Why Women’s Heart Health Deserves Special Attention

When the director of the Outpatient Cardiac Rehab Program first started at Burke Rehabilitation 8 1/2 years ago, there were so few women participating in the program that many classes were entirely men. That’s despite the fact that an estimated 44% of all women have some form of cardiovascular disease.

But now, says the program’s director, Robert Steigerwald, MS, RCEP, CPHQ, EIM3, some 37% of participants are women. “That’s a really good number,” he says. “But we still have more work to do in this area.”

Heart disease is the leading cause of death for women in America, claiming more lives than all forms of cancer combined. Yet women’s heart health remains persistently under-researched, underdiagnosed, and undertreated. February, American Heart Month, offers the perfect opportunity to elevate awareness.

We talked to Robert about how women can change the equation on heart health by understanding their unique challenges, building strength and capacity, increasing their confidence, and making a lifelong commitment to staying active. Pro tip: engaging with a community can help sustain an active lifestyle.

Understanding the Unique Challenges

Women on average develop heart disease 7 to 10 years later than men—typically after menopause—and they face a higher likelihood of severe outcomes, including being more likely than men to die following a severe heart attack.

Diagnosis presents additional complications. Women often experience microvascular issues harder to detect than typical blockages, with atypical symptoms, says Robert. “I see more cases where someone says, ‘I had no chest pain but I was just incredibly tired,’” he observes. “They got to the cardiologist, had an EKG, and the next thing they’re with us.”

Cardiac rehabilitation is recognized as the gold standard for treatment after a cardiac event, better than medication alone. Physical exercise can strengthen the heart, lower blood pressure and improve your muscles’ ability to pull oxygen from the blood—all reducing stress on the heart.

Building Strength and Capacity

Ashley was 41 when she received a heart transplant last summer. A lifelong runner diagnosed with cardiomyopathy at age 30, she’d managed the condition with medication while staying active. But by summer, she was in end stage heart failure and could no longer exercise without experiencing dangerous arrhythmias—that is, the heart beating irregularly. After a week on life support, she received a transplant at the Henry and Lucy Moses Division of Montefiore Health System and was discharged two weeks later - profoundly weak.

“I couldn’t believe how weak I was,” she recalls. “I couldn’t walk ten steps. I felt like I was starting over.”

Three months post-transplant, Ashley began cardiac rehabilitation at Burke. The staff established a baseline with gentle activities: treadmill walking, light biking, some arm movement. When she said she felt good and could do more, the care team incrementally increased her workload.

For women, building strength is critical, especially later in life (post-menopause). Lower muscle mass is associated with greater risk of pre-diabetes and diabetes, while strength training protects bone density and prevents falls. “Medication keeps you alive, and exercise keeps you independent,” Robert emphasizes. “The best way to stay independent is by reducing risk, and strength training becomes a really big part of that.”

The benefits multiply beyond heart health. When Robert mentioned bone density to a woman on the treadmill during cardiac rehab, she lit up. “That’s right,” she said. “I was told I have osteopenia.” Now, she had multiple reasons to commit to exercise.

“If you’re not moving much, it gets harder and harder, but as you move a little bit more, things get easier,” says Robert, who encourages people to reimagine how they define activity and exercise. A woman in rehab might say, “I can’t do a squat,” but, says Robert, “every time she stands up from a chair, that’s a squat.”

Increasing Confidence

For many cardiac patients, the mental hurdle proves greater than the physical one. “Everyone comes in nervous,” Robert notes. “But over time you’re working hard and at the end you’re stronger and more confident.”

Burke’s cardiac rehab offers many layers of input and oversight from an interdisciplinary team, including exercise physiologists who guide participants on exercises while an onsite doctor supervises their progress. Patients wear a monitor and follow an individually tailored program on variety of cardiac equipment, including treadmills and exercise bicycles.

After her transplant, Ashley struggled with trusting her new heart. “I almost didn’t trust my body anymore, and I was scared,” she recalls. Part of her goal at Burke was gaining more confidence in what her body and her heart were capable of. Being monitored on an EKG machine and by experts helped her feel safe. For the first couple weeks, she’d anxiously ask, “Did you see anything? Did I have any arrhythmia?” The reassurance—”You were normal. You can do a little bit more”—built both physical capacity and confidence.

Then, a breakthrough. Ashley was rotating between machines when her physiologist asked how she was feeling and how much she was doing on the treadmill. When she told him she was walking pretty fast, he surprised her by saying, “Why don’t you try jogging? I think you can do it.”

Assured that she could stop whenever she felt uncomfortable, “I went the full time,” she marvels. “I couldn’t believe it. I almost cried.” It was the first time she’d jogged since her transplant—not just physical progress, but a restoration of her identity as a runner. In addition, it gives her greater confidence to run around and play tag with her six-year-old son.

Recently, Ashley jogged her first 5K. “I’m running again—the thing I love most,” she says. “Me and my heart are good friends now. I couldn’t have done this without the coaching and oversight of these professionals.”

Making a Lifelong Commitment to Staying Active

Building community can make the difference between just completing a rehab program and sustaining a lifestyle. “I’m going to stand by community more than ever,” Robert says. “The world is just so isolating, with phones and technology. Being in a community where you realize ‘I’m not alone’ is invaluable to sticking with any activity.”

And when it comes to women and heart health, representation matters. “I remember when a woman would come into the program and see twelve men in a room,” Robert recalls, of a time years ago. “As more women come in, they develop friendships and relationships—another wonderful aspect.”

By way of example, he tells the story of two female participants who got to chatting during a blood pressure check, realized they lived blocks apart, and began carpooling to rehab sessions. They synchronized schedules, graduated together, remained friends—and recently came back to visit the program together.

Ashley, too, sees how community makes a difference. Although she is much younger than most in the program, she’s made friends both among fellow participants and the care team. “We share stories, talk about our families, and it’s nice to see them a couple times a week,” she says. “It’s something I look forward to.”

While Ashley’s heart disease was presumed genetic, experts believe that most—80 to 90 percent—of cardiovascular disease is treatable through lifestyle choices. “If everyone did 150 minutes of moderate activity a week, we'd be in a completely different world,” Robert notes. “Let’s prevent it from the beginning, where we can.”