Middle-aged men who partake in extreme exercise are not putting their heart health at risk, a new study contends.

Ageing athletes who do eight or more hours a week of vigorous exercise have no greater risk of early death than people who work out less often, researchers found.

Protective and not injurious

Extreme exercise included activities such as fast running or biking, as well as competitive sports such as basketball or tennis.

In fact, middle-aged men who didn’t already have hardening of the arteries saw their odds for early death fall by half if they regularly engaged in vigorous activity, noted senior researcher Dr Benjamin Levine. He’s director of the Institute for Exercise and Environmental Medicine, a collaboration of University of Texas Southwestern Medical Center and Texas Health Presbyterian Hospital Dallas.

“Being a high-level athlete was clearly protective and not injurious” for those with lower levels of arterial plaques, Levine said.

Previous studies had questioned whether extreme exercise could be harmful, because some very active athletes tended to have higher levels of coronary artery calcification (CAC), researchers said in background notes.

Heart doctors use imaging tests to check for CAC as a means of assessing risk for heart attack, stroke or heart disease. Coronary calcium is a footprint of atherosclerosis, in which plaques accumulate in the blood vessels that supply the heart.

Closer examination

“Particularly the male athletes tended to have more coronary plaques, and the plaques they did have were virtually all calcified,” Levine said.

But no study had ever taken the next logical step, he added.

“No one actually ever determined whether that made them at higher risk of death or not, and that’s really the whole question,” Levine said. “Who cares if they have more calcium if they don’t die [prematurely]?”

To examine this more closely, Levine and his colleagues studied data gathered on nearly 22 000 generally healthy men, aged 40 to 80, during the years from 1998 through 2013.

The men reported their activity levels and underwent coronary calcium scanning. Most were runners, but some were cyclists, swimmers, rowers or triathletes.

Extreme exercise was defined as eight or more hours a week of activity at an average of 10 metabolic equivalents, or METS, Levine said. METS are a measure of the energy spent in activity.

Levels of physical activity

Vigorous exercise at 6 METS or higher can include jogging at 6 mph (9.6kph) or faster, bicycling at 14 mph (22.5kph) or faster, carrying heavy loads, or playing competitive basketball, soccer or tennis, according to the Harvard T.H. Chan School of Public Health.

“People don’t typically do that for recreational fitness,” Levine said of these exercise levels. “They’re more likely to do that for competitive fitness.”

The athletes were split into two groups based on their CAC scores, and researchers compared them based on their levels of physical activity. The investigators tracked participants’ rate of death for any cause and specifically for heart disease.

During the study period, extremely active athletes with low CAC scores died half as often as the least-active men with similar CAC scores, the findings showed. They also were 61% less likely to die of heart disease.

Those with high CAC scores also appeared to do well. Extreme athletes with high arterial calcium were about 23% less likely to die compared with less active men, but there were so few deaths that the result was not statistically significant, Levine said.

“Rather than saying they have a lower risk of death, we say they had no greater risk of death,” Levine said of extreme athletes with high CAC scores.

Women not included

The study did not include women because their lower rates of death in middle age made a valid statistical comparison impossible. “The trend seems to be similar in men and women, but we can’t say anything convincingly because the death rates were so low” in women, Levine said.

Cardiologist Dr Nieca Goldberg said these findings support the advice she regularly provides.

“A really important message that I try to get across to my patients is you can have plaque present but if you lead a healthy lifestyle, it helps prevent dying of a heart attack,” said Goldberg. She is medical director of the Center for Women’s Health and Women’s Heart Program at NYU Langone Health in New York City.

However, Goldberg hesitated to say these results would apply to women the same as men.

“I would have to see a study done to see what the results are,” Goldberg said.

Levine pointed out that there are several potential reasons why extreme exercise might aid heart health rather than harm it.

“Exercise, particularly over a long time, causes increased flexibility and youthfulness of the heart and blood vessels,” he said. “Blood vessels are better able to flex and send blood where it needs to go.”

No upper age limit

It also appears that plaques in arteries of extreme athletes tend to be more calcified and harder, making them less prone to rupture and cause a blood vessel blockage, Levine said.

So how old might be too old to engage in extreme exercise?

“I don’t think there’s an upper age limit beyond which the benefit diminishes,” Levine said. “The trick is to sustain a meaningful amount of exercise across your lifespan.”

While extreme amounts of exercise don’t appear to harm your heart, you don’t need to do that much working out to keep yourself healthy, he noted.

“The biggest bang for your buck comes with the conversion from a sedentary to an active lifestyle,” Levine said. “Most of the benefit for cardiovascular mortality tends to plateau at about the three- to five-hour-a-week mark.”

The study was published online in JAMA Cardiology.

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Travonne Rhoda, 4, from Kraaifontein, Cape Town, has spent almost all of his four years on earth in hospital.

Travonne was only six months old when he developed a bad, persistent cough. Since then, he’s spent most of his life in hospital and was eventually diagnosed in 2018 with bronchiolitis obliterans — an incurable lung disease commonly known as popcorn lung.

The condition causes the smallest airways of the lungs to be obstructed due to chronic inflammation.

It’s possible that the condition was triggered when Travonne suffered pneumonia as a baby.

The damage to his lungs is irreversible, says the little boy’s mom, 35-year-old Simone Rhoda.

Simone spoke to YOU this week in the Melomed Belville Hospital. The little boy – who considers entertainer Emo Adams his bestie and thinks of the hospital as home — is on a ventilator.

