Is the way you exercise endangering your health?

Exercise is good for us, and most of us don’t do enough of it. But experts warn too much of a good thing has the potential to cause problems as we age.

Maintaining strength, stamina, suppleness and skill are crucial for long-term wellbeing. Picture: Supplied

Exercise is good for us, and most of us don’t do enough of it. The latest findings from Sport England’s Active Lives Survey suggest that more than 25 per cent of adults do less than 30 minutes physical activity a week and a further 11 per cent don’t reach the minimum target of 150 minutes a week to improve health by building bone density, preventing muscle atrophy and warding off disease.

At the other end of the spectrum is the growing number of people who work out diligently, training for endurance cycling and running events or triathlons or playing competitive sport well into midlife and beyond. For them the fitness gains seem obvious, but experts warn there is a tipping point with exercise and that too much of a good thing has the potential to cause problems as we age.

In the latest study to track the middle-age Lycra-clad brigade, researchers at the University of Leicester found that runners, cyclists, swimmers and triathletes who had trained and competed, even in local recreational events, for several years were more at risk of developing atrial fibrillation (AF), a condition that occurs when electrical impulses that trigger heart muscle contractions misfire chaotically, causing an erratic heartbeat.

With the heart pumping less efficiently than it should, AF increases the risk of blood clots developing, which can lead to a stroke, and of heart failure down the line.

Age is an unavoidable risk factor for the condition, but the new research suggests that intense and prolonged exercise may also play a role for some people. “It remains true that the benefits of exercise far outweigh any risks and you will live longer and have a healthier heart if you are fit,” says Dr Susil Pallikadavath, an academic foundation doctor and clinical fellow in the department of cardiovascular sciences who led the investigation. “But we found that for some people in our sample, all of whom were aged at least 40, long-term training for endurance events increased the risk of AF.”

Of the 1,000 participants in the study, about 20 per cent had AF and the keener the exerciser, the greater the risk. “In the general population, people are usually treated for AF with blood thinners based on a risk score for weight, fitness and health,” Pallikadavath says. “What we found with this group is that even though they had a low risk score for these health parameters they still seemed to be at a higher risk for stroke because of the AF, suggesting the exercise made a difference.” He accepts that there were limitations to his study, including that it attracted some middle-aged exercisers who might already have had concerns about heart issues, but, Pallikadavath says, “We would encourage everyone, male and female, to be aware of the risks.”

Bill Ribbans, a doctor and consultant in orthopaedic surgery who is also professor of sports medicine at the University of Northampton, says his clinics are full of enthusiastic patients aged 50-plus who have taken their exercise a step too far, and that a more cautious approach to hardcore workouts is required among the middle-aged. “As we age the body’s response to exercise changes significantly,” he says. “Our lung capacity diminishes and we have typically lost 30 per cent of our maximum heart rate – and so our ability to pump blood to muscles and vital organs during hard exercise declines.”

None of this means we should stand still. Far from it, notes Ribbans, who says that maintaining what he calls the four pillars of fitness – strength, stamina, suppleness and skill – is crucial for long-term wellbeing. There is no set upper limit for how much exercise you can do, but “know your body and know the warning signs” is his advice. Here’s how to make sure you don’t overdo it.

Experts warn there is a tipping point about the amount of exercise people do. Picture: Supplied

1. CHECK FOR AF SYMPTOMS

Symptoms of AF are not always obvious, Pallikadavath says, but keep an eye open for unusual fatigue, light-headedness or breathlessness on exertion. “If your heartbeat seems erratic, you sense any unusual palpitations, chest pain or shortness of breath associated with exercise, you should see a medical professional,” he says. Checking your own pulse is helpful and if it seems irregular and doesn’t follow a steady pattern get in touch with your GP. Doctors might refer you for an ECG, the standard test used to diagnose AF, or to use a cardiac event recorder, a small device that records your heart rate and rhythm when symptoms occur.

2. INVEST IN A SMARTWATCH OR FITNESS TRACKER

Smartwatches, smartphone apps and other gadgets that claim to identify your risk of AF are the latest health data tracking trend and Ribbans says they are useful for monitoring all elements of fitness.

