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Spring 2004, Volume 46, Number 1

To Her Health

By Marissa Emerson, Photography by Jason Marsh

Researchers at USF are making important inroads on issues that impact the health of women. From cardiac rehabilitation and hormone replacement therapy to premature birth studies and community initiatives, USF is committed to women’s health.

It was the first week of December. Joyce Ulm was expecting guests for a large company party the coming weekend and had holiday errands to run. What she wasn’t expecting, after having an artery cleaned out only months prior, was pressure in her chest and shortness of breath while walking on a treadmill. The pressure and shortness of breath are Ulm’s tell-tale signs of a heart incident or cardiac event—not a heart attack, a precursor to a heart attack, but just as scary.

Thankfully, Ulm is enrolled in a USF cardiac rehabilitation study by College of Nursing researcher Theresa Beckie, who insisted that Ulm be taken immediately to the cardiac catheterization lab to be examined by her physician. This time the signs suggested a narrowing at the entrance of one of the stented arteries in Ulm's heart which led to the placement of a new stent within the older, increasingly blocked stent.

Cardiac rehabilitation is the standard of care for all patients—men or women—after a heart attack, coronary revascularization, percutaneous coronary intervention or stable angina. Phase I cardiac rehabilitation begins while people are still in the hospital after a cardiac event. This usually includes education about risk factors, nutrition and lifestyle changes, physical therapy to gradually increase physical activity and ways to cope with the emotional and physical aspects of a cardiac event.

Phase II cardiac rehabilitation is typically a three-month, 36-session co-ed outpatient program involving education and exercise.

"Cardiac rehab is essential to recovering from a cardiac event and can prevent a second one," says Beckie. “This is especially important for women because they are twice as likely as men to die from a second event—usually within the first several months."

Beckie is the first in the U.S. to study cardiac rehabilitation specifically for women. She compares the physical and psychosocial effects of a traditional cardiac rehabilitation to a gender-sensitive, individualized cardiac rehabilitation program specifically and exclusively for women.

"Cardiac rehab traditionally was designed as an exercise program for low-risk, middle-aged men, but women are motivated differently and have different psychosocial issues than men do,” Beckie says. “The ultimate goal of this study is to improve access to and attendance in cardiac rehab for women who have had a cardiovascular event to improve their health, reduce their depression and improve their chances of survival.”

Beckie’s interest in cardiology began 18 years ago when she wrote her thesis on cardiac education and counseling. As her knowledge and expertise grew, so did her awareness of the unique needs of women with heart disease and their unique difficulties with adopting healthy behaviors as they recover.

"Traditionally, even if women do begin rehab, they don’t stay with it—they drop out after a few weeks because of family or financial obligations that they place a higher priority on than their own health,” Beckie says. “Women need gender specific classes and counseling for healthy behavior change in cardiac rehabilitation. We need to challenge the assumptions about women with cardiovascular disease and help women reduce risk factors that threaten their health.”

In 2002, the National Institute of Nursing Research at the National Institutes of Health awarded Beckie a $1.5 million grant to compare the physiological and psychosocial outcomes of women who completed cardiac rehabilitation in a traditional program versus a women-specific, individualized behavioral-change-focused program, which Beckie helped develop.

Beckie and her team will enroll and study 400 women over five years at St. Joseph’s Hospital cardiopulmonary rehabilitation center.

Since 60 percent of women’s risk factors are behaviorally-based, each woman in the study is assessed individually to determine her stage of motivational readiness to change her behavior. Cultural and social roles of women, access to transportation, availability of funds or insurance and probability of depression are some of the barriers to care that Beckie and her team consider.

Once the team and the woman determine specific goals for behavior change, they meet in groups of six to eight, three times a week for 12 weeks. The program involves 36 electrocardiogram-monitored exercise sessions and 10 education and counseling sessions. During exercise, each participant’s weight, blood pressure and pre- and post-exercise heart rate is recorded.

Ulm tried traditional cardiac rehab in 1993 when she had angioplasty in the artery in which she recently had a new medicated stent placed. She found the program helpful, but didn’t stick with it.

"In the traditional program the men weren’t very friendly, which didn’t bother me too much, but I feel more comfortable with this group being only women,” Ulm says. “We have bonds, and I feel more at ease than I did in the other program.”

In her preliminary study, Beckie observed that after six months of ending traditional cardiac rehab, women had dropped the healthy behaviors encouraged by rehab. As part of the NIH-funded study, Beckie will meet with her participants monthly for six months after rehab to monitor progress and encourage them to continue a healthy lifestyle.

"If I make a difference in one woman’s life, I’ve accomplished my goal,” Beckie says.

In the few months of open recruitment for this study, Beckie has accomplished her goal. In addition to catching a potential cardiac event in Ulm, Beckie insisted another patient see her physician immediately after having chest pains. While this woman did not require an intervention, the seriousness of her illness became apparent to her for the first time, and she began to give her health greater priority.

Like these patients, for many women, participation in this study has made the difference between choosing a healthy path and giving in to the number one killer of women.

"I don’t like to exercise, but I plan to continue exercising and eating right when I’m done with the study,” Ulm says. “Now I keep in mind that this will make all the difference, and I wouldn’t be in the trouble I’ve been in with my heart if I had been exercising all along. If I want to continue to do what I want to do, then I’ve got to take care of myself.”

More of This Feature Story:

>> Better Chances - black pregnant women
>> The Great HRT Debate - hormone replacement
>> Go Red For Women - cardiovascular disease awareness campaign