Did you know heart disease is the #1 killer of women, claiming more lives than all forms of cancer combined? High blood pressure accounts for one in five deaths among women in the U.S. and is a major risk factor for cardiovascular disease. While these statistics might surprise you, February as American Heart Health month serves as a crucial reminder: taking charge of your heart health is essential.  

Women of all ages should be aware of heart health risks, especially women with diabetes or obesity and those who smoke. High blood pressure occurs in one in 12 pregnancies in women 20-44 years old, putting both mother and baby at risk. Women in menopause and perimenopause, which can start as early as 35 years old, can start to experience lipid profile changes (high triglycerides and low HDL), accumulating visceral and paracardial fat, and high blood pressure. All of which puts them at increased risk for cardiovascular disease and metabolic syndrome for up to 40% of their lives.  

It’s important to know that while women also experience chest pain as a heart attack symptom, it may not be constant or as severe as in men. Women often describe their symptoms as pressure or tightness and they are more likely to report symptoms unrelated to chest pain, such as:  

• Neck, jaw, shoulder, upper back or upper abdomen discomfort 
• Shortness of breath 
• Pain in one or both arms 
• Nausea or vomiting 
• Sweating 
• Lightheadedness or dizziness 
• Unusual fatigue 
• Heartburn 

Given these symptoms and the range of potential causes, it’s extremely important for women to be strong advocates for proper testing and treatment when seeking medical care. Women are less likely than men to be treated with aspirin and statins, to have coronary bypass surgery, or to be referred for cardiac rehabilitation, all of which show benefits in both men and women. Don’t be afraid to be your own advocate. Remember, the squeaky wheel gets the grease.  

• Gather information: Learn about your family history, risk factors and symptoms. 
• Ask questions: Don’t hesitate to ask your doctor about any concerns you have, no matter how small they seem.  
• Seek second opinions: If you feel unheard or unsatisfied with your diagnosis or treatment plan, consider seeking another doctor’s perspective. 

Knowledge is power! By understanding your risks and taking proactive steps, you can significantly reduce your chances of developing heart disease. Empower yourself and the women in your life with the curated blogs and resources offered below to create a plan for a healthier heart and a healthier you.  

Resources 

Knowledge is Power: Wearable Heart Health Monitoring 

Healthy Hearts Power Fit Cities 

Blood Pressure Infographic 

ACSM Heart Health | Trending Topic 

Women and Heart Disease | ACSM Handout 

U.S. Surgeon General’s Call to Action to Control Hypertension 

Live to the Beat” Campaign Toolkit (focused on reducing risk in Black adults) | Million Hearts (CDC & CMS initiative) 

High Blood Pressure During Pregnancy | CDC 

Menopause Transition and Cardiovascular Disease Risk: Implications for Timing of Early Prevention: A Scientific Statement From the American Heart Association 

Heart Attack Symptoms in Women | American Heart Association

Originally published on February 19, 2024

Only 20  minutes after your last cigarette, your heart rate and blood pressure begin to drop. Within a few  days, the carbon monoxide level in your blood drops to a normal rate. After a few weeks your circulation and lung function improve, and after a year your risk of heart attack drops significantly. These are only some of the drastic changes your body undergoes when you quit smoking, as identified by the American Cancer Society.

Despite the benefits of a smoke-free lifestyle, an average of 12.6% of residents in America’s 100 largest cities are smokers. San Jose, California has the lowest rate with only 3.4% of residents who smoke, but Laredo, Texas has the highest rate with 24.8% of residents smoking. View the rate for your city. Across the 100 largest U.S. cities, more than 8.1 million people are at a heightened risk of certain cancers and coronary heart disease because of this habit.

The Great American Smokeout, presented by the American Cancer Society, is Thursday, November 16, 2023. On this date, Americans are encouraged to make a plan to quit smoking. We have gathered a number of resources here to help you or others in your life make a plan to quit smoking.

