Friday, March 21, 2014

High Intensity, High Volume Endurance Exercise and Cardiovascular Health: Clarifying the Risk-Protection Paradox

That is the title of the presentation I went to last night at Beaumont Cardiovascular Performance Clinic. The presentation was organized by the local triathlon club, which I just joined (literally just; this was the first meeting I went to and I didn't know anyone in the room). I was really impressed with the whole thing. The doctor who gave the presentation was a great speaker. Even though he works for Beaumont, I never at all got the feeling that he was trying to sell the screenings they perform. (Well, he didn't really have to, the screenings sell themselves.)

I also really liked the doctor himself. He is obviously passionate about the topic of cardio health for athletes. Listening to him talk about the effects of exercise on the heart was like listening to me talk about guide dogs. Let me tell you, people who work all day at something and can then talk about it after work with enthusiasm are lucky people, I should know. He has been in this field for a long time and has all kinds of academic and professional credibility, but is also one of those people who is really, really good at dumbing stuff down for those of us who aren't in the medical field. (Although, this being a group of triathletes, the number of highly educated people in the audience appeared to be a little disproportionate based on the vocabulary of the people asking questions. It's possible that I was the only one in there needing anything dumbed down.) I got the feeling this guy could hold his own in conversation with any leading cardiologist anywhere in the world, but at the same time he also said things like, "I could tell you you need to have the screening done every three years, or every five years, but I'd just be bullshitting you; the answer is we don't really know how often anyone needs it done," and also, "It's true that there are more people participating in marathons every year, but it's also true that there's more people sitting on their asses at home every year, because there's just more people every year." I love a speaker who is not afraid to talk like real people talk and who isn't afraid to say "I don't know" when the answer is "I don't know."

I wish I had taken better notes while I was there, but the main points I remember from the talk are:

*There aren't really that many deaths from exercise-related cardiac arrest. I think the average he said was 4 per year in marathons and half-marathons.
*The majority of deaths in people under 35 are from, I think, enlarged heart-something-or-other (see? I should've paid more attention) and the majority of the deaths in people over 35 are from cardiovascular disease, and most of those things are detectable by routine screenings.
*You do have a higher chance of having a cardiac event when exercising, but it's still pretty low compared to a sedentary person's risk of a cardiac event with any exercise at all.
*There are actually physiological reasons for doing a cooldown post-exercise. (I don't remember what they were, but I remember looking at the Power Point slide and listening to the doctor's explanation and saying to myself, "Oh, shit.") I have always disregarded the advice "do a cooldown", but maybe I will just go ahead and do one from now on.

The cost of the screening is $300, which seems like a lot, but I actually think you get a lot for that price, including an ECG, an EKG, and a stress test, including measurement of VO2 max. (Not that I particularly care about VO2 max, but it seems to be one of those things that it might be interesting to get at some point in my life.) I have had a cardio screening once in my life, five years ago, but the difference with this one is that it includes a focus on athletics and training. So, probably worth the $300.

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