Cardiac issues don’t discriminate based on fitness levels. Even the fittest among us can be at risk, and understanding the factors involved is crucial for prevention
Our common image of a heart attack victim often resembles a paunchy middle-aged man, whose idea of exercise involves lifting a burger from the nearest fast-food joint. However, this perception tells only part of the story and can lead the rest of us into a false sense of security. A heart attack occurs when the heart muscle is starved of oxygen due to a blocked artery.
While it’s true that most heart attacks do affect individuals with classic risk factors such as sedentary lifestyle, diabetes, and obesity, even those who lead a virtuous life can suffer one. Exercise, which is supposed to be good for health, may not offer complete protection; even elite athletes and bodybuilders can be afflicted by heart disease.
In 2021, during Denmark’s opening match against Finland in the 2020 UEFA Euros, Danish midfielder Christian Eriksen collapsed on the field and was later hospitalised for cardiac arrest. This wasn’t the first time soccer fans had witnessed a young, super-fit sportsperson experiencing health problems on the pitch. In the same year, Sergio Aguero announced his early retirement after suffering chest discomfort during a football game. He was sent to the hospital, where he was diagnosed with cardiac arrhythmia (an irregular heartbeat).
Creating a physique that can compete at the highest level of professional bodybuilding requires superhuman self-discipline, intense training, and genetic good fortune. However, the early deaths of more than a dozen bodybuilders from heart attacks and other heart-related events in recent years are surprising, given that we’re talking about young men and women who exercise regularly.
While it’s frightening to imagine the fittest among us being stricken by heart disease, we need to delve deeper to understand how it can happen to those who are very fit and active.
“A heart attack results from a complex interplay of multiple risk factors such as genetics, lifestyle, comorbidities, and diet,” says Dr Suma Malini Victor, Specialist Cardiologist, Prime Hospital and Prime Medical Center Burjuman. “Exercising in the gym alone will not prevent a heart attack, and no one should assume that just because they are in the gym daily, they are exempt from heart disease. Ignoring symptoms of a heart problem, such as chest pain, breathing difficulty, dizziness, or palpitations while exercising, can prove lethal, as the essential oxygen supply can be diverted from the heart muscle to the exercising leg or arm muscles, worsening the situation and potentially leading to cardiac arrest.”
Dr Wissam Al Sahli, Consultant Interventional Cardiology, Burjeel Hospital, Abu Dhabi, adds that gym-goers and fitness enthusiasts often have a high intake of eggs and dairy, which can result in a diet high in cholesterol, increasing their risk of heart attacks. “The hormonal injections and some supplements they take also increase their risk,” says Dr Al Sahli. “Excessive workouts may be a risk factor, especially for patients who are smokers. Sometimes, vigorous exercise can also cause hypertrophy (thickening) of the heart’s muscles, putting a strain on the heart.”
Dr Ashiq Sasidharan, Specialist Cardiology at Aster Clinic, Qusais 1, points out that problems can arise when people attempt to transition suddenly from being a “couch potato” to a 5K runner. “Two other factors contributing to this increasing trend are increased substance abuse among young gym enthusiasts and the Covid-19 factor,” he says. “The effects of Covid-19 on the heart are not yet completely understood. Acute Covid-19 to long Covid can increase the risk of heart attack and arrhythmias in affected individuals. While it’s estimated that only 4 per cent of Covid-19 affected individuals develop cardiac complications, the number becomes significant when we consider the total number of people affected by Covid-19.”
However, Dr Sasidharan emphasises that the importance of regular exercise should not be minimised. “Life expectancy at 50 years of age is 7-8 years more in physically fit and active people than in those who lead a sedentary lifestyle. Sudden cardiac deaths during exercise are rare.”
Experts suggest that we must recognise the signs of heart pain during exercise, such as heaviness in the chest, left shoulder pain, neck pain, and back pain, and stop exercising if these symptoms occur. “Exercise done without thought might strain the heart, and therefore, performing too many reps, being overweight, running continuously, and working out for an extended period of time all increase the risk of having a heart attack while engaging in any exercise,” says Dr Karim Ghannem, Specialist Interventional Cardiologist, Thumbay University Hospital. “Few people engage in regular physical activity before deciding to start exercising and living a healthy lifestyle. Therefore, it’s important to assess your health before beginning any exercise programme. Exercise-related sudden cardiac arrest can be caused by recognised or undiscovered blockages in the heart. A sudden cardiac arrest can also occur as a result of plaque rupture or heart electrical abnormalities brought on by too much pressure on the heart.”
What to keep in mind
People with pre-existing heart conditions are more likely to suffer a heart attack while exercising. Those who are overweight, have high blood pressure, or suffer from diabetes are all at greater risk than those who don’t have any of these conditions. It’s important to be aware of your body and to recognise when something isn’t quite right.