Help Someone Else Quit Smoking

Help Employees Stop Smoking | American Lung Association

Smoking-Cessation: Role of the Fitness Professional in Clearing the Air | ACSM’s Health & Fitness Journal®

Helping a Smoker Quit: Do’s and Don’ts | American Cancer Society 

Support  To Quit Smoking

Sign up for support via text message by texting QUIT to 47848 | NIH – National Cancer Institute

Download the quitSTART app | CDC

Call the State Quitline | 800-QUIT-NOW (800-784-8669, English) 855-DÉJELO-YA (855-335-3569, Español)

Call the National Quitline | 877-44U-QUIT (877-448-7848) (support in both English and Spanish)

Smoking Cessation Resources for Veterans  | NIH – National Cancer Institute

Freedom From Smoking, Smoking cessation support for public housing | American Lung Association and Anthem Foundation 

Smokefree.gov  | Resources from the  NIH – National Cancer Institute specifically supporting women, teens and seniors.

SmokefreeEspañol   | Recursos en español de NIH –   Transformación de Descubrimientos de la Salud®

Deciding to Quit Smoking and Making a Plan | American Cancer Society 

Other Ways to Quit Smoking | American Cancer Society

Getting Help with the Mental Part of Tobacco Addiction | American Cancer Society

You Can Quit Smoking: Here’s How | CDC

Originally published on November 8, 2023

It has been well-established that physical activity and/or exercise can help to reduce the risk of chronic diseases such as obesity, diabetes, cancer and cardiovascular disease.  

To reap these benefits, we only need to accumulate 150 minutes per week of physical activity1. That means that you can be physically active for as little as 10 minutes at a time to accumulate 30 minutes in a day for five days, or be active for about 20 minutes per day for seven days. Even though accumulating physical activity in small increments is just as good for our health as being physically active in one longer bout, many people still find it difficult to incorporate physical activity and/or exercise into their lives.  

Despite public health efforts to encourage more physical activity among the population, the Centers for Disease Control and Prevention (CDC) state that only about 28% of individuals exercise on a regular basis1. However, if the environment was such that it allowed individuals to be more physically active more naturally, perhaps more individuals would meet physical activity recommendations.

Research on the affects of built environment 

The built environment has been shown to have an effect on physical activity. For example, cities that have bike lanes, accessible parks, sidewalks and walking trails typically have higher levels of physical activity among their citizens. Conversely, cities that lack these features, tend to have lower physical activity levels among their residents. Other variables also come into play, including resources to make changes to the built environment, safety, lighting and the weather.  

Some researchers wanted to identify which changes to the built environment increase physical activity in residents at the local level, taking into account cost and socioeconomic status. It was found that enhancements to the infrastructure of a city tended to benefit those of lower socioeconomic status. It appears that improvements in walkability, enhancing parks and playgrounds, and having sufficient active transport within a city will increase physical activity in both children and adults2,3. This is encouraging, because increasing physical activity among all ages is important for the health of our population. 

Although increasing physical activity, and subsequently improving overall health among all ages is important, some researchers have studied whether changes in the built environment specifically increased physical activity levels in older adults (greater than 65 years of age). They found that the factors that led to increased physical activity in older adults included: walkability, how well streets connect, mixed land use, access to facilities, services available, street lighting, having more accessible green space and crime- and traffic-related safety4. It is important that cities take into account all of these variables when they are making decisions about improving infrastructure. The health of their citizens needs to be at the forefront in their decision making. In doing so, not only will this decrease healthcare costs, but it will attract more people to want to visit or reside in that city, helping the economy.  

Even if cities have good built environment infrastructure, it may not lead to increases in physical activity for all. For example, in neighborhoods of low-income it has been reported that when women went to parks, it was largely for the purpose of taking their children to play, whereas men typically went to parks for their own physical activity. Furthermore, it was found that older adults did not get to parks as much as they would like because many of the facilities for them were inadequate5.  