“Many fitness trackers have settings that indicate when you need rest and recovery based on your fitness levels and individual data,” he says. “They might not be entirely accurate but are a useful guide.”

Apple Watch users can enable notifications from the Heart Rate app on their device to receive alerts of any irregular rhythm that might be suggestive of AF and can also access a detailed history of heart rhythm and an estimate of how frequently their own heart rhythm displays irregularities. Some Fitbit devices, including the Fitbit Versa, also feature “irregular rhythm notifications” that have been validated in a clinical trial to record heart rhythm data while you sleep and analyse it retrospectively for signs of AF.

Health experts say that exercise should be taken regularly, not seriously. Picture: NCA Newswire /Gaye Gerard

3. DON’T BINGE-EXERCISE AT WEEKENDS

Ribbans says that back-to-back weekend warrior-style workouts are a “classic route to injury” for the middle-aged. “Binge exercising does not allow for the rest and recovery that becomes more important as we get older,” he says. “Muscles, tendons and bones need time to assimilate the impact of intense exercise and if you do a long run, bike ride, play tennis or football on a Friday or Saturday and go back to another strenuous session the following day you risk damage.”

Production of type 1 collagen, a building block of tendons and ligaments, peaks three days after intense exercise. “That is probably when you should be able to do another run or cycle, depending on how intense the previous session was,” Ribbans says. “Too little recovery and you are storing up trouble for the future, leaving yourself susceptible to strains and pain.”

4. ACCLIMATISE BEFORE GOING OUTDOOR SWIMMING

Swimming, in particular, presented heightened risks for AF in Pallikadavath’s new study, and although he says more research is needed to find out why, it is likely that the midlife trend for swimming outdoors in open water presents more risks than an indoor pool.

Mike Tipton, professor of human and applied physiology at the University of Portsmouth’s Extreme Environments Laboratory, has suggested that some deaths in outdoor swimming can be attributed to cardiac arrhythmias experienced in the first couple of minutes after immersion and says this could be down to cold water shock that is more likely if people take a prolonged inward breath before jumping in.

According to the Outdoor Swimming Society, even in summer water temperatures can be a fresh 17-20C, considerably lower than the 26-31C of a heated indoor pool. Getting in slowly helps to steady your breathing before you start to swim. In addition, Tipton says at least six short immersions in cold water are recommended to help your body adapt so that the cold water shock response can be reduced.

5. REMEMBER YOUR JOINTS AND TENDONS ARE ON BORROWED TIME

Our bodies have a finite number of miles – or hours of sport – on the clock before the machinery starts to splutter. “We can keep going for longer if we start exercise later, or if we take care of our muscles and joints and treat them carefully,” Ribbans says. “But thousands of miles of running or cycling, or endless high intensity and high-impact gym sessions while not heeding your body’s warning signals of injury and wear and tear will take their toll.” The first to succumb is often the achilles tendon, the strongest tendon in the body, which extends from calf to heel and is used to walk, run and jump. “One in nine of my middle-aged patients comes in with achilles problems that have forced them to stop exercise,” he says. “Be aware of the early warning signs of tenderness and seriously rein back on high-impact exercise if you reach the stage where your achilles is chronically sore and inflamed as you have significantly lower chances of getting it under control and carrying on.” We should also be kind to our knee, hip and ankle joints, varying the terrain on which we walk or run as much as possible and easing back if there is soreness or pain. “Avoid concrete and tarmac when you can and head for more forgiving grass, trails and mud,” Ribbans says.

6. DON’T OVERDO THE HIIT CLASSES

A study at Rutgers University found that those adults who did a lot of high-intensity interval training sessions combining weightlifting and body-weight calisthenics at maximum capacity were at greater risk of injury. HIIT classes typically included the use of barbells, kettlebells and boxes, and exercises such as burpees, push-ups and lunges, and the most common injuries involved knees, ankles and shoulders.

Men aged 20 to 39 were most likely to report injuries, although they were prevalent in all age groups. Ribbans says that injuries occurring in your twenties and thirties “when you think you can get away with it” will often exact revenge later in life. “Thirty years-plus later, you can often remember which tackle, fall or gym class caused which ache or weakness,” he says. “Take care not to overdo one particular type of activity and mix things up as much as you can, varying exercise forms particularly after the age of 40.”

The Times