#69 - Should middle-aged men pull on lycra? With Dr Andre La Gerche
Oct 22, 2023
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Dr Andre La Gerche, world-leading Sports Cardiologist, discusses the impact of exercise on heart health. Topics include abnormal right ventricle function, increased coronary artery calcium levels, atrial fibrillation in endurance athletes, and the benefits of exercise in preventing heart failure. The conversation touches on genetics, misinformation in the exercise field, and the positive impacts of exercise on longevity and quality of life.
Regular exercise, despite potential risks, has numerous benefits for heart health and overall longevity.
Maintaining a healthy lifestyle, including good cholesterol levels and blood pressure, can help mitigate the potential risks associated with increased coronary artery calcium levels.
Atrial fibrillation (AF) is more common in endurance athletes but does not pose a life-threatening risk, and regular exercise is still recommended for its overall health benefits.
Endurance exercise, particularly high-intensity and long-duration exercise, may increase the risk of arrhythmias, but the majority of athletes do not need to worry and should pay attention to any symptoms.
Deep dives
Exercise is good for the heart
Exercise is important for overall heart health and longevity. It increases one's health span and even lifespan. Although intense and prolonged exercise can cause some changes to right ventricle function and lead to increased coronary artery calcium levels and atrial fibrillation, exercise still has numerous benefits for the heart. Despite these potential risks, individuals who engage in regular exercise have lower mortality rates. The key is to keep exercise in context and understand that the benefits outweigh any potential negatives.
Coronary Calcium and Exercise
Calcium levels in the coronary arteries may increase with exercise. While a high calcium score can be a marker of potential heart attack risk, it should be considered in context. Regular exercise, particularly in combination with good cholesterol levels and blood pressure, is beneficial for overall heart health and reduces the risk of heart attacks. Calcium scores can vary among individuals, and it is important to focus on maintaining a healthy lifestyle and keeping the blood vessels as healthy as possible.
Atrial Fibrillation in Athletes
Atrial fibrillation (AF) is a relatively common arrhythmia that affects the heart's priming chambers. AF is more prevalent among endurance athletes but is not considered life-threatening. While AF increases the risk of stroke, regular exercise in athletes is still recommended due to its numerous health benefits. The risk of AF in women is relatively lower compared to men, but both genders can be affected by this condition. Screening for heart conditions, including AF, can be part of an athlete's health monitoring, but decisions regarding exercise should be made on an individual basis.
Considerations for Cardiac Screening in Athletes
Cardiac screening for athletes involves evaluating various factors, such as electrocardiograms (ECGs) and imaging tests. The focus is often on identifying specific heart conditions that could increase the risk of sudden cardiac events. However, the effectiveness and necessity of screening remain subjects of debate. While screening can help detect certain heart conditions, it does not guarantee prevention of adverse events. Decisions regarding participation in sports should consider individual risks, medical guidance, and an understanding that no screening method is 100% accurate or definitive.
Impact of Endurance Exercise on the Heart
Endurance exercise, such as long-distance races, can have significant effects on the heart. Research has shown that the right ventricle, which is normally thinner and less equipped for intense exercise, is put under more stress during long-duration endurance events. This can lead to changes in the structure of the heart, including an increase in size and thickness of the right ventricle relative to the left ventricle. However, it is important to note that these changes are typically reversible and the heart can recover within a day or two after exercise. It is crucial for athletes to prioritize recovery after intense endurance events to allow the heart to fully recover.
Risk of Arrhythmias in Endurance Athletes
Endurance athletes, particularly those who engage in high-intensity and long-duration exercise, may have an increased risk of developing arrhythmias, such as atrial fibrillation and ventricular tachycardia. These arrhythmias can be serious and require medical attention. It is worth noting that the risk of arrhythmias is still relatively small, and the majority of athletes do not need to worry. However, it is essential for endurance athletes to pay close attention to any symptoms, such as rapid palpitations or dizziness during exercise, and seek medical evaluation if needed.
