Can exercise cause trouble for my heart?

Everyone thinks exercise is good for you. It certainly is! Being fit does reduce the chance of health problems including heart attacks strokes and diabetes.

But it becomes more complex if you have heart problems. People who have had heart attacks are offered cardiac rehab to put them through a graded exercise program to get them back into safe levels of exercise.

Some people have inherited problems such as hypertrophic cardiomyopathy which can increase the risk of heart rhythm problems with exercise.

Very rarely, these can result in cardiac arrest with dramatic examples such as Fabrice Muamba collapsing on the football pitch during a premier league match.

To combat this professional athletes undergo screening for cardiac disorders.

Last month Professor Sanjay Sharma published the results of his experience screening adolescent footballers. This study was funded by the English football association and its great to see them taking this issue seriously and perhaps more so than the US national (American) football league and their ongoing problems with chronic brain injuries.

I have worked with Prof Sharma previously on similar screening events of England cricketers and Manchester City football club, so I know how much work is involved as well as the worry it brings when something abnormal is found.

But this study has covered many more people to give us much better data. They looked at 11,148 players with an average age of 16 over a 20 year period. 95% of these were male. 42 players were found to have a cardiac disorder with a risk of sudden cardiac death. A further 225 had other cardiac problems that were picked up.

The players were all youth players at English professional football clubs. The 42 players who were found to have cardiac disorders associated with sudden cardiac death were advised not to compete.

After follow up (obviously of varying durations – 20 years for those screened at the beginning, down to 2 years for those at the end), 23 people had died, 8 of which from Cardiac causes.

Clearly the risk of cardiac problems is small but not zero in these players, with 0.38% if screened players having a Cardiac disorder associated with sudden cardiac death, and 2% having some form of cardiac problem.

We don’t know how effective screening is at preventing problems – this study doesn’t address that as there is no control group, but it does tell us that screening is not perfect at preventing sudden Cardiac death and some problems are not detected at the point of screening.

Nevertheless the absolute risk is small.

The big gap now in my mind is the risk in veteran athletes – the MAMIL’s or middle aged man in Lycra – or people like me!

There is a growing trend for fitness and certainly there are far more middle aged people cycling / doing triathlons / marathons and so on.

Every year there seems to be a death in the ride London event. There’s no data to show that screening in this population picks up treatable conditions but I would certainly want to think about it before I took on a big race or competition.


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