Exercise is known to be a heart healthy lifestyle habit. It is thought to be the single best intervention to reduce several risk factors for heart attack including better control of blood pressure, blood sugar and cholesterol. Still, we hear about stories of sudden collapse and cardiac death happening in the setting of vigorous exercise which sounds paradoxical. Recent news of a young and popular TV actor who collapsed and died while playing shuttle badminton shocked many; raising concerns among public about the risk of sudden cardiac death from vigorous exercise. Similar stories of athletes collapsing in the field have captured our attention in the past although it is a very rare incident. This article will explore the link between exercise and the heart. Why it can rarely be fatal but for majority of people who exercise it is beneficial.
How exercise benefits the heart and prevents heart attack.
High blood sugar from Diabetes, high cholesterol and high blood pressure are the three main causes leading to cholesterol deposition in the heart’s blood vessel (Coronary Artery). This leads to blocked arteries (Coronary Artery Disease) resulting in heart attack. Moderate degree of regular exercise (20 minutes per day) favorably modifies all these three risk factors to prevent a heart attack. Exercise helps overcome insulin resistance in diabetic patients and thereby controls blood sugar, it increases the HDL (good cholesterol) in blood which helps to take away the LDL (bad cholesterol) deposition in the coronary arteries and exercise help relax the blood vessels thereby help reduce blood pressure.
Know the difference between heart attack and cardiac arrest
Heart attack happens when a crack develops in the cholesterol rich plaques in the coronary artery leading to sudden clotting and blockage of the coronary artery leading to heart muscle damage from lack of blood and oxygen. In simpler terms, it is a plumbing issue arising from clogged blood vessels. This causes chest pain and heart muscle damage.
Cardiac arrest is a rhythm problem of the heart. Cardiac arrest happens when instead of heart beating at a normal heart rate of 60-100 beats per minute, due to certain rhythm problems it suddenly starts beating at a very fast rate of more than 200-250 beats per minute to the effect that it goes into a stand still mode leading to stoppage of heart pumping. In simpler terms, it is an electrical issue of the heart arising from a form of short circuit in its electro-chemical wiring. Such rhythm problems are called Ventricular Tachycardia and Ventricular Fibrillation.
Heart attack and cardiac arrest are closely linked as one of the most common triggers for cardiac arrest is a heart attack. Lack of blood supply to the heart muscle sometimes make it very irritable, triggering Ventricular Fibrillation leading to cardiac arrest. Sudden cardiac death following collapse is most commonly from cardiac arrest due to various reasons. One of the most common causes of cardiac arrest is following a heart attack.
Apart from heart attack cardiac arrest can be caused by certain rare but primary heart rhythm problems (Long QT syndrome, Idiopathic VF, Brugada syndrome etc) and heart muscle problems (Hypertrophic Cardiomyopathy, ARVD etc)
Vigorous exercise and Sudden Cardiac Death
We have rarely witnessed competitive sportspersons who are otherwise healthy; suddenly collapsing and dying. These are usually not from heart attack but from cardiac arrest due to the rare heart rhythm and heart muscle problems discussed earlier. Previously, there used to be ECG screening for competitive sportsmen to help predict such events but these events are so rare that such a screening was not found to be useful. For the same reason there is no public health warning against vigorous exercise in otherwise young and healthy individuals.
On the other hand, middle or older age individuals who have coronary artery disease or cardiomyopathy (heart muscle weakness from previous heart attack) or risk factors for heart attack such as diabetes, high cholesterol, hypertension, smoking and obesity; particularly if they are otherwise sedentary get involved in sudden and vigorous or even moderate exercise, this could precipitate plaque rupture leading to heart attack. This will usually present with chest pain and for most of them, if they seek medical attention can be rescued. Rarely the heart attack can trigger a cardiac arrest and sometime massive heart attack can itself lead to collapse and death. This can occur not only with physical stress but also with emotional stress as well.
Such fatal events triggered by exercise is in fact very rare and should not prevent heart patients or those with risk factors from exercising. For those with coronary artery disease or cardiomyopathy who are sedentary, a Tread Mill Test (TMT) is advised wherein they are made to walk slowly in a controlled environment with ECG monitoring which can help assess any warning signs as well as recommend a safe level of exercise which can be initiated. After such an initiation they can slowly progress to moderate or higher level of exercise as tolerated.
