While studies emphasise the importance of exercise for our well-being, there is the possibility that one might put unnecessary strain on the heart. Sports physician David Attard tells Lorella Fava about the downside to exercise and advice on the right amount of physical activity for different ages.

Exercise has become the modern-day religion. It not only helps one look good but helps boost one’s confidence and, most importantly, it has tremendous health benefits such as strengthening bones and muscles, improving mental health and mood, reducing risk of cardiovascular disease and preventing Type 2 diabetes.

But is there such a thing as too much of a good thing when it comes to exercise? Could it, if done improperly or excessively, negatively impact our health?

David Attard, senior medical officer at the Malta Football Association, says: “The right dose gives us substantial benefits but too much of it can be deleterious in various ways.”

He explains that although “compulsive” exercisers or exercise addicts are a minority – usually long-distance runners or bodybuilders – too much exercise can lead to injuries, some of which may be permanent.

It can also have serious psychological consequences and “alter the body’s hormonal profile”.

Focusing specifically on the heart, he says that intense workouts and certain competitive sports tend to stress the heart and increase blood pressure.

Our hot summer sun may not be good for practising sports. Attard explains that the heart has to beat faster and pump harder in order to cope with a rising body temperature and increase blood flow to the skin.

“Sweating cools the body but it also leads to loss of electrolytes in addition to profuse water loss. All this constitutes a further strain on the cardiovascular system.”

Attard says that while many healthy individuals can cope with such strenuous physical activity when well-trained and properly hydrated, a weaker heart may succumb to such strain, potentially leading to serious consequences such as dizziness and heat stroke. It is thus important to watch out for “distress signals”.

The right dose gives us substantial benefits but too much of it can be deleterious in various ways

“Distress signals may be subtle and less dramatic,” the sports physician says.

These signals include pain or discomfort in one or both arms, the back, neck, jaw or stomach; shortness of breath which is disproportionate to the exercise intensity being performed; nausea or light-headedness; feeling of excessive tiredness and irregular heartbeat.

“If heeded and treated in time, such signals can be life-saving. Unfortunately, this may not always be the case. There have been various high-profile cases of top athletes collapsing on a field of play. The only life-saving measure in these cases would be immediate and efficient cardiac resuscitation.”

The death of a schoolboy in a playground in Malta some years ago had raised awareness about the importance of having AEDs (Automated External Defribillator), which can restart a patient’s heart in cardiac arrest, in schools and public places.

“Quick action can help save lives,” says Attard. “Defibrillation within three minutes of sudden cardiac arrest increases the chances of survival to 70 per cent. Shock within one minute of collapse raises the survival rate to 90 per cent. Because of this, all schools should consider having an AED as part of their first-aid supplies.”

Among others, St Andrew’s C.E. Primary School has invested in these electronic devices and offered training sessions for parents. Effort was also made by around 250 students from Sir Michelangelo Refalo Sixth Form, Victoria, last year to raise money to buy a defibrillator for their school.

Nonetheless, Attard stresses that although exercise may carry certain risks, inactivity is much more dangerous.

“Exercising adequately and regularly leads to beneficial adaptations in the body, rendering us fitter and stronger.”

Moderate exercise reduces overall cardiovascular risk, and its benefits, when combined with other lifestyle modifications, like proper nutrition and smoking cessation, can be “substantial”.

Attard adds that the type and duration of exercise one performs should ideally be individualised to a person’s capabilities and health status.

Referring to a series of studies conducted by the Lancet Medical Journal in 2012, he points out to the alarming fact that Malta was ranked the “laziest country in the world” with 71.9 per cent of the population being physically inactive.

“This warrants a serious and steady campaign to promote exercise and physical activity on this island.”

Physical activity recommendations

EARLY YEARS (Under 5s)

For children capable of walking

• Children of pre-school age who are capable of walking unaided should be physically active daily for at least 180 minutes (three hours), spread throughout the day.

• All under 5s should minimise the amount of time spent being sedentary (being restrained or sitting) for extended periods (except time spent sleeping).

For children who are not yet walking

• Physical activity should be encouraged from birth, particularly through floor-based play and water-based activities in safe environments.

CHILDREN and TEENAGERS (5-18 years)

To maintain a basic level of health, children and young people aged five to 18 need to do:

• At least 60 minutes of physical activity every day, which should range between moderate activity, such as cycling and playground activities, and vigorous activity, such as running and tennis.

• On three days a week, these activities should involve exercises for strong muscles, such as push-ups and exercises for strong bones, such as jumping and running.

• All children and young people should minimise the amount of time spent being sedentary for extended periods.

ADULTS (19-64 years)

• Adults should aim to be active daily. Over a week, activity should add up to at least 150 minutes (2½ hours) of moderate intensity activity in bouts of 10 minutes or more – one way to approach this is to do 30 minutes on at least five days a week.

• Alternatively, comparable benefits can be achieved through 75 minutes of vigorous intensity activity spread across the week or combinations of moderate and vigorous intensity activity.

• Adults should also undertake physical activity to improve muscle strength on at least two days a week.

• All adults should minimise the amount of time spent being sedentary for extended periods.

OLDER ADULTS (65+)

If generally fit and in the absence of health conditions that limit mobility, older adults should try to be active daily and should do:

• At least 150 minutes of moderate aerobic activity such as cycling or walking every week, in bouts of 10 minutes or more. One way to approach this is to do 30 minutes on at least five days a week.

• Strength exercises on two or more days a week that work all the major muscles (legs,  hips, back, abdomen, chest, shoulders and arms).

References

Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries’ Chief Medical Officers (2011)

Physical Activity and Public Health in Older Adults: Recommendation from the American College of Sports Medicine and the American Heart Association. Nelson, M.E. et al (2007). Medicine and Science in Sports and Exercise. 39(8 1435-1445.