When it comes to heart disease and heart attack there are a number of differences between men and women. Trainer and educator Clare Hozack looks at how we can manage certain factors in women, as well as reduce the risk of the worst happening.
Early 2022 saw a number of high profile tragedies due to heart attacks in prominent Australians. The sudden passing of Rod Marsh was almost immediately followed by that of Shane Warne and, within days, Labor Senator Kimberley Kitching. The Senator’s untimely death at the age of just 52 – the same age as Warne – brought into sharp focus for many the fact that heart attack is not only suffered by males.
Here’s a sobering statistic that you may not be familiar with: 1 in 4 women will die of heart disease. That’s nearly three times the number that will die of breast cancer, a disease with which many people will be more familiar. In Australia, 90% of women have at least one risk factor for heart disease, and 50% have two or more.
‘Heart disease’ refers to several types of problems that affect the heart, the most common of which is coronary artery disease (CAD). Heart disease is also called cardiovascular disease: disease of the blood vessels.
Heart attack symptoms in women
Symptoms of a heart attack vary between men and women, and women are more likely to have ‘non-typical’ symptoms, such as heartburn. Heart attack symptoms in women are subtle, compared to the symptoms in men. As with men, women’s most common heart attack symptom is uncomfortable pressure, squeezing, fullness or pain in the centre of the chest, lasting more than a few minutes, or going away and coming back.
However, women are more likely than men to experience some of these other common symptoms:
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach
- Shortness of breath, with or without chest discomfort
- Breaking out in a cold sweat, nausea or lightheadedness.
It has been noted that women often display symptoms when resting, or even while sleeping.
When it comes to heart disease, there are a number of risks that can be controlled, including:
- Metabolic syndrome – encompassing hip-to-waist ratio; blood pressure; blood glucose; high cholesterol; high triglycerides (more on this below)
- Stress (more on this below)
- Physical activity
- Eating habits
Long-term psychological, emotional, or physical stress raises your risk of heart disease. If you have heart disease, long-term stress also makes you more likely to have a heart attack. Stress includes emotionally upsetting events, especially involving anger, and can be a trigger for heart attack. Stress also may indirectly raise your risk of heart disease if it makes you more likely to smoke, eat unhealthy foods, or less likely to exercise.
As a fitness professional, you’ll know that metabolic syndrome is the name for a group of risk factors that happen together and are related to your metabolism (the process the body uses to convert food into energy). Having metabolic syndrome doubles your risk of heart disease and it’s more common in women than in men. You have metabolic syndrome if you have any three of these five risk factors:
- Waist measurement of more than 35 inches
- Triglyceride level greater than 150 mg/dL (milligrams per deciliter)
- HDL cholesterol less than 50 mg/dL
- Blood pressure of 130/85 mmHg (millimetres of mercury) or higher
- Blood glucose greater than 110 mg/dL after fasting for at least eight hours.
If you have metabolic syndrome, you can take steps to control the following risk factors.
- Excessive blood clotting
- Lupus and rheumatoid arthritis
- Sleep apnea
- C-reative protein: C-reactive protein (CRP) is made by the body and released into the blood in response to swelling. Swelling (or inflammation) is how your body reacts to heal infections or cuts. Swelling can also happen over time in response to high stress levels or poor eating habits. Swelling for infections or cuts will raise your CRP levels for a short time, but swelling that continues for a long time may mean your arteries are damaged, which puts you at risk for heart disease.
Of these risk factors, the most common ones affecting women are high cholesterol, being overweight, and physical inactivity.
Risk factors you can’t control
It’s great that a number of risk factors are within our control, but there are several that are not, namely:
- Menopause (increases risk significantly)
- Family history
- Race and ethnicity
- Pregnancy history.
Prevention and treatment
If your client has multiple risk factors, or any symptoms, they should be referred to their GP to ask specifically about heart health.
While they may not be able to completely eliminate their risk for heart disease, they can take steps to reduce it. These include:
- Checking blood pressure regularly. If it’s high, work with their doctor to lower it. This may include medication and lifestyle changes.