“He’s been on the machines since last week after he had another setback. For months he was doing better,” Simone tells us. She adds the nursing staff have become like family to them.

Travonne has had to spend the past two Christmases and New Years in hospital. Last year in June he was discharged, only to be readmitted a day later.

In September he spent a few days at home before his family had to take him back to hospital. He’s been on a ventilator four times since then.

“It takes its toll. It’s especially stressful and hard on me when I’m at work and he’s at home. The longest he’s been home, was a month and a half,” Simone says.

Doctors prefer to have Travonne in hospital where he can get the best possible care. She says she and her husband, Clement, 37, can’t thank the hospital staff enough for everything they’re doing for the family. During the crisis times, she and her husband are there day and night, she adds. “They give us a place to sleep and three meals a day.”

She gets emotional when she talks about how Travonne nearly died on September 29 last year. They were at home when the hospital called to say his organs had started failing. Upon their arrival, the nurses were in a circle around the little boy’s bed, holding hands and praying.

“People’s prayers are the only thing that’s keeping us standing,” Simone says.

To help cover medical costs, various fundraisers have been organised in the past four years, including an annual golf day and the Travonne Rhoda Sevens Rugby Tournament. Last year Emo Adams visited Travonne at the behest of the Reach for a Dream Foundation. “Since then Travonne thinks of Emo as his bestie.”

The little boy is also a huge fan of South African performer Early B. “He loves watching YouTube videos — Early B’s Ben 10 is his favourite.”

When Travonne was discharged in September, he’d asked to go back to hospital. “The hospital is home to him.”

Simone says there’s no cure for her son. “All we’re asking is that people pray for him.”

Jana van der Merwe

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“You have cancer” are words no one wants to hear. The reality is that many people receive that exact diagnosis every year. 

Fortunately the news is not that bad anymore — nowadays many cancers, when detected early, have a much better prognosis and aren’t terminal.

Yet, it remains gut-wrenching and life-changing when you hear those words after what you thought would be a routine examination.

Even with the focus on early detection, we realise that no cancer diagnosis, no matter how early or late, is easy for a patient to bear. We spoke to Dr Charleen Muller, a radiation oncologist from Cancercare on what to do and what to expect when you are diagnosed with cancer.

1. Get all the medical information as soon as possible

Dr Muller says that every cancer patient they see, will have an hour-long consultation with an oncologist. Here, the prognosis and treatment options are discussed.

“It is important to get as much information as possible from an accredited oncologist,” she says. “We usually send a patient home with enough printed material to read in their own time as we know that the information can often be overwhelming, especially when you receive bad news.” The best advice is to receive realistic information and to be as proactive as possible. You might want to read up on your illness from every source you can find, but focus on what your oncologist is saying to you right now.

2. Find a support network

Dr Muller says that they make use of in-house social workers to offer additional emotional support to their patients. “It is vital to make use of a support structure as early as possible, whether it’s family, friends or a community support group. They can lend an ear when you want to talk about your feelings, but they can also give advice and positive reinforcement,” she says.

3. Consider your lifestyle, but don’t make drastic changes

While there is sufficient evidence to prove that quitting smoking, a healthy body mass index, a balanced diet and enough physical exercise can reduce the risk of cancer mortality, it’s important to remember that the early stages after a cancer diagnosis are stressful and that it’s important to go easy on yourself.  

A cancer diagnosis doesn’t mean you should pressurise yourself and make drastic lifestyle changes then and there, says Dr Muller. “It is an emotionally rough time, and while a healthy lifestyle is never a bad idea, any changes in your lifestyle should be incorporated gently,” says Dr Muller.

It’s important to note that any drastic weight loss or other changes due to a change in your lifestyle may mask weight loss that may be a result of the cancer. It’s important for your doctor to keep track of what’s happening, and any drastic changes you make may cloud this process.

4. Prepare for treatment

“Invest in a notebook and pen and write things down in point-form as it might be hard to remember everything during appointments,” says Dr Muller. “Also note that each cancer treatment and its side-effects, be it radiation or chemotherapy, will differ from patient to patient, but I usually tell patients to reduce the stress and pressure in their lives and to reach out to their support system.”

Ask your doctor what possible side-effects you can expect and make practical preparations — including stocking up on lotion if your skin might be affected by chemotherapy, or simply having ice-lollies or ginger tea at hand for possible nausea — anything to relieve discomfort.

“It’s also imperative to keep your brain stimulated during a round of chemotherapy, as the impact of the medication may alter your memory. We call this chemo brain,” says Dr Muller. Do things that you enjoy that will also stimulate your mind, such as reading, completing crossword puzzles, or playing Sudoku.

5. Maintain your normal life

Note that the biggest burden during the early stages of cancer will not be necessarily physical, but emotional. Dr Muller states that it’s vital to maintain a normal pattern. “If you are someone who’s used to going out with friends, don’t stop doing that. It’s easy to want to isolate yourself, but it’s important to keep a support network close.”

Don’t hesitate to tell people how you want them to react. Family and friends may treat you with kid gloves or might not know what to do or say, and tend to shy away from the topic. On the other end of the spectrum, they might overload you with opinions, platitudes and advice. This doesn’t come from a bad place, so communicate clearly how you feel.

Do you have personal experience of a cancer diagnosis? Share your experience by emailing marelize.wilke@24.com and should you wish to remain anonymous, please let us know.

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Marelize Wilke