2023-08-14 08:47:40
We know that moving is important for maintaining good cardiovascular health. But is there an amount of sport above which activity damages the arteries? The explanations of Pr François Carré, cardiologist and sports doctor.
Professor François Carré is a cardiologist, sports doctor at the University Hospital of Rennes and professor emeritus of cardiovascular physiology at the Faculty of Medicine of Rennes, he is very committed to the fight once morest physical inactivity and sedentary lifestyle. He is the author of the book Danger sédentarité (Le Cherche Midi). He modestly and has always practiced running.
Would too much sport harm the heart? In any case, this is what one might think when reading a recent study which shows a greater progression of atherosclerotic plaques in middle-aged men who have been practicing intense endurance efforts for a long time than in men of same age with lower physical activity. What do you think?
This question has arisen for several years among sports cardiologists. We indeed observe in enduring sportsmen cardiac particularities, slow and dilated heart, which define the athlete’s heart. However, what is abnormal is not necessarily pathological. The best proof is that, all the studies show, athletes who have practiced endurance for a long time live on average four to six years longer than the rest of the population. That being said, it is true that certain cardiac arrhythmias, such as atrial fibrillation, are more frequent in athletes, endurance or team sports, males over 50 years old. This risk of arrhythmia which is a little higher, 4 to 5% once morest 2% in the general population, remains low.
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But not all marathon runners have these rhythm disorders, far from it. Thus, pain in the Achilles tendon remains the most frequent obstacle to the practice of the marathon, while atrial fibrillation is very rare. Now let’s take the study you refer to. Like others before her, she shows an increase in the calcium score, calculated with a simple chest scanner, in highly trained enduring athletes compared to the general population. As calcium binds to the atheroma plaques, the calcium score makes it possible to measure the extent of the atheroma deposits observed at the level of the walls of the arteries of the heart, the coronaries. In the general population, the calcium score is a well-validated marker of cardiovascular risk. The higher the score, the higher your risk of having a myocardial infarction. However, in these enduring athletes, there are fewer cardiovascular accidents.
Isn’t that contradictory?
No, because in these athletes the atheroma plaques observed are very calcified and therefore less at risk of breaking and going to form a clot which, by blocking the coronaries, causes myocardial infarction. The question of the level of calcium score to be taken into account for athletes therefore remains. Should it be the same as in the general population? We do not know. The real problem is that at present we do not really know what cardiac explorations to carry out to detect the asymptomatic athletes most at risk of having a heart attack.
Doesn’t the stress test which is most often prescribed make it possible to identify these athletes at risk?
The standard stress test remains a very good examination which provides essential information, such as physical capacity, a reflection of our health capital, but it is not effective in detecting the risk of myocardial infarction in a subject who does not complains regarding nothing. Stress infarction is mainly due to the rupture of a small atheroma plaque which obstructs 30 to 50% of the blood vessel and which the stress test cannot detect. This examination can only detect plaques that occupy 60 to 70% of the lumen of a vessel.
What do you do today when faced with an athlete in whom we discover a high calcium score?
Sport does not immunize once morest cardiovascular accidents: the risk of having one is reduced but not ruled out. All athletes must identify the occurrence of a symptom on exertion, malaise, palpitations, chest pain, shortness of breath or abnormal fatigue. In the event of a high calcium score, it is necessary to look for symptoms and risk factors (tobacco, cholesterol, diabetes, arterial hypertension, etc.). Not all athletes have a healthy lifestyle.
Very short but intense exercises associated with marked shortness of breath also reduce mortality. By moving ten minutes a day, you reduce your cardiovascular mortality
In addition, remember that tobacco never mixes well with sport and that advancing age is a major risk factor for developing atherosclerotic plaques. You should always remember this when doing sports intensively with younger comrades. Risk factors must be addressed and balanced in all athletes. In the event of a high calcium score, a cardiovascular examination should be carried out during exercise by a cardiologist.
For each of us, sportsman or not, an analysis has just shown that ten minutes a day of physical activity is enough to reduce cardiovascular mortality by 19%. So we forget the thirty minutes a day recommended by the World Health Organization?
Especially not. It must be recognized that today, as with junk food, we are not very effective in our messages… According to the work of the National Food Safety Agency (Anses), 70% of women and 42% of men are below these thirty minutes of activity. Worse, more than a third of adults combine a high level of sedentary lifestyle (daily waking time spent sitting or lying down) and insufficient physical activity. Since people don’t have the time, it is important to know if lower levels of physical activity are also beneficial in terms of health. This is what has been demonstrated: very short but intense exercises associated with marked shortness of breath also reduce mortality. By moving ten minutes a day, you reduce your cardiovascular mortality; if you increase to twenty minutes and especially thirty minutes, the gain will be greater. Beyond half an hour a day, the benefits still exist but are more marginal. It is for this reason that the WHO advises this duration of activity with moderate shortness of breath: I can speak but not sing. These sessions can be divided, for example three times ten minutes.
How much physical activity do you recommend for healthy people?
Follow WHO recommendations. However, on the day when you don’t have time to do your thirty minutes of moderate activity, I advise you, as soon as you have three or four minutes, to move intensely. You can climb a few flights of stairs quickly, walk to a meeting very quickly, even jump rope or do a series of squats.
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