Dr. Phil Maffetone 21: Heart Health For Athletes – Identifying Risks, Weeding Out Hype and Why Exercise Is Still Your Best ‘Medicine’

June 14, 2017


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Dr. Phil Maffetone is back for this instant classic episode talking about heart health and athletes with everything you need to know, what information out there that you can ignore, and proactive tips to stay healthy for a lifetime.

  • We often see articles and hear unfortunate stories of athletes with heart health complications, sometimes resulting in death. It understandably would make anyone a bit nervous to think their exercise routine might be deadly. But is it as simple as assuming that exercise puts one’s heart at risk? Or are there underlying issues that would make one more prone to developing a heart condition or experiencing a cardiovascular event.
  • What are legit vs. inaccurate concerns about types of damage to the heart muscle that may be associated with running and endurance sports?
  • The basic physiological adaptations that occur in the heart and CV system when one trains for endurance – these adaptations all boost performance but could put more “stress” on the heart.
  • Phil outlines the real reasons athletes get heart issues—from diet to stress—and why you can rest easy that exercise is ok and that a lot of the news media you hear is hyped up or not telling the whole story.
  • Even if someone appears healthy and eats clean, could there still be an underlying risk?

Easy ways to monitor and assess your health and risk:

  • Things we can do to be proactive:
    • Clean diet low in “junk” foods and rich in nutrient dense whole foods
      • Mostly avoid refined sugars/carbs and vegetables oils; avoid carb intolerance
      • Tailor carbs to your needs
      • Interview with Dr. Cate Shanahan
    • MAF test
    • HRV measuring
    • Recovery focus
    • Frequent blood work
    • Fasting blood glucose—monitor this often
    • Measure your waist circumference—waist to height ratio;
    • Health history and physical from doctor; with you asking the right questions – record your office visits or appointments!
    • Blood pressure monitoring
  • Risk factors:
    • Pre-diabetes or diabetes
    • Pre hypertension or hypertension—sympathetic system revved up, will perform well at expense of health.
    • Waist-to-height ratio—if waist circumference is half your height or more, that’s not good. More info here.
    • Only then go to: EKG, ECG, treadmill stress test (don’t go to this first).

Studies mentioned:

  • Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise
    • Long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. What are issues with the heart that can happen over years?
    • Acute effects:
      • Volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers.
      • Returns to normal within 1 week.
    • Months to years of repetitive injury may lead to:
      • Adverse CV remodeling
      • Patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias.
      • Coronary artery calcification
      • Diastolic dysfunction
      • Large-artery wall stiffening.
  • Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352participants from Athens 2004 to Sochi 2014
    • Assessed the prevalence and type of CV abnormalities.
    • 2352 Olympic athletes average age of 25.
    • 92 athletes (3.9%) showed abnormal CV findings.
    • Structural abnormalities (6 types) included
      • Inherited cardiomyopathies (n=4)
      • Coronary artery disease (n=1)
      • Perimyocarditis (n=4)
      • Myocardial bridges (n=2)
      • Valvular and congenital diseases (n=45)
      • Systemic hypertension (n=10)
    • Primary electrical diseases (4 types) included
      • Atrial fibrillation (n=2)
      • Supraventricular reciprocating tachycardia (n=14)
      • Complex ventricular tachyarrhythmias (non-sustained ventricular tachycardia, n=7; bidirectional ventricular tachycardia, n=1)
      • Major conduction disorders (Wolff-Parkinson-White (WPW), n=1; Long QT syndrome (LQTS), n=2).
    • Conclusion: “This study revealed an unexpected prevalence of CV abnormalities among Olympic athletes, including a small, but not negligible proportion of pathological conditions at risk. This observation suggests that Olympic athletes, despite the absence of symptoms or astonishing performances, are not immune from CV disorders and might be exposed to unforeseen high-risk during sport activity.”
  • Running as a Key Lifestyle Medicine for Longevity
    • Recently, specific questions have emerged regarding the extent of the health benefits of running versus other types of PA, and perhaps more critically, whether there are diminishing returns on health and mortality outcomes with higher amounts of running.
    • In general, runners have a 25%–40% reduced risk of premature mortality and live approximately 3 years longer than non-runners.
    • After controlling for smoking, booze consumption, body mass index, and the like, running still was found to reduce all-cause mortality risk.
    • Roughly each hour spent running adds 7 hours to one’s lifespan.
    • Running might just be the most cost-effective “life medicine” from a public health standpoint,
    • Found that even slow jogging is consistently considered a vigorous-intensity physical activity.
  • Physical activity and telomere length in U.S. men and women: An NHANES investigation
    • Telomeres are nucleoprotein caps positioned at the end of chromosomes.
    • Aging causes telomeres to shorten significantly and results in gradual cell deterioration.
    • Regular physical activity reduces disease risk, possibly due to the preservation of telomeres.
      Results showed that regular activity accounted for significantly longer telomeres in U.S. adults.
    • The longer telomeres found in active adults accounted for 9 years of reduced cellular aging.
  • Dose of jogging and long-term mortality: the Copenhagen City Heart Study
    • Compared with sedentary nonjoggers, 1 to 2.4 h of jogging per week was associated with the lowest mortality.
    • The optimal frequency of jogging was 2 to 3 times per week.
    • The optimal pace was slow or average.
    • The lowest HR for mortality was found in light joggers, followed by moderate joggers and strenuous joggers.
    • “The findings suggest a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. Light and moderate joggers have lower mortality than sedentary nonjoggers, whereas strenuous joggers have a mortality rate not statistically different from that of the sedentary group.”

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