What's safer - chilling out or working out?

Five years ago, Anna Loyley, a healthy super-fit 26 year-old theatrical agent, was photographed crossing the finishing line of the Bath half-marathon – triumphant, radiant, happy…  Ten second and 10 strides later, she fell to the ground and died.  At the inquest, it was determined that Anna, who had completed several full marathons, jogged nearly every day and regularly visited the gym, had a rare and undiagnosed congenital heart defect, and that while endurance running was not the cause, it had triggered the catastrophe – leading the coroner to recommend that, in future, athletes should be screened for heart conditions before taking part in sporting competitions. 

This and other recent deaths of relatively young individuals in the middle f their exercise sessions – Douglas Adams, cult author of The Hitchhiker’s Guide to the Galaxy, who collapsed and died in the idle of his regular workout in the gym in Santa Barbara, at not even two score year and 10; Prince Takamado, seventh in line to Japan’s Chrysanthemum throne, who suffered heart failure at the age of 47 during a quash lesson; and Fulham accountant, Andrew Jackson, who died on a treadmill at just 30 – has sent shockwaves down the spines of all of us who pound pavements or treadmills or running tracks, convinced we are doing ourselves the biggest health favour since….  Well, since we last went out exercising.

Could the very thing we do to prolong our lives also be shortening them?  I asked Dr Dan Tunstall Pedoe, consultant cardiologist at St Bartholomew’s Hospital.  Of all people, he should know.  A committed runner himself, he has been medical director of the London Marathon ever since it started back in 1981 and is a firm believer in the huge health advantages of reasonably vigorous exercise.  “Only if you’ve already got heart disease”, he replied.  “there’s absolutely no evidence that exercise itself can precipitate a fatal attack in a normal heart.”  Of the seven fatalities in the London Marathon since the race began in 1981 – all men – six had sever underlying heart disease (and the seventh a brain haemorrhage), which could have come to light, he claims, “if they had had the appropriate tests”.  Namely, a risk-factor evaluation, an exercise electrocardiogram (ECG) and, if indicated, an angiogram – a more invasive and potentially risky procedure that looks for any narrowing of the all-important coronary arteries.

The problem is that cardiovascular screening is not routinely available.  Even our Olympic athletes do not get it as part of their pre-competition work-up and, while most reputable gyms run fitness tests for ordinary mortals, they cannot detect the one thing that is the near-invisible precursor of sudden middle-age deaths – coronary arterial disease (CAD).  According to Greg Whyte, exercise physiologist for the British Olympic Centre, even the exercise ECG – in which the pumping of blood around the body is measured during exercise, can fail to pick up as many as four out of five cases of CAD.  And while there are sometimes warning signs of impending coronary catastrophe – pain in the chest radiating through the left arm to the jaw is the classic one – most are vague and easily misattributed.  Often the first sign of heart disease is a heart attack and half of these are fatal.

The hard fact then is there is no such thing as a “clean bill” of cardiac health.  Last year my husbanded attended the funeral of a much-liked colleague, a highly fit individual who regularly played football and had been a sprinter in his youth.  Like Adams, he died suddenly of a massive heart attack at the age of 39, after climbing a low wall to get into his garden.  Two days later, the report from a recent health check-up dropped on to his doormat.   Opened by his grieving widow, it proclaimed him in A1 health.

Alison Cox, a former Wimbledon player and founder of the charity CRY (Cardiac Risk in the Young) is campaigning to have a five-to-10-minute ECG run alongside the BCG vaccination as a routine secondary school procedure, so that the one in 500 individuals who have an unknown inherited heart disorder can be identified and, thanks to modern medical technology, treated.  She explains that under the age of 35, sudden cardiac death is likely to be caused by rare rhythm disorders and cardiomyopathies that turn a healthy young person like Anna Loyley into a heart attack waiting to happen.  Cox estimates that there are between four and eight such deaths every week in the UK, with an undue proportion brought on by exercise.  Her own son was one of the lucky unlucky ones: his potentially dangerous heart abnormality came to light in a screening arranged by the US college he was attending after a fellow athlete dropped dead/

In the UK, sudden exercise-related deaths after the age of 35 have as much to do with lifestyle as heredity.  For most of the 4,000 plus individuals under 50 who die of sudden heart attacks every year – a few on treadmills, running tracks and exercise bikes, but most at their desks, on their feet or in their sleep – the underlying cause is not strenuous exercise.  It is the steady damage they have been doing to their cardiovascular systems since their teens, often twinned with an inherited susceptibility, which makes the coronary arteries, which are no wider than a drinking straw, susceptible to clogging with fatty plaques.  Narrowing can result in pain on exertion, known as angina, or if the plaque ruptures – as it can when blood pressure and heartbeat rise on exertion, particularly unaccustomed exertion – to life-threatening clots, known as thromboses.

