Last week we had a look at exercise through clinical lenses, and likened it to a prescription medication due to its ability to assist in the prevention, treatment and management of a range of conditions and diseases. Just like a drug, however, exercise administered in excessive dosages can become addictive and might even cause some adverse reactions.

We do not often discuss this darker side of exercise, so for the sake of fairness, it is probably about time we had a crack at it here. International competitive sport often brings such gremlins to the surface in spectacular style, since it is of course one of the most extreme manifestations of exercise and physical activity we are routinely exposed to.

Have you ever wondered how elite athletes in the prime of their lives can suffer such sudden, surprising and lethal heart attacks? It is with alarming frequency lately that headlines have been reporting sudden deaths in a range of sports including football and cycling.

It always comes as an unnerving shock, since we tend to see our elite sporting heroes as symbols of pure power, strength and supreme health. It stands as a contradiction in terms to witness such athletes fall victim to tragic and unexpected deaths with such apparent fragility.

The phenomenon indeed reveals a more sinister side to sport and physical activity and it would be almost as tragic should the public ever suspect that exercise itself is fatally dangerous to all. The question arises therefore, is exercise really so potentially hazardous if it can strike down even the fittest of the fit?

Back in 2012, Belgian scientists hypothesised that intensive endurance training at elite level leads to abnormal growth of the right ventricle of the heart. They, in turn, associated this growth with an increased risk of suffering from sudden and lethal heart attacks.

Sports physicians at the University of Saarland, however, debunked this view just last month. Based on findings obtained from a large sample of former elite endurance athletes, including triathletes and footballers, they revealed no adverse effects to the heart resulting form long-term intensive endurance-based training.

Safe and effective programming and monitoring of exercise intensity will remain pretty effective strategies for ensuring your safety

So it is not the training itself, or the physiological effects resulting from it, that are necessarily the problem. Indeed, the physiological changes undergone by the heart in response to physical activity are well known by exercise scientists and generally regarded as positive and conducive to better health. The problem appears to be a little more complex.

The heart attacks affecting elite sports performers usually occur during competition itself, or during bouts of extreme physical activity where athletes are generally operating at near maximal potential. Autopsies reveal that abnormal growth in either the muscular walls of the heart or in the main arteries serving it tend to be the main culprits, but where does this abnormal growth come from?

Unfortunately the potential for such abnormalities to develop generally tends to lay dormant and undetectable until it is too late. Sudden death is the only known symptom, leaving it next to impossible to make an effective diagnosis until it is obviously too late. In other words, it is pre-existing and difficult-to-detect genetic abnormalities that eventually lead to undesirable changes to the structure, function and rhythm of the heart, which can in turn lead to sudden heart failure in response to extremely vigorous bouts of physical activity.

So assuming you’re not an elite athlete operating at the very top of your game, you can rest assured that safe and effective programming and monitoring of exercise intensity will remain pretty effective strategies for ensuring your safety. So all things being equal, how safe is exercise really? It is healthy to keep in mind that exercise itself does actually pose an element of risk. The moment you decide to start moving around more than you did before, your risk of sustaining physical injury or aggravating some unknown condition or disease suddenly increases.

Exercise-induced asthma for instance is actually caused by exercise, even though appropriate identification and treatment methods have progressed in leaps and bounds of late. If you suffer from chronic pain or auto-immune disorders, exercise can sometimes also trigger painful flairs, however apparently well-planned it is.

That said, the advantages of participating in increased physical activity still tend to far outweigh the disadvantages, which is why exercise if so vigorously promoted from almost all quarters. When you join a gym or fitness class, you will generally sign an informed consent form or waiver where you agree to participate in spite of the risks you understand to be present. A simple screening or medical questionnaire will rule out any major risk factors placing you in potential danger, and once you begin exercising, a fitness professional will always take basic steps to help ensure your safety and enjoyment.

Making sure you can perform the techniques correctly without compromising joints or muscles will cut down your risk of acute or overuse injuries. Keeping the intensity appropriate to your fitness levels will also ensure your heart is not subjected to undue stress.

So do not be discouraged by the darker side of sport and physical activity, because while it is important to understand exercise does pose certain potential risks, these should serve only as motivation to take your developing regimen even more seriously and start enjoying some of the far more plentiful benefits and rewards that await you.

matthew.muscat.inglott@mcast.edu.mt