Exercise and heart health: are there any risks?

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Following on from the feature published in the April issue of Retail Pharmacy Assistants e-magazine, in which we explored the topic of exercising and heart attack risk, we recently spoke with Tim Douge, Accredited Exercise Physiologist from Studio 99 Fitness Centre in Brisbane to gain further insights and to learn how to incorporate exercise safely into regular routine.

It’s well known that regular exercise helps improve a person’s cardiovascular profile; however, some studies have shown that there may be a risk when it comes to strenuous/extreme, prolonged exercise. What are the impacts of extreme exertion on heart health and cardiovascular risk? 

It’s important initially to understand what these studies mean when they say extreme, prolonged exercise.

Researchers describe a typical extreme exerciser as a marathon runner but also include people who do ultra-distance events, competing for up to 24hrs continuously.

Like most forms of stress on the body, when applied in the right amount, extreme exercise can be hugely beneficial and improve health and disease risk.

The detrimental effects of extreme exercise are due to elevated levels of chemicals in the blood, which are harmful to the heart for hours or days after an event.

The body will normally recover back to normal after such events – however, if these levels of exercise are repeated with a short duration in between, the sustained level of these chemicals is more likely to cause physical changes to the heart and increase the risk of heart problems in the future.

A thickening of the heart muscle is a common outcome in these cases, which is known to increase the risk of a heart attack. Sufferers may also experience arrhythmias or irregular heartbeats following chronic heart stress. 

Who is at the greatest risk of suffering a cardiac event during prolonged or strenuous exercise? 

People with pre-existing conditions are most at risk from acute cardiac events with extreme exercise. For them, the benefits of moderate exercise are far more valuable.

Men also seem to have a higher incidence of cardiovascular events, this is because oestrogen has a protective effect on the heart muscle. 

What are the early warning signs that someone is experiencing cardiac issues due to strenuous activity? 

Warning signs of cardiac issues can be shortness of breath, chest tightness or pain, dizziness, nausea, and discomfort in other limbs.

It’s important to note that these can be quite common feelings during intense, extreme exercise even when someone is not having a cardiac episode.

This is why it’s important for people to understand their underlying heart health before considering any extreme events. 

Is an acute cardiac episode something that can be prevented? 

If you have a family history of heart disease it’s important to get checkups with your GP to detect any early problems.

Regular, moderate exercise can be protective against cardiac events however it would be best to consult with an Accredited Exercise Physiologist about what type of exercise is best for you.

Warning signs of a heart condition can be similar at rest as when a person is exercising.

Things like shortness of breath, dizziness, chest tightness or pain, jaw pain, and even swelling in the lower legs can indicate underlying heart issues.

When in doubt, get checked out. 

How can awareness be increased around cardiac risk with strenuous exercise? What needs to be done in terms of education to help people recognise signs early and seek medical attention? 

Simple screening tools can be very valuable in making people aware of their family history or even any symptoms they may already be experiencing but were unaware of what they could indicate.

Pharmacies can be an easy access point for people to check their blood pressure, which can have no other symptoms.

People are often motivated to start exercising – their chosen fitness professional can also be a good first point of education. This is why we recommend exercise physiologists as the first option for people starting exercise.

How can people participate in more extreme or strenuous sports safely? What are the health checks that need to be considered prior to participating in these sports? 

It’s important for people to have a good understanding of their current health status before undertaking these events.

If they are considered otherwise healthy, an appropriate training program is important to manage risk.

Being unprepared for an extreme event would be inherently riskier than conditioning your body over an appropriate time frame before participating. 

Participants should undertake a general health check with their GP, however, cardiac stress tests can provide more insight into how the body may respond during the event.

These can be arranged through referral to a cardiologist if a person has risk factors or a family history of heart disease. 

In terms of risk, do the benefits of regular exercise still outweigh the risks? What is the optimal/safest level of exercise for long-term heart health? 

Absolutely. Exercise is one of the most effective medicines for heart health and preventing heart disease.

The optimal dose for each person can vary however a general rule for otherwise healthy people is 30-60mins of moderate to vigorous activity on most days of the week.

To understand more about what “moderate” and “vigorous” mean relative to a person’s own fitness, it’s best to get an assessment from an Accredited Exercise Physiologist. 

What other lifestyle factors should people be mindful of in order to keep their hearts healthy?  

People who are going to participate in extreme events should avoid other behaviours that will place undue stress on the heart and adopt other “heart safe” options.

Things like smoking, alcohol, poor sleep, and chronic psychological stress can be harmful.

Conversely, a balanced diet, good recovery practice and good hydration can all have protective effects on heart health. 

When providing advice to their customers, what should pharmacy assistants know in terms of cardiac risk and exercise? When should they recommend referral to a cardiac specialist and/or exercise physiologist? 

For the vast majority of the population, general exercise is going to be perfectly fine.

Ensure customers are aware of their family history and current personal heart health.

Customers who are considering taking up exercise for the first time should be recommended to an exercise physiologist.

They may also give customers the Adult Pre-Exercise Screening Questionnaire, which will direct the patient on when to see their GP.