And no, we women cannot fancy ourselves immune from this sinister scenario.  While women are traditionally seen as being at negligible risk of sudden death from heart disease before the menopause, thanks to the cardio-protective hormone oestrogen offering near magical arterial protection, a US survey of sudden cardiac deaths between 1989 and 1998 noted a “disturbing new trend for women”: a 21 percent increase in deaths in the 35-44 age group, suggesting that “in the area of sudden cardiac death risk, women are rapidly achieving equality with men.”  What proportion of these deaths had been triggered by arduous exertion, however, science does not say.

Scary isn’t it?  And what’s the solution?  How can we safeguard our health, our hearts and our lives?  Sorry, all you slackers, but the answer is not to hang up your trainers and reach for the TV remote control – it’s to get on your bike.  Yes, really.  All the experts I’ve spoken to over the years believe the risk of not making exercise an integral part of your life far outweighs any risk of doing it.

Regular appropriate exercise really is the world’s best panacea.  Over time – which means years and years and, preferably decades – it builds you bones, tunes your immune system, lowers your blood pressure, improves your insulin sensitivity, rebalances your cholesterol levels, reduces the tendency of your blood to clot, lowers your risk of stroke, and slices your chances of developing colon and breast cancer by as much as a third.  Day to day, it improves your digestion, enhances your mood and helps you sleep, work and relax better.

Nevertheless, the conventional wisdom that “exercise is good for you” needs rewriting.  While the right types of exercise, done with the right mindset and continued in the right way (which means for the rest of your life) are indisputably good for you, the wrong type of exercise might be even worse than lolling on the sofa.  Physiologists have found that the sweat and grind of high-intensity workouts releases the stress hormones cortisol and nor-adrenalin into the system; if they remain elevated they can have a whole range of deleterious metabolic affects on the circulation that cancel the cardiovascular benefits of the training.  The harder and more competitively you work out (even if only competing with yourself), the higher the levels of these bad-news hormones.  Research shows that while you need to push yourself beyond your comfort zone from time to time to get a training effect, once you start pushing yourself well beyond the limits of tolerance, all the benefits of exercise start to come undone.  Immunity to infection falters, mood plummets, sleep suffers and the risk of ill health (and even death) starts to rise over and above that of your sinfully sedentary neighbour.  Although the world’s longest running survey on the impact of fitness on survival – in which 17,000 Harvard college graduates took part – found death rates were significantly lower among men who were involved in regular physical activity, survival rates started to dip among exercisers expending more than 3,000 extra calories a week.

It’s that old moderation thing again.  Clearly it’s a question of pacing yourself.  Yet the passion for pushing yourself to your limits, and then some, shows no signs of abating.  Once, completing a marathon was really something.  Now, to qualify as a seriously fit person, you’ve got to complete the 26.2  miles in under four hours or run gruelling “ultra marathons” such as the 150 mile Marathon des Sables, on inhospitable Moroccan desert trails with temperatures topping 40◦C and dunes reaching a couple of thousand feet.

These events, arduous beyond imagination, may be the extreme end of the extreme.  But it is part of a general trend.  These days everything is harder, faster and a whole lot more furious.  Whether its “hot yoga” or BodyPump (step aerobics with weights to work the muscles to their absolute, exhausted maximum), these new variants, which often come complete with visualisation exercises to distract from the pain, are so exacting that experts say you’ve got to be fit before you so much as think of taking a class.

Why, a full 30 years since the value of aerobic exercise first burst into the national consciousness, do we still need to work out until our chests hurt and our heads feel as though they are going to explode, in order to feel adequately exercised?  It’s a recipe for almost certain injury and/or disenchantment, with any health benefits vanishing along with the enthusiasm: for the hard fact is that exercise is only associated with less heart disease and cancer and greater longevity if it is a lifelong habit.  If you exercise for a while and then stop, most of the benefits are lost within weeks.  The Harvard College athletes who slumped into inactive middle aged turned out to be more at risk of sudden premature death than sluggards who had never been near a gym or an athletic race meeting in their lives.

The first fitness essential, then, is to determine what activities you can do, enjoyably for the rest of your life.  The second is to recognise the health value of rest.  Exercise – vigorous exercise, especially – results in a very real amount of wear and tear and the body’s maintenance system needs the opportunity to repair the damage.  Sleep alone won’t do it.  While a day of rest is considered a criminal waste of 24 hours by many fitness fanatics, it’s now emerging as just as essential an element of a fitness regime as your regular 30 minute run or weight-training session.  It’s the Yin/Yang principle of light and shade, and one we ignore at our peril.