How to rescue if someone collapses during sports or exercise
First aid in the form of bystander CPR (Cardio Pulmonary Resuscitation) can be helpful in rescuing someone who collapses during sports. A Basic Life Support (BLS) training is required to administer bystander CPR. If the collapsed person is unresponsive without any breathing or pulse, chances are that they are in cardiac arrest. Chest compression and mouth to mouth breathing has to be initiated until the subject responds or till an ambulance arrives to administer an external defibrillator shock to correct the heart rhythm back to normal. Studies show that only 50% of sudden cardiac arrest patients during outdoor activity survive. Bystander CPR, presence of Automated External Defibrillator (AED) in vicinity of sports facility, rapid response of ambulance equipped with defibrillators are factors which can improve the survival chances.
Exercise – the feel good and look good mantra
Although only a minority of general public routinely exercise, majority of those who do are big fans of routine exercise. This is because of how it makes them feel good more than a specific targeted benefit to heart health. “Runner’s high” is a commonly described sense of euphoria, which is experienced following moderate to vigorous exercise not only in the form of running but any exercise. Exercise is known to release endorphins and certain other brain chemicals which makes one feel euphoric and can reduce stress and anxiety. Exercise is also a very good antidepressant although finding the motivation to exercise when you are depressed can be difficult. Losing the extra fat from routine exercise makes you look healthier and younger. Exercise can give your skin a slight glow and help yourskin look healthier.
Integrating exercise into routine life
Exercising for the sake of doing it can be a boring affair for many. This may be why many fail to develop a habit of routine exercise. Going to the gym can also turn out to be monotonous and not sustainable for many. For those who like to dance, Zumba classes at gyms or just dancing to a favorite Bollywood song on Youtube in your living room could be a good option of a fun exercise. Making exercise a daily routine while listening to morning news etc will help make it a sustainable habit. Picking up a sport can be a smart way of integrating exercise into one’s routine. Cricket, football and basketball are popular amongst the youth. Although sporting options for youngsters are plenty, options for the middle aged are limited. In recent years indoor badminton courts have been getting popular with the middle-aged public in Kerala. Tennis seems to be more limited to clubs of the affluent society. Going for a morning or evening walk is a popular way of exercise amongst the middle aged as well as the elderly. Brisk walking may be more beneficial for the heart as opposed to slow walking. For the elderly slow walking is appropriate as staying physically active is what is important and need to be cautious of fall risk and fractures due to old age. Taking the stairs instead of the elevator lift, getting off at an earlier bus stop and walking the rest back home may be smart techniques of integrating physical activity into daily life. Integrating exercise into your daily routine can be one of the most valuable investment of time and energy one can make to retain oneself healthy and happy.
Cardio workout vs weigh training exercise: Which is more heart-friendly?
Cardio workout such as brisk walking, jogging, swimming, cycling etc are aerobic exercises which enhances the heart and lung function, helps burn fat and improve stamina. Weight training such as free weights or machine weight workout are more intense and helps in muscle building. Both cardio and weights can help you become healthier and fit. Cardio workout is found to be more heart friendly. Individuals with heart disease and other medical conditions are generally advised to refrain from weight training exercises. Initiation of exercise in a sedentary individual with a heart condition is preferably done after a Treadmill Test assessment. Once they are initiated and comfortable with cardio exercise, they may be selectively initiated on weight training exercise if desired.
Take home message
Routine exercise is one of the best habits we can integrate into our lives for a healthy and happy life. It can help prevent as well as treat all lifestyle diseases. Moreover, it makes us feel and look good. Very rarely in young and healthy sportspersons, exercise can trigger cardiac arrest leading to fatality. Those with heart disease and are sedentary should initiate vigorous activity only with medical guidance, else if might rarely be problematic. Both cardio and weight training exercise helps with health and fitness, but cardio is more heart friendly.
(Dr. Anand Marthanda Pillai MD FACC FHRS, is a Consultant Interventional Cardiologist and Electrophysiologist, Ananthapuri Hospitals and Research Institute, Thiruvananthapuram, Kerala)