Gabor Szendi:
Exercise and death

The biggest bad luck is to die because of what we do to achieve a long, healthy life. Yet this danger lurks for every carelessly person who leaps into sport suddenly.

 

 

The biggest bad luck is to die because of what we do to achieve a long, healthy life. Yet this danger lurks for every carelessly person who leaps into sport suddenly.

Regular exercise is extremely important in our lives, as we were born to exercise. I'm not thinking about professional competitive sports, where ranking is the only thing that matters today, and the impact of sport on health is the least important aspect. When a sports magazine asked Olympic athletes the question, "If you received an undetectable performance boosting agent and you could win with it, would you take it?" 98% of athletes answered yes. To the question, "If you won every race for five years and could die after that because of the boosting agent, would you still take it?" 50% of athletes said yes (Baron et al., 2007). We know that none of the questions were rhetorical.

Of course, we average people are less threatened by this danger. Except for some obsessive bodybuilders, we exercise for our health, and are not at risk of doping because we don't want to win races at all costs. When I cycle up a mountain at my own pace, it doesn't bother me when a younger, stronger cyclist passes me. I want to beat the mountain, not others. No team will be doping for victory at football games played amongst friends. Nevertheless, amateur sports are not without danger. I am not thinking about the risks of extreme sports, because the goal there is not health either, rather the search for excitement. Everyday sporting activities like running, cycling, swimming, and tennis also entail risks.

The most common cause of sport-related death is heart-related. The issue has been much studied in professional athletes. Extreme exertion and prolonged, intense physical activity can exacerbate congenital or acquired cardiovascular problems, and this is obviously true for amateur gymnasts as well. Sudden cardiac death in young athletes is due to hidden heart defects, while in older athletes it is due to atherosclerosis - the narrowing of the heart vessels (Borjesson and Pelliccia, 2009).

Although sudden cardiac death or cardiac arrest is 3-4 times more common among professional competitors than in the general population (Harmon et al., 2014), this is less comforting for an amateur who, let's say, meets their death while running. God forbid that I discourage anyone from exercising, rather I would like to encourage everyone to have periodic medical check-ups of the condition of their heart and blood vessels. A French study estimates the number of people who die suddenly as a result of sport as 5-17 per million. This seems to be a small risk, but in France between 2005 and 2010 an average of 200 people died each year this way. 78% of cases were medically unexplained, and only 19% showed narrowing in the coronary arteries (Marijon et al., 2011).

There is a significant difference in the risk of sudden cardiac death between those who train regularly, and occasional enthusiasts. The risk of sudden cardiac death was 56 times for non-regular athletes and 'only' 5 times for regular athletes compared to their resting state (Siscovick et al., 1984). In another study, the risk of sudden cardiac death was 74 times for those who rarely exercise, 19 times for those who exercise 1-4 times a week, and 11 times for those who exercise more than five times a week (Albert et al., 2000). Before anyone clutches their heart, let's add that in the study just one sudden cardiac death occurred in one and a half million training sessions. The lesson to be learned is important in my view: Frequent exercise reduces even this small but existing risk by seventh-tenths.

People who are not used to regular physical exertion are 100 times more likely to have a heart attack during exercise compared to resting state (Mittleman et al., 1993). This high risk is reduced by 2 to 5 times, but also exists among those who exercise regularly (Bärtsch, 1999). One of the reasons for this is the lesser known effect of increased blood coagulation due to exercise and physical exertion, which increases the number of circulating platelets in the blood. These are the elements of blood that can stick together to form a blood clot in the blood vessels. The rate of increase in platelet count and the risk of blood clot formation are much higher in untrained people who start intensive activities suddenly, or during hard workouts. One of the main reasons for this is that blood clot formation is significantly influenced by increased levels of adrenaline and norepinephrine due to physical exertion. However, the elevation of these hormones is greater in the untrained than in the trained people. The more trained someone is, the lower the risk of exercise-induced blood clot formation (El-Sayed et al., 2005).

It seems paradoxical that regular sport is one of the greatest defenses against cardiovascular disease, yet it carries an increased risk of cardiac death. The contradiction is apparent. The risk during regular exercise is low, which can be further reduced by inhibiting blood clotting. Unfortunately, the highly recommended aspirin is worth nothing against exercise-induced blood clot formation (Hurlen et al., 2000). However gamma-tocopherol, a member of the vitamin E family, is very effective (Vucinic et al., 2010). The only problem with this is that most of the products sold as Vitamin E actually contain only alpha-tocopherol. Omega-3 from fish is also useful because it reduces blood clot formation without the risk of increased bleeding.

 

References

Albert: N Engl J Med. 2000, 343(19):1355-61.

Baron: World Psychiatry. 2007, 6(2):118-23.

Bärtsch: Lancet. 1999, 354(9192):1747-8

Begtrup: Dan Med J. 2017, 64(5).

Borjesson: Br J Sports Med. 2009, 43(9):644-8.

El-Sayed: Sports Med. 2005, 35(1):11-22.

Harmon: Heart. 2014, 100(16):1227-34.

Hurlen: Thromb Res. 2000, 99: 487-94

Marijon: Circulation. 2011, 124(6):672-81.

Mittleman: N Engl J Med. 1993, 329(23):1677-83.

Siscovick: N Engl J Med. 1984, 311(14):874-7.

Vucinic: Thromb Res. 2010, 125(2):196-9.