Lifestyle Factors

A healthy lifestyle can contribute significantly to good fitness and health. Heart disease is a leading cause of death in the Western world and, like most other chronic illness, is a preventable condition. Both improved health and prevention of disease can be accomplished with the help of a healthy diet, and the moderation of stress, including not overtraining. (Even in those with so-called genetic predispositions, lifestyle factors can “turn on” or “turn off” the gene for heart disease.)

In addition, stress in its broadest definition can be a significant contributing factor in the development of heart disease. Stress can come from an imbalanced diet, from trying to squeeze too much training into a day also filled with work and family obligations, and from mental pressures, including competition.

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Overtraining is a significant and common stress in athletes. In addition to causing an imbalance in the brain, nervous, and hormonal systems (through increased sympathetic activity), it can increase chronic inflammation as well. Any of these problems can contribute to heart disease and increased risk of death. Stress and abnormal cardiac changes can be measured in overtrained athletes, even in the early stages. These include peripheral vascular resistance, high blood pressure, high cortisol levels, and abnormal heart rate variability.

Overtraining in its early stage, just beyond the normal overreaching aspect of training, can produce abnormalities; ironically, this can result in short-term improvements in athletic performance. Many athletes who experience this phenomenon continue pushing themselves, mistakenly thinking their training is successful. Continuing on this path brings further ill health, including clearer indications of overtraining. For example, abnormal blood markers (such as plasma cardiac troponin T and I) have been found in triathletes and marathon runners following long races. These tests are indicative of a transient myocardial problem—a heart injury. Experts say they are still unsure about the seriousness of this problem. Immune markers are also distorted in many athletes following competition, and during periods of hard training, even following a single, long training session. This is associated with an increased frequency of upper respiratory illness in athletes. Some have severely compromised immune function making them vulnerable to more serious health problems. Overtraining ultimately results in declining performance.

The acceptance of poor health, by both athletes and even their coaches, is well documented in all sports. This has led to an epidemic of physical injuries. There is even a name for athletic cardiac changes: “athlete’s heart.” Other overtraining outcomes have special names, too, and are often glorified: runner’s knee, swimmer’s shoulder, and runner’s anemia.

Can countries with higher death rates of young athletes, such as the United States, mandate more effective screening? The International Olympic Committee and European countries already do this to reduce the number of deaths during competition. Many oppose such a requirement, saying it’s impractical. The American Heart Association’s report in 2007, “Recommendations and Considerations Related to Pre-participation Screening for Cardiovascular Abnormalities in Competitive Athletes,” states that, despite being able to detect heart disease in young athletes, “A large population pre-participation screening initiative for U.S athletes that mandates a 12-lead ECG, such as that proposed by the ESC and IOC, is probably impractical and would require considerable resources that do not currently exist.”

While there are clear ethical considerations, the responsibility also rests with the athlete or, in the case of minors, the athlete’s parents. Consider that many athletes, even weekend warriors, are more than willing to place themselves at high personal risk for the thrill of competition.

Should the government impose restrictions on sports because of potential health problems? Can we prevent a young, talented athlete from fulfilling his or her dreams because an ECG shows abnormal readings? How many of those tests are false positives (meaning the test shows a problem but none really exists), leading to unnecessary testing, anxiety, and removal from a potentially rewarding career? There are obviously more questions than adequate answers. We do, however, treat athletes differently because we put them on a pedestal, and from an early age. This includes the media, who write about them, colleges, universities, and professional teams who recruit them, companies who sponsor them, and the public who glorify them. But does this special treatment include making a different medical decision regarding their health? Most health-care professionals would say no, but the problem continues.

Until many of these ethical and legal issues are sorted out, one important factor is clear: Each person is responsible for his or her own health. Should we choose to put a marathon or triathlon ahead of our health, we must also be responsible for the outcome, win or lose. Most importantly, we must teach ourselves the importance of health and that it’s an important part of building fitness.