Sport is good for the heart, but for agonistic athletes the relationship with the cardiologist becomes more than essential. If a sedentary lifestyle promotes overweight and reduces the strength and circulatory capacity of the heart, it is also true that intense sport can overload the heart. So is exercise good for the heart, or only to a certain extent? We talked to Andrea Vitali, sports cardiologist and lecturer in physiology at UniCamillus University.
“Anyone who wants to do sport, whether it be at a competitive level or not, should have a cardiovascular check-up”, explains Vitali. “This applies not only to those who are taking up sport for the first time, but also to those who define themselves as ‘experienced sportspeople’, who have often been sedentary for years and are unaware of the changes in their cardiovascular system”.
While physical activity has a positive effect on mood, body weight and lipid and glycaemic balance, it can also lead to an overload of cardiac work and, in those susceptible, excessive exertion can cause acute damage or aggravation of a latent condition.
Sedentary and active people: what are the health risks for the heart?
When it comes to heart risks, both sedentary people and athletes can be exposed. “Both are at risk; nobody is immune”, says Vitali. “The cardiovascular risk is never zero, at any age. Sedentary people have a higher risk than those who regularly do at least 30 minutes of physical activity five times a week, as the guidelines confirm. On the other hand, the athlete who performs long and strenuous performances and does not undergo adequate cardiovascular screening is also at risk of acute damage”.
What check-ups for sportspeople?
Before you start competing, here are the steps you should take to ensure your heart is healthy:
- The check-ups start with a cardiological examination (including laboratory tests) and a resting ECG.
- This is followed by a step test (for men under 40 and women under 50) or an ergometric test for those over these ages.
- The step test is performed by walking up and down a step at a steady pace for a set period of time and then measuring the heart rate immediately after finishing. The faster the heart recovers, the better the physical condition.
- The ergometric test measures the cardiovascular response to maximum exercise intensity. It is performed by walking or running on a treadmill or pedalling on a stationary bicycle while heart rate, blood pressure and other vital signs are monitored. It helps to assess cardiovascular health and detect possible heart problems under stress.
- If necessary, a full cardiovascular check-up may also include a colour Doppler echocardiogram, which is an ultrasound test that visualises the heart and its structures. It uses ultrasound to create a moving image of the heart and blood vessels. Colour Doppler provides an analysis of blood flow, showing the speed and direction of the blood, which is useful in detecting problems such as valvulopathy or structural heart disease.
“If any suspicious signs or clear pathology are detected at this stage to assess agonistic fitness, other specific tests are carried out”, explains Vitali.
However, as far as follow-up examinations are concerned, these always include a cardiological check-up with a resting ECG, together with a step test or a maximum progressive growing ergometric test.
When it comes to competitive activity, the question arises as to whether some sports are more dangerous for the heart than others. The answer is that each sport has its own risks. “Some sports, such as diving, are directly life-threatening in the event of an illness”, stresses the expert, “while aerobic sports with a high cardiovascular impact, such as cycling and swimming, can have a negative impact on those with latent or undiagnosed heart disease”.
Warning signs not to ignore
While it is true that there are no clear symptoms of heart disease, there are certain signs that should never be overlooked. “Episodes of syncope, symptomatic irregular heartbeat or chest pain during or after exercise are warning signs that require further clinical and diagnostic investigation”, warns Vitali.
What if you discover that you have a congenital or acquired heart condition? The good news is that most cardiovascular conditions do not prevent you from exercising, as long as you do so under medical supervision. “Congenital pathologies that have been surgically corrected or simple forms without significant arrhythmias are often compatible with sport”, says Vitali, “while the aforementioned ergometric tests and colour Doppler echocardiogram are essential to establish the safety of each specific case”.
The most worrying cardiac event is undoubtedly the risk of sudden death during exercise. In fact, this dramatic outcome seems to be the worst possible symptom of existing but undiagnosed heart disease. “In most cases, good prevention and adequate cardiovascular screening will reduce the risk”, Vitali reassures. “However, in young people, careful attention must be paid to detecting coronary anomalies, cardiomyopathies or channelopathies, all of which are associated with an increased risk of sudden death. A simple ECG can be the first step in raising the alarm, but it is not always enough: in some cases, more in-depth tests such as genetic testing or cardiac MRI are needed”.