Exercise is often referred to as the best preventive medicine, but how much is it to the heart of middle-aged athletes?
Sports Cardiologist Dr. Benjamin Levine led the study, which is now published in JAMA Cardiology, to find the answer. Dr. Levine is a professor of internal medicine and director of the Institute of Exercise and Environmental Medicine, a collaboration between UT Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas.
What is coronary calcium scanning and why is it important?
Coronary Calcium Scan is a diagnostic test that helps physicians classify patients with no heart symptoms as low, medium or high risk of heart attack. It represents how much calcium (and thus cholesterol) accumulates in the blood vessels that supply the heart. Scanning can help doctors determine the need for medicines, lifestyle changes, and other risk mitigation measures.
"The question has never been whether the exercise is good for you, but is extreme exercise bad for you. In the last decade, there is growing concern that high volume and high intensity exercise could hurt the heart. We've found that large amounts of exercise are safe, even when the levels of coronary calcium are high, "Dr. Levine said.
Exercise of high volume, high intensity is defined in this study as at least five to six hours per week at a rate of 10 minutes per mile. The average number of high intensity exercises in this group was eight hours a week.
Coronary calcium is the imprint of atherosclerosis, a disease in which plaques accumulate in the arteries and cause heart attack and stroke. When coronary calcium is detected in the heart, the process of blockage within the blood vessels begins. Most high intensity athletes had a low level of coronary calcium, although it is likely to have a higher level of 11% higher than the men who had less. Most importantly, researchers have found that higher levels of calcium did not increase the risk of high intensity athletes for cardiovascular or death from all causes.
Dr. Levine studied the data from Longitudinal Studies Cooper Center. Overall, 21,758 were generally healthy men aged between 40 and 80 years without cardiovascular disease due to mortality between 1998 and 2013. Athletes, most of them middle-aged, reported the level of their physical activity and underwent scanning of coronary calcium. Most were mostly runners, but some were cyclists, swimmers or rowers. An athlete's sub-team trained in three of these sports.
Women are not included in the study because mortality rates are lower than in men.
Despite the findings that extreme exercise does not increase the risk of heart disease, Dr. Levine advises not to use the protective effect of exercising for excuses for bad habits. "You can not overcome bad behavior throughout your life – smoking, high cholesterol, high blood pressure – only from high levels of physical activity, so do not use it as a magical remedy," said Dr Levine, who has prominent UT practitioners Southwestern.
It also recommends caution when launching a new training program. "If you want to train for a marathon, you must have a long-term plan to build up slowly before you achieve that amount and intensity of exercise."
"The well-known benefits of regular physical activity in the general population include reduced mortality, heart disease, diabetes, and many other medical conditions that remind us of how important it is to participate in regular physical activity as recommended by the Physical Activity Guidelines for 2018." Laura DeFina, Chief Scientist of the Cooper Institute and co-author of the study. "Current research does not show an increased risk of mortality for high-grade exercise-makers who have coronary artery calcium. Of course, these high-level exercise examiners should look at the risk of cardiovascular disease with a primary health care practitioner or cardiologist, and research findings provide helpful clinical guidelines.
"The most important message that the public learns about exercise is that large amounts of exercise are safe. The benefits of exercise far outweigh the risk of having a little more coronary calcium, "Dr. Levine said.
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Defina, L.F., Radford, N.B., Barlow, C.E., Willis, B.L., Leonard, D., Haskell, W.L. , Levine, B.D. (2019). The association of mortality from all causes and cardiovascular diseases with high levels of physical activity and simultaneous calcification of coronary arteries. JAMA Cardiology, doi: 10,1001 / jamacardio.2018.4628