A question I often get asked, is whether it is safe to exercise with a heart condition. Almost always, the answer is yes, and more often than not, a person is more likely to do themselves a disservice by not exercising, or taking it easy, than if they push themselves a bit. It’s perfectly understandable though, to think if there’s something the matter with your heart or blood pressure for example, that one should take it easy.
The blood pressure point is an interesting thing in itself. It’s common for people to reach a systolic blood pressure well over 200mmHg during intense exercise. It’s incredibly uncommon for that spike in blood pressure to cause an acute medical issue. A healthy blood pressure will be capable of being high during exercise, but then low at rest. In some really intense load bearing sports such as power-lifting, the blood pressure will even reach 300mmHg!
I was interested to read this week some guidance for general practice doctors, on what to say to their patients who have not exercised for a while, or have a heart condition, about the safety of exercise. This is obviously not intended as a one -size-fits-all, or indeed tailored medical advice, but it does give some good pointers that I thought worth sharing.
The first question to consider is if the person has a history of heart disease, such as a heart attack, pacemaker, cardiomyopathy, arrhythmia and so on, as this may affect the type of sport, and the intensity level recommended. I often tell my patients however that the exact type of exercise doesn’t matter as much as whether the person can do it regularly. For that, they need to either enjoy it, or at least not hate it!
The second consideration is what sport the person wants to do. Advice will be different for someone wanting to do a marathon than gentle cycling. The third consideration is about the environment – temperature, altitude, water and so on.
A history of a heart attack is not necessarily a barrier to intense exercise. In fact, a couple of my elite athlete patients have in fact had a heart attack. Provided patients are properly trained, the risk is only marginally higher than the normal population.
Alcohol history, smoking, and other recreational drugs including anabolic steroids should be asked about. Symptoms, particularly chest pain, breathlessness, dizziness or blackout during exercise should always prompt medical assessment. These days, many people wear smart watches and other trackers. I know some doctors hate it when patients pull these out! I love it, it makes my life easier, and shows that person is invested in their health.
Blood pressure, cholesterol, diabetes assessment are all useful to build up a picture of a person’s heart health risk, and physical examination findings such as a heart murmur may prompt a heart scan referral. An ECG (paper tracing of the heart) is often sensible. Other more specialist tests like an exercise test are only used in certain circumstances.
The recommendations also referenced CT calcium scores. There are other videos on my website about these – but my take is a CT calcium score is near-pointless, as it will miss so-called ‘soft plaque’ which is more prone to rupture. Over the age of 50, a heart attack is the most common cause of death in athletes (as opposed to cardiomyopathy in younger athletes) and so a CT coronary angiogram (see my other video which explains the difference) can be really valuable in identifying people who may be at risk, without having any symptoms.
We should be encouraging everyone to exercise, and so having some simple recommendations for GPs to give to patients I think is a really positive step. I love working with patients to find out what they may be able to do differently in the world of sports. It’s just such a rewarding thing for both doctor and patient.
In this week’s research video, I discuss a trial I read of one of my favourite things in the world – coffee. Do check it out!