Exercise Testing Warns Women of Heart Trouble

Poor performance more than triples death risk

TUESDAY, Sept. 23, 2003 (HealthDayNews) -- A brief exercise test can identify seemingly problem-free women who are at high risk of heart attack and stroke.

While exercise testing is known to help single out men at high risk of cardiovascular diseases, there has been controversy about its value for women.

But a just-published 20-year study by physicians at Johns Hopkins Medical Institutions finds two measures of physical performance can spot potential problems in apparently healthy women.

Those two measures are simple endurance -- how long a woman can keep walking as the speed of a treadmill increases -- and the rate at which the heart returns to normal after the 30 minutes or less of exercise, says a report in the Sept. 24 issue of the Journal of the American Medical Association.

The study included nearly 3,000 women who had no signs of heart disease and were followed for two decades. Those who ranked in the bottom quarter of the test results were 3.5 times more likely to suffer a cardiovascular death than those in the upper half, say Dr. Roger S. Blumenthal and colleagues at the Hopkins Ciccarone Preventive Cardiology Center.

Does the study mean every woman should have an exercise test as part of her physical examination? Blumenthal, who is director of preventive cardiology at Hopkins, stops short of that.

"Our study suggests that an exercise test can provide a good prospective into the cardiovascular risk of women whose capacity is below normal or who have a slow return rate," he says. "This should be a consideration, but it is still up to the individual doctor to determine whether an exercise test should be done."

The message for women, he says, is that "they have to realize that if they have a low level of physical capacity, they can improve their performance and improve their cardiovascular health with regular exercise."

Dr. Nieca Goldberg is chief of women's cardiovascular care at Lenox Hill Hospital in New York City and a spokeswoman for the American Heart Association. She says, "There has been a lot of controversy about the value of exercise testing in women. Not until this week has there been convincing evidence about its value."

"We are always looking for things that tell about heart risk in women. This test is readily available and cost-effective," she says.

The American Heart Association and other health organizations have been trying to get women to pay more attention to the risk of cardiovascular disease, the leading cause of death in American women and men.

Women who should have an exercise test include those with heart disease. But so should symptom-free women "who have multiple risk factors, such as obesity, smoking or diabetes, those who are totally sedentary and are over 50, and those who are thinking of starting an exercise program," Goldberg says.

Poor results on the exercise test should prompt a woman to start a program of regular exercise, under a doctor's supervision. And they should also serve as a warning sign that "it is time to start paying attention to all the risk factors, keeping blood pressure under control, lowering cholesterol and not smoking," Goldberg says.

A brisk half-hour walk every day can be enough to promote heart health for most people, cardiologists say.

More information

The American Heart Association and the National Heart, Lung, and Blood Institute have more on the benefits of exercise.

SOURCES: Roger S. Blumenthal, M.D., F.A.C.C., F.C.C.P., director, preventive cardiology, Johns Hopkins Hospital, Baltimore; Nieca Goldberg, M.D., chief, women's cardiovascular care, Lenox Hill Hospital, New York City; Sept. 24, 2003, Journal of the American Medical Association
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