, practitioners can help reduce disparities on cardiovascular disease outcomes. 

3. Assessisg your 10-year artheoscelrotic cardiovascular disease risk estimation (ASCVD) 

Between the ages of 40 to 75, this risk estimation can help identify your risk factors and lead to discussions about changes and/or appropriate pharmacological interventions.  

4. Healthy Diet

Plant-based and Mediterranean diets, with increasing fruits, vegetables, nuts, lean animal proteins, and fiber, are recommended to improve cardiovascular health. Consulting with a registered dietitian is recommended, especially if you are overweight or obese.  

5. Increase your Physical Activity

Recommendation to engage in 150 minutes of moderate-intensity exercise (such as brisk walking) or 75 minutes of vigorous activity (like running) can help reduce cardiovascular risk. Learn more later about how physical therapy can advocate for improving your physical activity health. 

6. Control Type II Diabetes

If diagnosed with Type II diabetes, it is crucial to start making lifestyle changes such as nutritional and exercise habits.  Also, discussing with your physician if pharmacological intervention is appropriate. 

7. Stop Smoking! 

8. Reduce Aspirin Use 

It is suggested that aspirin is used infrequently; however,  a conversation with your physician is warranted to understand why and how to use aspirin. 

9. Reduce High Cholesterol  

Being prescribed statin medication is typically the first line of defense for high cholesterol, a diagnosis of diabetes, or increased risk based on the ASCVD evaluation.

10. Lower your Blood Pressure

The first line of defense should be non-pharmological interventions such as physical activity or diet.  However, if medication is prescribed, the target blood pressure should be <130/80 mm HG. 

Now you have a better understanding of risk factors and prevention techniques, so how can Physical Therapy help you? 

Enhancing your physical activity! 

It is found that exercise is one of the leading prevention techinques to reducing cardiovascular disease (7) According to a statement from the American Physical Therapy Association, “Physical Therapist, like most health professionals, are educated to provide services in the health service delivery environment.”(8) Physical Therapist have the ability to address many behaviors of the above recommendations and become a part of your team in lowering your risk of cardiovascular disease.  Also, you tend to see PTs on a more regular basis compared to your physician, so they can guide you in the following:(9) 

• Removing social determinants 

• Education on ceasing smoking 

• Mointoring your exercise and helping you progress

• Educating on exercise benefits 

• Identify obsetiy 

• Identifying your blood pressure 

• Mointoring your cardiovascular response to exercise

If you are overwhelmed by the above information, one easy start is walking!

Walking offers numerous benefits, including weight management, lowering blood pressure and cholesterol, improving energy levels, enhancing mental health, strengthening muscles and bones, and improving cardiovascular health. A study showed for older adults, by walking between 6000 to 9000 steps per day, can lower your cardiovascular risk by 40%!(7) After meeting with your physician, schedule an appointment with a physical therapist but in the meantime, get walking!  

---

🚨 This blog is for educational purposes only and is not intended to treat or diagnose any medical condition.  Perform any exercises at your own risk or consult a medical provider before starting an exercise program. 🚨

Dr. Susan Miller PT, DPT is a licensed pelvic floor physical therapist and the owner of Lotus Core Physical Therapy in Colorado. She welcomes both in-person and telehealth appointments for Colorado residents, as well as coaching call for clients residing out of state.  

Resources: 

1. Kuehn, Bridget M. Gynecologist and Cardiologist Team Up to Identify Women at Risk of Heart Disease.  Cardiology News. February 2020. 141: 600-602. DOI 101161/CirculationHA.119.045067

2. Know the Difference : Cardiovascular Disease, Heart Disease, Coronary Heart Disease. October 2021. https://www.nhlbi.nih.gov/resources/know-differences-cardiovascular-disease-heart-disease-coronary-heart-disease

3. Garcia M, Mulvagh SL, Merz CN, Buring JE, Manson JE. Cardiovascular Disease in Women: Clinical Perspectives. Circ Res. 2016;118(8):1273-1293. doi:10.1161/CIRCRESAHA.116.307547. 

4. CDC. Women and Heart Disease. In. CDC.gov: Centers for Disease Control and Prevention; 2020.

5. National Institute of Health. Health Topics (2015) How Does Heart Disease Affect Women? Published online:https://www.nhlbi.nih.gov/health/health-topics/topics/hdw 

6. Arnett DK, Blumenthal RS, Albert MA, et al. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in Circulation. 2019 Sep 10;140(11):e649-e650] [published correction appears in Circulation. 2020 Jan 28;141(4):e60] [published correction appears in Circulation. 2020 Apr 21;141(16):e774]. Circulation. 2019;140(11):e596-e646. doi:10.1161/CIR.0000000000000678

7. Paluch AE, Bajpai S, Ballin M, et al. Prospective Association of Daily Steps With Cardiovascular Disease: A Harmonized Meta-Analysis. Circulation. 2023;147(2):122-131. doi:10.1161/CIRCULATIONAHA.122.061288

8. American Physical Therapy Association. (2019). Physical therapist’s role in prevention, wellness, fitness, health promotion, and management of disease and disability [Amended: HOD P06‐16‐06‐05; Initial: HOD P06‐15‐23‐15]. (Position). Last updated 09/20/19

9. Van Zant RS, Cape KJ, Roach K, Sweeney J. Physical therapists' perceptions of knowledge and clinical behavior regarding cardiovascular disease prevention. Cardiopulm Phys Ther J. 2013;24(2):18-26.

10. Paluch AE, Bajpai S, Ballin M, et al. Prospective Association of Daily Steps With Cardiovascular Disease: A Harmonized Meta-Analysis. Circulation. 2023;147(2):122-131. doi:10.1161/CIRCULATIONAHA.122.061288