Marianne and  Family
​Marianne Watkinson, a past outpatient of Toronto Rehab’s women-only cardiac rehab class, alongside her husband and children. (Photo: Courtesy Marianne Watkinson)

Marianne Watkinson spent years waking up in the middle of the night to a sharp pain in her chest, before extensive tests resulted in a diagnosis of endothelial dysfunction, a condition that causes the larger blood vessels on the heart's surface to narrow instead of opening.

The result is an increased risk of heart attack.

The good news is that endothelial dysfunction can be managed, with regular exercise and the alleviation of stress. The not-so-good news is that it's a prescription which is easier said than done, especially in our over-scheduled, fast-paced world.

But in Toronto Rehab's women-only class, under the Women with Heart program, which is part of UHN's Cardiovascular Prevention and Rehabilitation program,* Marianne learned the strategies she needed to get – and stay – healthier.

"After I started the program, I instantly felt an improvement," says Marianne.

"But it was the level of care and understanding I received from the team that really made me feel like I could learn strategies to help manage this condition."

And Marianne is not alone.

This year is the 15th anniversary of Women with Heart – a program designed to address the gap in cardiac rehab among women, and offer practical and sustainable solutions for improving heart health.

Women's heart health in Canada

Heart disease and stroke are the leading cause of death for women in Canada, but the Canadian Women's Heart Health Alliance says cases of heart disease are largely preventable by modifying lifestyle.

The women-only class provides just that, by offering a structured weekly in-person onsite class, on top of creating an exercise prescription that participants are asked to complete – and log – at home.

Classes include exercise and resistance training for endurance, and education sessions on a range of topics, from stress management and meditation, to how to obtain quality sleep.

Nutrition consultations with a dietitian and mental health support by the psychologist and social worker are also offered through the program.

"The completion of cardiac rehabilitation can reduce morbidity and mortality by up to 50 per cent, improve quality of life, and reduce hospital readmissions by over 30 per cent," says Dr. Tracey Collella, a research scientist at Toronto Rehab and Lead of Women with Heart.

"However, our teams recognize life for our participants will not go back to how it was pre-heart condition.

Toronto Rehab's Dr. Rajni Nijhawan, Medical Lead of the women-only class, says: “As participants navigate their new normalcy through our cardiac rehab, women have reported they feel stronger, can maintain balance in old age, stay independent and mentally more alert with better cognition, sleep and mood."

Dr. Collella says peer support is another component that women find helpful in their journey to recovery. This is built into the virtual and on-site classes, by giving participates opportunities to share and connect about their stories.

"Sharing the lived experience with other women going through recovery from a cardiac event can be inspiring, providing validation and a supportive network for sharing," says Dr. Collella.

Engagement in cardiac rehab up dramatically in the past 15 years

Looking back at the program's track record of success in supporting women, Dr. Collella feels rewarded by the impact the program has made over the past 15 years.

"It is truly amazing how much awareness makes a difference," she says. “Women are used to being the caregivers, and therefore don't often take the chance to care for themselves.

"But we are focused on changing that and furthering the delivery of this quality care."

Dr. Nijhawan says: “When we launched the program in 2009, there was only 10 per cent engagement. Now, we are seeing engagement levels reach 80 per cent."

During the COVID-19 pandemic, the team developed a virtual Women for Heart program, offered through Cardiac College – a virtual site that was developed specifically to help guide patients in developing positive and healthy behaviour to live and thrive with cardiovascular disease.

A recent addition includes Cardiac College for Women, a curriculum targeting women-specific topics, led by Dr. Gabriela Ghisi of UHN's KITE Research Institute and the Women with Heart team.

"This provides patients with the ability to get the resources they need, without having to commute to our centre," says Dr. Nijhawan.

For Marianne, who has a busy life as a high school teacher, access to online programming made all the difference.

“I had online access to such a wide variety of resources that taught me strategies on how to manage my disease," she says. “I now have a personalized workout plan I can continue with at home, while also attending virtual sessions dedicated to general information like medication use."

*We are proud of the cardiovascular care we provide at UHN. From prevention, to acute, to rehabilitation, we offer an integrated continuum of care through the Peter Munk Cardiac Centre and Toronto Rehab. The Cardiovascular Prevention and Rehabilitation Program at UHN is located at Toronto Western Hospital's GoodLife Fitness Cardiovascular Rehabilitation Unit and Toronto Rehab's Rumsey Centre.

Wear Red Canada Day 2024

Teams at UHN are committed to spreading awareness of women's heart health – locally at the hospitals and beyond UHN's walls, with partners such as the Canadian Women's Heart Health Alliance (CWHHA).

CWHHA brings together a national network of experts, women with lived experience, and advocates, working together to share evidence-based strategies to transform how we deliver care.

Just this year, the final chapter of the women's heart health atlas was launched and published in the Canadian Journal of Cardiology. This living document is the first of its kind, that showcases the current state of heart disease in women in Canada.

Each February, during Heart Month, Wear Red Canada takes place. This is a movement dedicated to raising awareness about women's heart health, complete with a calendar of events held across the country. This year, events such as an in-person cooking class, group hikes and educational seminars were just a couple of activities participants could choose from.

More than 85 key structures across Toronto, including the CN Tower, were lit up in red on Feb. 13, to foster this awareness.​

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