Hearts: Healthy Concerns

Heart disease kills more Australians each year than any other disease- and athletes aren’t immune. The recent heart related death of Frenchman Laurent Vidal (aged 31), who finished fifth in the London Olympics before suffering a cardiopulmonary arrest in 2014, brings this fact into sharp focus. February is home to a campaign to raise awareness and financial support for heart research in Australia. So what good are we doing by exercising? And should we be doing more or less?

One of the most memorable Simpsons episodes (for me, being a medico), that contains so many truisms about cardiac health and communicating with patients in general is contained in the following scene. Dr Julius Hibbert is trying to consent Homer for an operation in his medical rooms.

Dr Hibbert: “Homer, I’m afraid you’re going to have to undergo a cornonary bypass operation.”

Homer: “Say it in English Doc!”

Dr Hibbert: “You need open heart surgery.”

Homer: “Spare me your medical mumbo-jumbo…”

Dr Hibbert (exasperated): “We’re going to cut you open and tinker with your ticker.”

Homer: “Could you dumb it down a shade?”

Homer’s response is typical of a patient being given bad news. The internal monologue is going wild and it’s hard for rational thoughts to take control. He’s undoubtably thinking (hilariously) “Why me?” In Homer’s case, he has many unmodified risk factors: terrible diet (“I’d be a vegetarian if bacon grew on trees); high alcohol intake (Duff); and little to no exercise  (Can’t somebody else Just Do IT?). Most of us can’t relate to these issues…but we should. At the very least, getting a good plain language explanation of your risks is worth a visit to your sports doctor or GP.

Many athletes can wind up with heart problems, even if they exercise and train regularly for triathlon. Cholesterol, blood pressure and genes are all a part of  heart health. And if we exercise too much, that can lead to tricky tickers too. Knowing your own limits is important, in the context of both health and disease. For instance, having familial hypertension requires regular checks and may medication or a reduction in exercise intensity to ensure your heart isn’t overloaded.

My Ticker

After doing thirty Ironman and countless halves, I started to worry a bit. I had participated in Andre La Gerche’s “Ironhearts” trial, but relatively normalcy hadn’t put my mind at rest. I had an athlete’s heart (as expected), which had grown in size and wall thickness after years of heavy endurance loads. I worked out that I had spent a full year worth of weekends (over a period of twelve years) riding (200km+) and running (2hr+) long. My main worry had become, “How much exercise and intensity should I superimpose on top of my stressful/busy work life?” especially in the context of hitting forty years old!

Physiological vs Pathological

So the question is, what is a normal physiological response to endurance exercise and what is pathology? The response of an athlete’s heart is to build up the pump, both in way of increased chamber size and wall thickness of the heart muscle. This means more blood can be pumped with less beats during exercise. At some point however, this tips over to problems. Atrial fibrillation (AF) is one such example, with endurance athletes facing a 5.3 fold greater life time risk.

A lot of research is being conducted in the stress of exercise on the right heart, rather than focusing on the main side of the pump, the left ventricle. Mechanisms to explain this link (endurance training and AF) are proposed from genetic all the way through to training load, but have not undergone rigorous long-term investigation.

Too much of a good thing?

Dr La Gerche is kicking goals for athletes world wide, becoming an internationally renowned sports cardiologist- he has recently taken up as an Associate Professor and Head of Sports Cardiology at the Baker IDI. The Baker IDI is the preeminent Heart and Diabetes research centre in Australia. His work has included triathlon as a focus fro many years, which relates directly to his sporting participation. He finished 3rd place (18-24) in his first and only participation in Kona, and has run under 2:30 for a flat marathon.

His advice or moreover current interpretation of the data is that ”endurance exercise most likely increases your chance of living longer but may increase your risk of some arrythmias (La Gerche and Heidbuchel 2014).” This great paper (which is free online) goes through a number of cases and makes the case for continuing to exercise, not stopping for fear of a cardicac problem. “Exercise, including intense endurance exercise, offers a plethora of population health benefits that likely exceed any excess risk of arrhythmia.”

What can you do?

For starters, be sensible. If you’re tired, then rest. Half sessions will help you maintain fitness, rather than lose it. Consider reducing the volume and intensity of your sessions to allow your body to recover. The heart is like any muscle- it can remodel and strengthen with work, but it needs a chance to do this with rest. And keep in mind that it’s always relative rest for the heart- it’s active every minute for the whole of your life!

Check out yourself.

Will Walker (exe elite cyclist who suffered career limiting arrhythmia) and Matt Keenan (@mwkeenan, elite commentator) are both heavily involved with promoting cycling and heart health through the Baker IDI- a very worthy cause. The Baker run a free heart health check which comprises: a lifestyle and medical questionnaire; body height/weight/blood pressure check; and a cholesterol and resting blood sugar measurement. You can google them, or punch in the reference provided.

Additional resources are available from Heart Research Australia, which funds first-stage research into prevention, diagnosis and treatment of heart disease. Additionally the Australian Heart Foundation run terrific campaigns like: Jump rope for heart (300 000 participants) and Livelighter (achieve and maintain a healthy weight).  They also have an informative and interesting site.


Top Ticker Training Tips:
1. Exercise is good for you (to a point)- so don’t avoid it!
2. Never train when you have a virus (at least 3 days rest).
3. Take one complete rest day per week
4. Commuting is a great daily exercise
5. Half sessions (halve intensity/volume if you’re tired)

Top Ticker Lifestyle Tips:
1. Urgent attention if you have any chest pain or palpitations
2. Unmodified cardiovascular risks are dangerous
3. Shoot to eat good fats, low simple sugar, high fibre diet
4. Regular (annual) GP check ups (BP/lipids/HR/weight), esp. over 40.
5. Ingest lifestyle drugs in safe amounts (caffeine, alcohol)

More information and references




Can intensive exercise harm the heart? You can get too much of a good thing. La Gerche A1, Heidbuchel H2. Circulation. 2014 Sep 16;130(12):992-1002.