It’s great news that running events like marathons and ultras are appearing on the calendar again, but does this form of exercise and competition come with risks to our heart health? We asked Hong Kong cardiologist DR ARTHUR YUNG for some answers.
Are there proven links between endurance activities like long-distance running and heart issues?
It’s very well proven that regular exercise can bring a lot of health benefits to a person – for example, it can reduce the risk of heart attack and stroke; it can help lower body weight and blood pressure; it can improve our sleep quality and our overall mood. The list goes on. Moderate exercise really is the best prescription for a long and healthy life.
Having said that, like most things in life, you can have too much of a good thing, and it is actually possible to over-exert ourselves with exercise or training. Through research, we have come to recognise that some individuals who participate in chronic high-intensity endurance training such as marathon runners, triathletes and long-distance cyclists can develop heart muscle damage, which in turn – paradoxically – can increase their chance of developing certain cardiovascular disorders.
What kinds of disorders?
Studies have shown that chronic endurance athletes have an increased risk of coronary calcification whereby abnormal calcium as well as plaque can deposit in the coronary arteries, which can lead to coronary artery disease. They also have increased risk of a condition called myocardial fibrosis – essentially, scars developing inside the heart muscle. And they’re at risk of developing heart rhythm abnormalities such as atrial fibrillation, which is a condition where the heart rhythm becomes irregular.
Can a runner appear 100 percent fit and still have an illness?
Looks can be deceiving, and a lack of exercise is really just one of many cardiovascular risk factors. It’s absolutely possible that someone can look and feel physically fit and live a very healthy lifestyle while having underlying cardiovascular risk factors that are undiagnosed. Examples include high blood pressure, high cholesterol and even high blood sugar. And while most patients with underlying heart issues can have symptoms, it’s not uncommon for me to see patients living a very healthy lifestyle who look physically fit but who end up having significant blockages in multiple coronary arteries with minimal to no symptoms.
The bottom line is, regardless of how well you look or how physically fit you appear, don’t neglect a regular bodycheck.
How can we get the balance right between exercising for good heart health and over-exercising?
I think the key is moderation. We usually recommend 150 minutes of moderate intensity aerobic exercise per week – and spread out evenly as opposed to “binge- exercising” it all on the weekend! If you exercise regularly, it’s also important to take a rest day every now and then. But we have to put things into context. People who are potentially at risk of over-exercising are really the high-endurance athletes who are training many hours a day and typically exercising 10 to 20 times more than the recommended amounts. The average person in Hong Kong who’s going to the gym one hour a day isn’t going to be at risk of over-exercising and harming the heart as a result.
What symptoms might a person experience while training or competing that indicate a problem?
There are several symptoms which may indicate underlying cardiac disease. One is angina, where a person experiences chest discomfort. Usually, this is a compressive type of discomfort that covers a relatively large area in the chest, though the discomfort can migrate to the arms, jaw, neck and even the back, and can be associated with nausea and cold sweats. Other symptoms include shortness of breath even at very low levels of physical activity, or any unexplained reduction in exercise tolerance, and also experiencing palpitations, where you feel your heart beating extremely fast or irregularly. Lastly, if you feel light-headed or have had episodes where you’ve totally blacked out, these are also potential symptoms of underlying cardiac disease. If you experience any of these during exercise or immediately after exercise, they are red flags.
What course of action do you recommend for runners of different ages, as far as heart health goes?
One thing that’s commonly forgotten with exercise is the need for a good warm-up and cool-down. We’re very busy in Hong Kong – once we get to the gym, we often only have 30 minutes, so it’s “go time”! However, a warm-up period raises the body temperature, loosens the joints and ligaments, and also raises the heart rate and dilates the blood vessels; it’s essentially preparing the heart for the upcoming exercise so there’s not a sudden impact. Cooling down is equally important because the heart really needs time to revert to its original resting state.
Can heart monitoring devices be useful for runners?
I think one of the most useful benefits of wearable technology like a chest strap or smart watch is that a runner can monitor their heart rate for the duration of the activity to ensure the heart rate is within their target zone. A lot of these devices also have integrated technology with irregular heartbeat detection; they will alert the wearer that they may have a heart rhythm abnormality. This has actually led to us to be able to screen for and detect patients with cardiac conditions such as atrial fibrillation that otherwise might have gone undetected. Of course, these sensors are not 100 percent accurate; so, if you do receive an alert saying that there might be a heart rhythm abnormality, it’s important not to be completely afraid of it. But it’s probably a good idea to see a doctor to have it investigated more thoroughly.
If you’re diagnosed with a cardiological issue, does it mean no more marathons or running in general?
For most patients with heart disease, including those with coronary artery disease, as long as the condition is stable and is well managed, we usually do still recommend the regular moderate intensity exercise as we do with regular healthy patients. The difficulty is that some patients, once they’re diagnosed with a heart condition, find returning to exercise a daunting task – there can be a psychological barrier there. That’s why a supervised exercise programme or cardiac rehabilitation programme can really be helpful, so these people can continue to reap the benefits of exercise.
Tell us about your background in cardiology – why did you choose it as a specialty?
Cardiovascular disease is the leading cause of death globally. It’s very fulfilling being able to impact this common but also deadly condition. There’s also a very wide spectrum of disorders that we have to take care of as cardiologists, from prevention and imaging to structural heart problems and heart failure. So it’s a specialty that’s constantly interesting and never boring.
This article first appeared in the December 2022 issue of Expat Living magazine. Subscribe now so you never miss an issue.