- Support quitting smoking: this can be difficult, but a doctor can help create a smoking cessation plan that’s right for them.
- If they have risk factors for diabetes, such as family history, get their blood sugar tested.
- If they have diabetes, work with them to get their blood sugar under control.
- Help them maintain a healthy weight that works for their body.
- Encourage them to eat a healthy diet that’s high in whole grains, fruits and vegetables, and lean meats.
- Encourage them to limit their alcohol intake to no more than one drink per day.
- Manage stress levels – this includes making changes to exercise that is excessively intense or that they don’t enjoy.
- Get their cholesterol checked and take steps to lower high cholesterol if need be.
- If they have sleep apnea, or suspect they do, encourage them to seek diagnosis or treatment.
- Regularly participating in moderate intensity exercise.
- If they have previously had a heart attack, they should talk to their doctor about daily low-dose aspirin. This isn’t recommended for women who haven’t had a heart attack or stroke, as it can increase bleeding.
“Exercise can help prevent further narrowing and hardening of the blood vessels that supply the heart, prevent blood from clotting, and reduce the stress on the heart during everyday activities”
What you can do
Once diagnosed with CHD, a client’s doctor will generally treat the disease with medication and determine if the person is clinically stable enough for exercise.
Regular exercise is a very effective secondary treatment (with medication as primary), and a preventative measure, for CHD without any of the side effects that medication may have. Exercise can help prevent further narrowing and hardening of the blood vessels that supply the heart, prevent blood from clotting, and reduce the stress on the heart during everyday activities – all of which are beneficial for people with CHD.
Exercise recommendations for CHD are 30-60 minutes per day, 3-5 days per week of both aerobic and resistance training.
General Exercise Guidelines
Once clearance from their doctor has been obtained, these guidelines can help you to optimise your client’s training, as well as their health and safety:
- Include at least a five-minute warm-up and five-minute cool-down in every exercise session. This reduces the likelihood of oxygen deprivation to the heart in response to a sudden physical effort or abrupt cessation of exercise.
- Engage in moderate-intensity physical activity such as brisk walking for at least 30 minutes on most, preferably all, days of the week.
- Monitor exercise intensity closely. Make sure the client stays within their individual heart-rate zone (usually determined from a treadmill test under the supervision of a physician). 60-80% is generally advised.
- Be cautious about engaging in vigorous physical activity. If planning to begin a vigorous program, the client should discuss it thoroughly with their physician. They should also complete an exercise stress test first.
- Avoid strenuous activity in extreme environmental conditions. Vigorous physical activity in the cold (such as snow shovelling) is associated with heart attack. Hot conditions require a dramatic increase in the heart’s workload. High altitude increases demands on the heart, particularly for individuals who are not acclimatised. In these situations, it is best to take it slow and increase incrementally.
- Inform you, their personal trainer, and their physician if they have any abnormal signs or symptoms before, during or after exercise. These include chest pain, extreme fatigue, indigestion or heartburn, excessive breathlessness, ear or neck pain, upper respiratory tract infection, dizziness or racing heart and severe headache.
- If prescribed, always carry their nitroglycerin with them, especially during exercise.
- Never exercise to the point of chest pain or angina. If your client develops chest pain during exercise, call 000 immediately.
- Make sure the facility where you exercise is well-equipped in case of an emergency. Ask the managers if the facility has an emergency response plan and an automated external defibrillator (AED), with staff trained on how to use it, on the premises.
Weights for cardio health
To reduce heart attack risk, cardio (aerobic) exercise is most often promoted as the exercise of choice for improving heart health. However, lifting weights for less than an hour a week can also reduce risk for a heart attack or stroke by 40-70%, as well as increase functional strength, bone density and balance. Clients can start a resistance training program by lifting weights two or three times a week for 20-60 minutes, and build up to a heavy intensity (about 80% of 1RM, or 8-12 repetitions) over time. Three great exercises include:
- Shoulder press
- Upright row
If you have access to a Power Plate, you can progress your client to super-setting using this Whole Body Vibration training apparatus by adding:
- 3D Lunges
- 3D Shoulder press
- 3D Upright row
Strength training clients with cardiac disease has been, until relatively recently, avoided due to the haemodynamic response observed during isometric (static) exercise – where blood pressure increases up to 2.5 times normal.