“Fitness enthusiasts should avoid smoking and try not to smoke after severe exertion,” says Dr Abou Bakr Mitkis, Consultant Cardiologist, Burjeel Hospital, Abu Dhabi. “They need to avoid hormonal injections and eat a balanced diet. Sometimes, heavy exercise may result in heart problems. They must slowly increase the intensity of training and train within their limits. Any time they experience abnormal chest discomfort or tachycardia, they should stop and seek medical attention.”
Dr Sasidharan requests gym-goers to always consult a doctor before embarking on a new fitness routine. You need to hydrate yourself well and seek medical help if there are any unusual symptoms during exercise. “Do adequate warm-up before starting a workout and avoid substance abuse and the use of anabolic steroids,” he recommends. “Make sure your blood pressure, cholesterol, and sugar levels are regularly monitored and are all within the normal range.”
Dr Victor says, “Prolonged high-intensity exercises may even result in a condition called athlete’s heart. Bulking up does not contribute much to the heart’s health and may even be counterproductive. Moderate aerobic exercises are generally adequate for most people’s heart health.”
Exercising with heart issues
Exercising when you have heart failure can feel challenging, but it offers many benefits and can reduce the risk of hospitalisation. It’s possible to exercise if you have heart disease, but you should do so under the guidance of a healthcare provider. “Exercise can be beneficial for improving heart health and overall fitness in many individuals with heart disease, but the type, intensity, and duration of exercise will depend on your specific condition and overall health,” says Dr Abdul Rauoof, Specialist Cardiology, Aster Hospital, Qusais & Muhaisnah. “Cardiac rehabilitation programmes are often recommended for people with heart disease, as they provide structured exercise routines and monitoring in a safe environment.”
Moderate exercise is recommended for patients with heart disease, says Dr Al Sahli, as it’s important to avoid a sedentary lifestyle. She says, “While isotonic exercises are okay, heavy weightlifting is not recommended. For patients with heart disease, 30 minutes of brisk walking per day is recommended.”
“We usually recommend a graded exercise regimen,” explains Dr Victor, “which means they can start to exercise slowly and increase the intensity of exercise at regular intervals. Isotonic exercises such as weightlifting can cause a sudden increase in blood pressure and heart rate and are best avoided in cardiac patients. Most importantly, avoid exercise when you have chest pain or breathing difficulty or when you are feeling unwell.”
There are cardiac rehabilitation programmes designed to build on your gradual increase in physical activity, providing a structured and monitored environment. They offer a comprehensive approach to recovery, including education, counseling, and exercise regimens tailored to your specific needs. “These programmes are not only for those who have experienced a heart attack or heart surgery but also for individuals who have dealt with chest pain, heart failure, or atrial fibrillation,” says Dr Ghannem. “It’s important to understand that these rehabilitation programmes are complementary to the care provided by your cardiologist. They can be delivered in various formats, including one-on-one sessions, group settings, over the telephone, or through mobile applications and web services. The flexibility in programme delivery ensures that you have access to the support you need in a manner that suits your preferences and lifestyle.”
Return to fitness after a heart attack
After a heart attack, it’s normal to worry about what exercise you can and can’t do. Staying physically active is crucial for your heart and overall health. It speeds up your ability to return to normal activities, reduces the chances of having another heart attack, and helps you feel healthier and more energetic.
“I would advise individuals who have experienced heart-related issues like heart attacks, surgeries, or heart diseases to consider joining a cardiac rehabilitation and prevention programme,” says Dr Ghannem. “These programmes provide structured physical activity, which can enhance strength, energy levels, mood, and emotional well-being while reducing the risk of future heart problems. They also offer crucial education and counseling to support lifestyle changes, including smoking cessation, healthy eating, weight management, and stress reduction.”
After a heart attack, it’s crucial to undergo a comprehensive medical evaluation to assess the extent of damage to your heart and determine your overall health.
“Apart from a cardiac rehabilitation program and gradual progression to exercise, patients have to continue taking prescribed medications as directed by your doctor and make necessary lifestyle changes, such as improving your diet and quitting smoking,” says Dr Rauoof. “Regularly follow up with your healthcare provider to monitor your progress and make adjustments to your exercise routine and medications as needed. Pay close attention to how your body responds during and after exercise. Also, recovering from a heart attack can be emotionally challenging. Seek support from a mental health professional or support groups if needed.”
Dr Mitkis concludes, “There is a fixed protocol of cardiac rehabilitation that we follow to guide patients back to health. This starts after full stabilisation. The pace is increased on an interval basis, and we can help the patient define the target when they are exercising.”