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Cardiac rehabilitation can be a lifesaver for women: a structured program of exercise and education can help you improve your heart health safely.

Cardiac rehabilitation programs can mean the difference between life and death for women with coronary artery disease (CAD). Women with CAD who completed a 12-week cardiac rehab program had a much higher rate of survival than those who didn't participate, according to a study presented at the American College of Cardiology's 62nd Annual Scientific Session in San Francisco in March 2013.

Researchers analyzed data from more than 25,000 adults with CAD, 24.6 percent of whom were women. Compared to men, the women in the study were older and had a higher prevalence of heart failure and diabetes. Only one in three women was referred to cardiac rehab, and, of those who were referred, only half actually attended. Women with CAD who completed a cardiac rehab program were nearly two-thirds less likely to die from all causes than women who did not participate.

"The findings are impressive," says Paul Kligfield, MD, director of the cardiac rehab program and professor of medicine at Weill Cornell Medical College. "Gender differences in utilization are well-established. Not only are women less likely to be referred to cardiac rehab, but their participation falls short because of financial barriers and logistical problems, such as child care and transportation."

Cardiac rehab for longer life

Cardiac rehab consists of exercise, education, and counseling. Most programs meet three times a week for 12 weeks. Each session typically includes 15 minutes of warm-up, 30 minutes of aerobic exercise, and 15 minutes of cool-down. Initially, rehab specialists evaluate your fitness level and other factors and consider your medical history to determine a safe starting point for your exercise regimen. Once you're in the program, they keep an eye on your heart rate, blood pressure, and heart rhythm while you're walking on a treadmill or riding a stationary bike. "Your general practitioner or your cardiologist can refer you," says Dr. Kligfield. "And keep in mind that the cardiac rehab staff does not rake over your regular care from your primary caregiver, but works with your physician."

Participating in aerobic activity, along with other positive lifestyle changes, can help you take charge of your own heart health. Medicare and many insurance plans cover at least part of the cost of cardiac rehab after coronary artery bypass surgery, heart valve repair or replacement, coronary (balloon) angioplasty, stent placement, device implantation, or a heart transplant. You also may be eligible if you have chest pain that worsens with exercise, heart failure, or have suffered a heart attack within the past year.

Exercise takes time

"Most doctors give patients three or four medications after a heart attack," says Dr. Kligfield. "In the acute-care setting, survival is critical. Drugs have a more immediate effect than non-medical, long-term treatments such as weight loss, exercise, and smoking cessation."

However, over time, Dr. Kligfield says, cardiac rehab provides a survival benefit equivalent to any heart medication. Even moderate exercise, under strict medical supervision, can strengthen a weak and damaged heart. You also can learn to manage stress with relaxation techniques, counseling, and simple lifestyle changes.

Unfortunately, the benefits of cardiac rehab are underappreciated by both patients and their doctors, according to the American Heart Association. "Your doctor may say you don't need a formal program and can exercise on your own," says Dr. Kligfield. "But most people who are referred to cardiac rehab aren't already exercising on their own and are anxious about starting to do so."

Less likely to be referred

"Both men and women with CAD have low rates of referral to cardiac rehab," says Dr. Kligfield. "Also, studies show that African-Americans experience cardiac events up to 20 years earlier than Caucasians, which argues for aggressive referral to cardiac rehab for this younger population."

The numbers are dear. One in three women has CAD by age 65. Although more research is needed, the study presented this year at the American College of Cardiology meeting shows that a cardiac rehab program can do more than help you regain strength and endurance. Lf you're a woman with CAD, a cardiac rehab program may save your life.


Cardiac rehab programs use evidenced-based methods to improve outcomes among women with CAD and are offered in most hospitals and medical centers. Cardiac rehab typically includes the following:

* Supervised exercise

* Nutrition counseling

* Lipid (cholesterol) management

* Stress management

* Smoking cessation

* Educational programs

* Peer support
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Title Annotation:TREATMENT
Publication:Women's Health Advisor
Date:May 1, 2013
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