On Tuesday night, I ran 10K. It took just under an hour. My heart rate went no higher than about 130bpm. I stepped off the treadmill, had a quick shower and carried on with the day. I didn’t have any pain. It felt good.

Perhaps this shouldn’t be a cause for celebration. It’s not an exceptional time and I am firmly middle of the pack at my local Park Run on Saturdays. But it was for me. 16 years ago, I stopped running. A year ago, or so I started again on holiday. It was awful and I could barely run a mile with the kids.

Since then there has been a battle with iliotibial band syndrome, Achilles tendonitis, shin splints and a slipped disc. I have had physio and after several insoles, I am now on my third pair of shoes (Mizuno Running Solution selected – it worked!). I am best friends with a foam roller. I am also 20Kg lighter.

I am now edging towards 50K a week. Most of it is pretty low intensity and in Zone 2/Zone 3. But, what also went through my mind in what was a pretty boring hour on the treadmill was the nagging question as to whether what I was doing was healthy and good for me.

Coronary heart disease – the narrowing of the coronary arteries which supply the heart muscle – is bad. When the narrowings reach a certain point, then on exercise not enough blood can get to parts of the heart. This typically (but not always, nothing is ever always in medicine – some people get breathlessness or undue fatigue) causes pains in the chest. The pains are usually described as an ache or pressure – angina. If an artery blocks suddenly then part of the heart muscle can die – a heart attack (myocardial infarction). This is usually painful – people get severe and prolonged pain, they are often pale and sweaty. They can feel nauseated and vomit.

Coronary heart disease is more common as you get older, if you are a man, or if you have high blood pressure, diabetes or a high cholesterol. It runs in families too. If you want to get an idea of your risk then follow this link: https://www.qrisk.org/2017/.

A marker of coronary artery disease and risk is coronary calcium. This gets deposited with age, along with cholesterol. You can see it on CT scans particularly clearly. Typically, if you take a group of ordinary individuals, the more calcium that is there, the more likely you are to have a heart attack.

Athletes have more calcium in their coronary arteries than non-athletes. And coronary artery disease is the most common cause of sudden death in athletes. I can recall a couple of people on the ward recently who “died” and were then resuscitated during exercise. It’s not uncommon.

See:

  1. http://circ.ahajournals.org/content/136/2/126
  2. http://circ.ahajournals.org/content/136/2/138

 

So, exercise is bad then?

Not so fast. In fact, generally, the more exercise you do, the less likely you are to have a heart attack. Some articles suggest your risk is about 50% less (but NOT zero). This is one of those annoying paradoxes that crops up in medicine all the time. It is probably down to the composition of the plaques that are seen – the plaques in athletes are more “stable” – less likely to rupture and cause a heart attack. More work is required to understand this though.

So, keep exercising – but listen to your body. If you are doing the same route and you are struggling more than you would expect then be careful, although everyone has good and bad days, and everyone ages. If you are getting chest tightness when you exert yourself which eases off with rest, then seek medical attention.

Post Script: I ran 24K on Saturday. It felt good. But, of course, the jump was too much and now my knee is sore and swollen. I really should know better…

Written by mjd

A 40something cardiologist from the UK

Leave a Reply

%d bloggers like this: