Women less likely to go to rehab without support

Cardiac rehab a low priority for many

Women are busy working, washing, cooking, and cleaning. They take care of everyone around them before they take care of themselves. They have strong needs for social support. And they frequently have no idea they are at risk for heart disease.

Add all those components together, and you have the perfect recipe for a population that is not always well-served in cardiac rehab programs. "Women with heart disease often return to a home where the demands upon them do not change," says Charles Emery, PhD, associate professor of psychology at The Ohio State University in Columbus. "It’s very different from what men experience with that same diagnosis. That sounds stereotypical, but it’s often true that people at home become more supportive when a man has a heart attack. For women, there is often a lack of recognition on the part of the people around them."

Emery recently presented the results of a study on gender differences in quality of life among cardiac patients to a meeting of the Washington, DC-based American Psychological Association. The study of 536 Ohio State University Medical Center patients with a variety of heart problems found that heart disease takes a greater toll on quality of life in women than it does in men. Women reported poorer physical and psychological functioning than did men immediately after hospital treatment and for a year following.

"For women, lower quality of life was associated with feeling they didn’t have enough support from friends and family, but levels of social support did not influence psychological functioning among men," Emery says. "In cardiac rehab, the way we treat women is the same way we treat men. We don’t recognize that they have different needs."

Ongoing support needed

Emery and his colleagues provide monthly stress management classes for cardiac rehab patients, and they encourage rehab staff to refer patients to them for counseling when needed. Patients are given questionnaires to fill out, and if they report any type of emotional distress, they are referred to the psychology staff. But more could be done at Ohio State and in rehab programs across the country, he says.

"There is no ongoing degree of social support built into the rehab system," Emery says. "Certainly in other patient populations, such as women with breast cancer, we have seen the benefits of group therapy. But it typically hasn’t been done in women with heart disease. In standard cardiology practice there hasn’t been a focus on longer-term care and rehabilitation. We need to pay more attention to that aspect of treatment."

The best and most cost-effective way to address women’s psychosocial needs in rehab is to develop support groups, Emery says. They don’t have to be formal, and they don’t have to be led by rehab staff. Patient-led groups can create both a sense of belonging and a sense of responsibility to the program. The need also could be addressed through an informal buddy system in which a long-time patient mentors a new one.

"The staff is overworked most of the time. We have to find a way to get patients to help each other and let the staff serve as a resource," Emery says. "The patients who stick with rehab are the ones who connect with other patients and staff and who feel a sense of belonging."

Family needs often come first

Part of encouraging that sense of belonging may lie in staff recognition of the difficulties women face, says Amy Eyler, PhD, assistant professor of community health at St. Louis University School of Public Health. Eyler is editor of a book, Environmental Policy and Cultural Factors Related to Physical Activity in a Diverse Sample of Women (Haworth Press, 2002), that explores why women exercise less than men. The book consists of seven research studies funded by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation as part of the Women’s Cardiovascular Health Network.

"Women were so adamant about their social roles," Eyler says. "They said they just don’t have time to exercise. We heard it loud and clear: They said, We’re too busy and it’s not a priority.’ They feel guilty about taking time away from their duties."

While women across cultures mentioned feeling guilty about exercising and lacking social support for the activity, there were differing explanations for lack of physical activity among some groups:

  • African American women said they feel it is more culturally acceptable for them to be heavier than Caucasian women.
  • American Indian women said their communities often frowned upon women who did "purposeful exercise" rather than chores.
  • Latina immigrants mentioned not speaking English and a lack of confidence as barriers.

Eyler suggests that cardiac rehab programs emphasize the idea that women who take care of their health will be able to take better care of their families. She recommends being aware of the lack of confidence older women who have never exercised may feel. "My mother is 72 and went through cardiac rehab, and just the idea of putting shorts on was really hard for her," Eyler says.

Need More Information?
  • Charles Emery, PhD, Associate Professor of Psychology, The Ohio State University, 1885 Neil Ave., Columbus, OH 43210. Telephone: (614) 688-3061. E-mail: Emery.33@osu.edu.
  • Amy Eyler, PhD, St. Louis University School of Public Health, 3545 Lafayette Ave., St. Louis, MO 63104. E-mail: eyleras@accessus.net.