Exercise and Heart Health
Regular exercise, including both endurance and strength training, is highly beneficial for heart health. Endurance training can increase the heart's capacity and improve cardiovascular function, while strength training helps maintain overall fitness and muscle strength. A well-rounded exercise routine that includes a combination of endurance, strength, and high-intensity exercises is recommended for optimal health. It is also essential to consider individual factors, such as age, gender, and pre-existing conditions, and consult with a healthcare professional for personalized exercise recommendations.
Dr Glenn McConell chats with Assoc Prof Andre La Gerche a world leading Sports Cardiologist from St Vincent’s Institute of Medical Research, Melbourne, Australia. Acute exercise for long periods at a high intensity can result in abnormal right ventricle function. In addition, years of long, hard exercise training is associated with increased coronary artery calcium (CAC) levels and atrial fibrillation (AF). Despite this, Andre is a huge advocate of exercise across the population and generally even in these individuals. The evidence is that exercise training increase healthspan and reduces mortality rates despite some of these changes. A very important, interesting chat. Twitter: @ALaGerche 0:00. Introduction + how Andre got into sports/exercise research 5:30. Andre’s excellent marathon running 7:32. Is exercise good for the heart? 10:50. Media fear around ex and the heart 13:45. Increased CAC and heart attack risk 17:00. Exercise protective even if increased CAC 18:56. Andre hasn’t had a CAC scan 22:28. Plague build up in the coronary arteries 23:50. Some people never have coronary issues 24:50. Genetics and the heart 26:55. Jim Fixx: died running 27:40. How can exercise increase CAC? 32:00. Get into exercise slowly 33:30. Coronary “hot plagues” and heart attacks 35:30. Exercise before a heart operation 36:45. Exercise training increases hearts reserve with age 37:33. 1969 marathon WR holder Derek Clayton: still amazing heart 43:15. AF more common in endurance athletes 45:43. Female endurance athletes have increased AF 47:55. Generally if in doubt, keep exercising 50:43. Women have relatively more stable hearts 52:50. Cardiac screening of athletes 55:55. Ventricular arrhythmias: continue sport or not? 59:50. It's hard to estimate heart attack risk 1:01:58. Right ventricle after long hard races 1:08:10. Rare ventricular tachycardia in professional athletes 1:11:34. The importance of seeing a sports cardiologist 1:14:40. Big vs enormous hearts in top endurance athletes 1:18:10. Genetics and the heart 1:19:25. EPO, anabolic steroids, very hard training and the heart 1:24:20. Resistance training, anabolic steroids and the heart 1:28:15. Best exercise to do for the heart and health 1:29:50. What’s the cutoff of ex for increased AF? 1:33:50. Blood indicators of heart damage/recovery 1:36:45. Right ventricle “fatigue” and recovery 1:40:50. Heart failure/heart reserve and exercise (sex differences) 1:44:00. Don't assume sudden death in athletes drug related 1:45:45. Negative cardiac effects of the Covid19 vaccine in some people 1:50:12. Takeaway messages 1:52:38. Outro (9 seconds) Inside Exercise brings to you the who's who of research in exercise metabolism, exercise physiology and exercise’s effects on health. With scientific rigor, these researchers discuss popular exercise topics while providing practical strategies for all. The interviewer, Emeritus Professor Glenn McConell, has an international research profile following 30 years of Exercise Metabolism research experience while at The University of Melbourne, Ball State University, Monash University, the University of Copenhagen and Victoria University. He has published over 120 peer reviewed journal articles and recently edited an Exercise Metabolism eBook written by world experts on 17 different topics (https://link.springer.com/book/10.1007/978-3-030-94305-9). Connect with Inside Exercise and Glenn McConell at: Twitter: @Inside_exercise and @GlennMcConell1 Instagram: insideexercise Facebook: Glenn McConell LinkedIn: Glenn McConell https://www.linkedin.com/in/glenn-mcconell-83475460 ResearchGate: Glenn McConell Email: glenn.mcconell@gmail.com Subscribe to Inside exercise: Spotify: shorturl.at/tyGHL Apple Podcasts: shorturl.at/oFQRU YouTube: https://www.youtube.com/@insideexercise Anchor: https://anchor.fm/insideexercise Google Podcasts: shorturl.at/bfhHI Anchor: https://anchor.fm/insideexercise Podcast Addict: https://podcastaddict.com/podcast/4025218 Not medical advice
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