Adding green (grass) and blue (water) spaces can also lead to greater physical activity. Some researchers found that putting grass on hard spaces in school yards led to increased physical activity and improved social well-being among children in elementary school6. 

The built environment is extremely vital for both physical activity and social interactions, leading to improved physical and mental health. When making decisions for city infrastructure renovations, policy makers should empower their citizens to help make informed decisions based on age, sex and socioeconomic status. Even if parks have meeting places where people may only go to sit and talk with their friends or play chess, this can still result in more physical activity than if people were to remain at home. If citizens are empowered to help make decisions for their cities and towns, they are more likely to use the facilities, leading to healthier lives. 

Author:  Stella L. Volpe, Ph.D., RDN, ACSM-CEP, FACSM 

Chair, American Fitness Index 

President-elect, American College of Sports Medicine

Originally published on October 30, 2023

References 

1. Centers for Disease Control and Prevention. https://www.cdc.gov/physicalactivity/basics/adults/index.htm 
2. Smith M, Hosking J, Woodward A, et al. Systematic literature review of built environment effects on physical activity and active transport – an update and new findings on health equity. Int J Behav Nutr Phys Act. 2017;14(1):158.doi: 10.1186/s12966-017-0613-9. 
3. Laddu D, Paluch AE, LaMonte MJ. The role of the built environment in promoting movement and physical activity across the lifespan: Implications for public health. Prog Cardiovasc Dis. 2021:64:33-40. doi: 10.1016/j.pcad.2020.12.009. 
4. Bonaccorsi G, Manzi F, Del Riccio M, et al. Impact of the built environment and the neighborhood in promoting the physical activity and the healthy aging in older people: An umbrella review. Int J Environ Res Public Health. 2020;17(17):6127. doi: 10.3390/ijerph17176127. 
5. Cohen DA, Han B, Park S, et al. Park use and park-based physical activity in low-income neighborhoods. J Aging Phys Act. 2019;27(3):334-342. doi: 10.1123/japa.2018-0032.  
6. Raney MA, Hendry CF, Yee SA. Physical activity and social behaviors of urban children in green playgrounds. Am J Prev Med. 2019;56(4):522-529. doi: 10.1016/j.amepre.2018.11.004.  

I love my local public green spaces. I have two (a town park and a nearby school) within easy walking/biking distance from home. We see friends and acquaintances regularly when at the playground, swimming in the river or attending community events like concerts, fairs or athletic competitions. It is wonderful to connect with your neighbors and really feel part of the community. Public green space is lovely in my rural town, but they are a necessity in urban settings. Urban green spaces have been shown to support healthy behaviors including increased physical activity and social engagement. 

Urban green spaces are public land with vegetation, parks, forests or water features, located within an urban setting. They are typically open spaces to support people gathering for social, leisure and recreational activities, and are critical components in fostering social cohesion and a sense of belonging. Social cohesion refers to the interpersonal dynamics and sense of connection among humans, and higher levels are associated with physical and psychological benefits. Maslow’s Hierarchy of Needs starts with physiological needs (food, water and rest) and safety/security, then the next important need is that of love and belonging. Humans have a need for affiliation; to be part of a team or tribe. From an evolutionary perspective, social bonds have helped humans to survive and thrive. Urban green spaces provide a place for people to gather to build these social connections.  

A “green third place”

To further emphasize this concept, consider that there are several places in our lives where we can connect with others and build relationships. Urban green spaces are ideal “third places”; Ray Oldenburg’s concept of social surroundings for your community life versus your first place (home; personal life) or second place (work life)1. It should be a comfortable, welcoming, and accessible space for social interaction that fosters a sense of belonging. Like Cheers pub in Boston, “Where everybody knows your name.” 

