The heart of the matter: Be gentle with your health while in gym, say experts

How is excessive physical activity harmful?

Exercise should be safe, efficient, enjoyable as well as beneficial for an individual’s health. If done in excess, it can have harmful effects on a person’s physical and mental health. Symptoms of gym weariness include inability to perform regular activities, needing longer periods of rest with continuous tiredness, having trouble sleeping, sore muscles, depression, lack of motivation, mood swings, irritability and anxiety. Sometimes exhaustion brought on by over-exercising is also often linked to eating disorders. So, watch out for these red flags. Excessive exercise can also lead to a condition called “compulsive exercising” in which you feel guilty and anxious about not meeting your daily goals. In extreme cases, you continue to exercise even in sickness

What are the harmful effects of excessive physical activity?

About 0.001 to 0.002 per cent of deaths following excessive physical activity happen every year and 95 per cent of these are due to sudden cardiac death after rigorous physical activity. The most common cause is cardiomyopathy, which is an acquired or hereditary disease of the heart muscle. This condition makes it hard for the heart to pump blood into the system and can lead to heart failure. This results in 80 per cent of deaths per year. Coronary artery disease and arrhythmias are other well-known causes. In our own practice we have seen heart attacks being precipitated by extreme physical activity in normal people with undiagnosed, underlying cardiac problems as well as in cardiac patients with other lifestyle diseases like diabetes, hypertension and obesity, who undertake high-intensity physical activities without knowing associated complications. These complications are seen most frequently in winters when a person does vigorous exercise early in the morning or late in the evening. As arteries are constricted during winters, blood has higher viscosity and the heart has to do extra work to maintain body temperature.

How would you describe excess physical activities? What are the parameters?

According to the WHO, an adult should do about 150-300 minutes of moderate intensity physical activity or 75-150 minutes of high intensity physical activity in a week. In gyms, treadmill workout should be done only till 50 to 60 per cent of the maximum possible heart rate. What’s a heart rate? According to Johns Hopkins Medicine, “The average resting heart rate is between 60 and 100. The fitter you are, the lower your resting heart rate; for very fit people, it’s in the range of 40 to 50 beats per minute. Target heart rate is generally expressed as a percentage (usually between 50 per cent and 85 per cent) of your maximum safe heart rate. The maximum rate is based on your age, as subtracted from 220. So, for a 50-year-old, maximum heart rate is 220 minus 50, or 170 beats per minute. At a 50 per cent exertion level, your target would be 50 per cent of that maximum, or 85 beats per minute. At an 85 per cent level of exertion, your target would be 145 beats per minute. Therefore, the target heart rate that a 50-year-old would want to aim for during exercise is 85 to 145 beats per minute.”

Those who want to reduce weight and burn excess calories may achieve 60 to 70 per cent maximum achievable heart rate while those preparing for athletic or sports competition may cross 70 per cent. However, no one should cross 80 per cent of their maximum possible heart rate, which is considered a red zone and drastically increases the risk of a heart attack and collapse due to sudden cracking of the wall of the artery supplying blood to heart muscles. A higher heart rate can cause a stroke as the wall of the arteries supplying blood to the brain snaps.

What are the general considerations while choosing an exercise regime?

First, assess your range of motion or the extent to which a body part can be moved around a joint. Another factor includes pregnancy and the postpartum period in women. The third factor is nutritional status, which is vital while you are working out in a gym to prevent dehydration, electrolyte imbalances, huge amounts of weight loss, hypotension, low blood sugar levels, muscle cramps and heat strokes.

What is the health evaluation one must undergo by a medical professional before taking up an exercise programme?

Every person must undergo screening for cardiovascular risk by expert medical professionals. This should include an assessment of Body Mass Index (BMI), height, weight, waist circumference, pulse rate, blood pressure, oxygen saturation, blood sugar and haemoglobin. ECG, 2D ECHO and TMT are ordered by specialists if the individual has a family history or shows a risk of cardiovascular disease on screening.

What are the red flags that people must be aware of?

Some of the signs that you should never ignore are difficulty in breathing, chest pain, pain in the left shoulder, throat pain and back pain after a workout. Other red flags are excessive fatigue, dizziness, nausea and vomiting, blurred vision, joint pains and losing an excessive amount of weight, which can be due to eating not enough food.

How has the rampant use of dietary supplements increased our risk of cardiovascular complications?

The most commonly used dietary supplements are whey protein (59.2 per cent), vitamin integration (43.4 per cent), Branched Chain Amino Acids or BCAA (39 per cent), anabolic steroids and testosterone. These are usually not standardised mixes and used in excess, without an assessment of how much your body needs or doesn’t need, can lead to arrhythmias, cardiac arrest, elevated cholesterol and blood sugar levels and an accelerated arterial plaque progression. Anabolic steroids cause high blood pressure and osteoporosis while testosterone can cause heart attacks. High intake of calcium and vitamin D precipitate kidney stones and cause abnormalities in cardiac and kidney function. Fatigue, loss of coordination and seizures are the adverse effects of BCAA. There are studies stating that there is a strong correlation between impaired BCAA oxidation and contractile dysfunction in heart failure.

How can one regulate one’s exercise?

Always begin with a warm-up period and on achieving the peak performance, sustain the exercise or work out just up to the onset of fatigue. Then gradually slow down to rest for a while. Then restart. The same cycle must be repeated till the target heart rate is achieved. If the person experiences any discomfort during this process, they should seek medical help immediately. Ensure that your entire exercise programme is supervised by highly qualified medical professionals. Gym professionals should compulsorily undergo basic life support training and keep automatic electronic defibrillators and other resuscitation facilities to deal with any emergencies in their premises. Regular screening and awareness workshops by expert cardiologists should be mandatory in each gym.

Why are we witnessing cardiovascular complications in youngsters?

An increase in unhealthy and sedentary lifestyles, active and passive smoking, alcohol consumption and increased levels of stress have led to a rise in lifestyle diseases like diabetes, hypertension, and obesity. Even with a family history, routine annual health check-ups are still not done very commonly in our country due to a lack of awareness about asymptomatic cardiovascular diseases. In these cases, pushing one’s limits beyond capacity while working out results in increased demand and puts undue strain on the heart. Also, dehydration and electrolyte imbalances result in increased stress on the heart.