Weight lifting, however – or strength training generally – is not an isometric exercise. Isometric is a stationary contraction (like a wall sit or plank), and weight lifting works more like a blood pump; there’s a period of constriction (during the contraction), and a period of release (which effectively ‘sucks’ the blood into the tissues).
Considering this, recommendations for people who have heart disease include:
- Only performing strength training if they are asymptomatic or only mildly symptomatic
- Beginning strength training after an initiation of aerobic training only
- Starting with single limb activities
- Setting weight at a maximum intensity no greater than 60% of 1RM (approximately 15-20 repetitions)
- Training at their own pace, progressing at their own pace, and taking a break when they need it
- Their first few sessions being medically supervised
- Checking in periodically for reassessment
- Recording their heart rate and response to exercise
- Performing strength training once a week, for no more than one hour
Once your client has settled into their cardio and strength training program, they can start supplementing their exercise with Whole Body Vibration, which has a positive effect on arterial stiffness in middle-aged and older adults.
Using Whole Body Vibration as a stand-alone prevention and heart disease management tool
As well as being used as both a progression and a starting point, for beginners, Whole Body Vibration can also be used as a preventative tool in itself.
Because you can train strength, balance, flexibility, mobility, and cardio fitness at the same time, it is very effective in both heart disease management and prevention, as well as the management of other health issues that contribute to heart disease risk, such as obesity and diabetes.
Set the plate to 25-40Hz (I have mine on 30Hz) and prescribe the following exercises:
- Stepping side-to-side (holding on – cardio)
- Step ups (weights on one side, holding on other side – strength and balance)
- Single leg (balance)
- Sitting legs wide (circulation and recovery) – because research also shows that whole body vibration can improve circulation.
Build up to three sessions per week, for a minimum of 15 minutes (the Power Plate app has additional workout ideas powerplate.com.au).
Reassure clients, and prospective clients, that it is never too late to start an exercise program or increase their levels of physical activity. Combined with a healthy diet, it’s the best choice they can make for their heart health.
- https://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/heart-disease/art-20046167 https://www.cdc.gov/heartdisease/women.htm
- https://www.victorchang.edu.au/womenheartdisease https://www.hri.org.au/health/learn/cardiovascular-disease/women-and-heart-disease https://www.aihw.gov.au/reports/cvd/49/women-and-heart-disease-cardiovascular-profile-of/contents/summary
- https://www.heartresearch.com.au/heart-disease/women-and-heart-disease/ https://thefhfoundation.org/detecting-early-symptoms-heart-disease-women https://www.pulseheartinstitute.org/heart-disease-in-women-understand-the-signs/ https://www.healthline.com/health/heart-disease-in-women
- https://www.health.harvard.edu/heart-health/the-many-ways-exercise-helps-your-heart https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172294/
- https://www.womenshealth.gov/heart-disease-and-stroke/heart-disease/heart-disease-risk-factors https://www.heartfoundation.org.au/heart-health-education/risk-factors-for-women https://www.heart.org/en/health-topics/heart-attack/warning-signs-of-a-heart-attack/heart-attack-symptoms-in-women
- https://www.heartsupport.org.au/post/heart-attack-symptoms-in-women https://www.exercise-physiology.com.au/blog/coronary-heart-disease-and-exercise https://www.acefitness.org/education-and-resources/lifestyle/blog/6636/exercising-with-heart-disease/
A former athlete and strength and conditioning coach, Clare applies this experience to her work training and educating pre- and post natal women to help them develop ‘next level’ fitness for parenting. A trainer with IntoYou studio on Sydney’s Northern Beaches, she is also the Australian and NZ Master Trainer for Burrell Education, which delivers a range of women’s health and pregnancy-related courses. You can download Burrell Education’s free Pre-Screening tools for pregnant women here and post natal women here.