In a third place you are free of obligations, all are of equal social status, newcomers are welcomed, connection is the focus with playful conversation and socializing, and it is a homey, inviting space that is conveniently located. Connections can be through shared leisure interests, activities or hobbies, shared neighborhoods or shared cultures. Third places can be a commercial space like a café, pub, bookstore, barber shops, quilt store; religious places; libraries; shared leisure facilities like gyms or bowling alleys; or outdoor recreation/gathering places such as parks and green spaces (my personal favorite).  

One of the characteristics of a third place is accessibility—ideally being within walking distance of home. One of the key metrics of ACSM’s American Fitness Index rankings is percentage of a population within 10-minute walk to a park. My two closest cities, Boston and New York, tied for highest score (99%) with Arlington, San Francisco and St. Paul. Additionally, that walk should be safe, so the Fitness Index also assesses pedestrian fatalities, Complete Streets policies and bike/walk scores.  Other related community/environment Fitness Index indicators include parks per 10,000 residents, recreation facilities (ball diamonds, basketball hoops, playgrounds, recreational centers, swimming pools and tennis courts), and park expenditure per resident. Perceived pedestrian and leisure facilities (including park density) are key aspects of sense of community belonging2. Having green spaces nearby contributes to the health of the individual and the community while enhancing social cohesion.

See how your city ranks on the above indicators by using our rankings comparison tool. 

Supporting all aspects of health

Neighborhood/built environment and social/community context are key social determinants of health. Simply having more green spaces nearby can help address some of the disparities in health outcomes that especially affect marginalized communities. Access to urban parks has been shown to decrease the negative effects of inadequate housing and emotional stress as well as increase social cohesion for immigrant families3. There are also climate related benefits with more trees improving air quality and decreasing the temperature of urban areas.  

Urban green spaces are multifunctional and multigenerational, supporting a variety of communal activities. I especially like the physical activity opportunities from athletic courts and fields, playgrounds, skateparks/plazas and water features. Skate parks provide recreational space for various wheels including skateboards,  rollerblades, BMX bikes and scooters, and are an alternative to organized sports where kids coach one another. When there is greater social cohesion in a community parents can feel more comfortable allowing kids more freedom knowing that their neighbors will look out for them. Having places for kids to safely gather can contribute to their sense of belonging and decrease feelings of loneliness. Third places are vital for nurturing healthy relationships where you can let your guard down and can feel part of something bigger than yourself.  

Urban parks provide open spaces for communal gatherings, parties, concerts and games like Mah-Jongg or Ultimate Frisbee. Opportunities for synchronous movement like dancing, yoga, Tai Chi or group training can enhance social cohesion by activating the mirror neural network releasing dopamine, creating feelings of pleasure and bonding. Urban green spaces can also provide commercial space for farmers markets or flea markets and agricultural space for urban or community gardens. This can increase the percentage of residents consuming more fruits and vegetables per day (other Fitness Index indicators!). Exposure to nature and green spaces directly contributes to improved physical and psychological health as also discussed in our previous blogs (here, here and here). 

So, find your local “green third place” to really connect to your community and start living your best life. 

Author: Melissa W. Roti, PhD, FACSM

Professor, Director Exercise Science Program

Westfield State University, Westfield, MA

On Twitter: @MelissaRoti 

Originally published on August 31, 2023

References

 1. Oldenburg, Ray (1989). The Great Good Place: Cafes, Coffee Shops, Community Centers, Beauty Parlors, General Stores, Bars, Hangouts, and How They Get You Through the Day. New York: Paragon House. ISBN 978-1-55778-110-9.

2.  Du, Y, Jiang H, Huang Z, & Yang H. (2023) Associations between neighborhood environment and sense of community belonging in urban China: Examining mediating effects of neighborly interactions and community satisfaction. Front Public Health vol 10: 1105473.

3. Hordyk, SR, J Hanley, & E Richard. (2015) “Nature is there; its free”: Urban greenspace and the social determinants of health of immigrant families. Health Place Vol 34:74-82.