Women: Get With the Heart Rehab Program

Too many women drop out of the exercise and nutritional regimens that follow a heart attack.

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Not that you could tell it from the gender makeup at my gym in the morning, but women don't exercise as much as men. According to a 2005 Gallup poll, in fact, only 42 percent of women engage in vigorous physical activities at least once a week, compared with 56 percent of men. That's an all-around-bad trend, but the consequences are especially bad when it comes to cardiac rehabilitation, the programs for heart patients incorporating exercise, nutritional advice, counseling, and other preventive steps. There, the disparity continues: Studies have shown that women are less likely to participate in cardiac rehab, and if they do start, are as much as 30 percent more inclined to drop out. Since rehab is believed to cut the risk of further heart problems and improves quality of life, that's a gap worth tackling.

Chris Blanchard is trying to find out why women aren't sticking to rehab programs. He's a health psychologist at Dalhousie Medical School in Canada who is now leading a three-year study of 1,200 heart patients to investigate their behavior plus what their families, doctors, and hospital administratorsand specialists have to offer on possible reasons for the gender divide. One theory: Women tend to get heart disease later than men do, which means female heart patients are more likely to be older. and perhaps not as accustomed to organized or vigorous exercise as are men (or today's Mia Hamm-idolizing teenage girls). "When they grew up, exercising wasn't what a woman did," Blanchard says. "They say, 'I wasn't an exerciser then, and I won't change now.' "

Other possible reasons that he and other researchers have posited:

Gender roles. Many women are responsible for the care of kids, spouses, parents. Once they're out of the hospital, they may again shift the focus away from themselves.

The wrong sort of support. "Everyone always assumes social support is key," says Blanchard. But some women have told him that what their husbands consider support and encouragement ("Honey, why don't you hit the gym today?"), they see as nagging.

Other medical problems. Because women are older when they get heart disease, they often have additional diseases or conditions. "That means it may be harder for them to get to rehab, and they may be more frail," says Jennifer Tremmel, clinical director of Women's Heart Health at Stanford University Medical Center.

Cost and access. Women tend to outlive their husbands, and widows often have reduced financial resources. They may lack the insurance coverage or the means of transportation to make cardiac rehab possible.

I should note that men could do better, too: The American Heart Association describes cardiac rehab as "vastly underutilized," noting that only 30 percent of eligible patients participate. The medical establishment shares responsibility, says Tremmel, because it needs to more consistently make sure that referral to cardiac rehab is standard operating procedure after a heart attack or surgery. Blanchard aims to get everybody moving.

Have you noticed a gender gap among your friends and family when it comes to exercise? What do you think accounts for it?