Vascular health in athletes

Interview with Prof. Martin Halle, Director of the Center for Prevention and Sports Medicine, Technical University Munich, Germany

"Sports are good for your health", as the saying goes. Regular exercise promotes the health of our blood vessels and prevents vascular diseases. However, many years of competitive sports can also have negative effects on vascular health and increase the risk of myocardial infarction.


Photo: Smiling man with glasses and brown suit - Prof. Martin Halle; Copyright: TU München

Prof. Martin Halle; ©TU München

Prof. Martin Halle of the Technical University Munich explains at what athletes need to pay attention to.

Prof. Halle, what impact do regular amateur and competitive sports have on vascular health?

Martin Halle
: Vascular health is subject to cardiovascular disease risk factors. It is a fact that given a distinct risk profile, children can already exhibit early changes such as vascular dysfunctions and proliferations of the vascular walls. This is particularly the case, if they are overweight and physically less active and already show early stages of diabetes mellitus. In adults, we also notice that risk factors like smoking, high blood pressure and high cholesterol levels can significantly accelerate vascular aging. This way, a 30-year-old can already have the blood vessels of a 60-year-old.

Conversely, it is also known that a healthy lifestyle, which above all else also includes physical activity protects against vascular diseases. 60-year-olds can exhibit the equivalent vascular elasticity of 30-year-olds. Overall, the vascular system can therefore be maintained in its function for 30 years.

Nevertheless, athletes can definitely also exhibit myocardial infarction and early vascular aging.

: Even though exercise can have a beneficial effect on risk factors – by lowering blood pressure, increasing HDL cholesterol or improving blood sugar levels – these effects are not distinctive enough to where the risk for myocardial infarction can be completely reversed if you are pre-disposed to high cholesterol. What’s more, you also need to consider that many people often start to exercise again at 40 – after taking a 20-year break. During the time in between, arteriosclerosis, calcification in the arteries has begun. It can subsequently no longer be completely reversed.
Photo: Rugby players; Copyright: Bowden

Even athletes are not immune to heart attacks. However, overall they have a significantly lower risk to suffer one versus people who don’t exercise at all; © Alison Bowden

How often do athletes exhibit vascular diseases?

: In athletes 50 and older, cardiovascular diseases also dominate as the cause for sudden cardiac death for example. By comparison, congenital diseases such as genetically based thickening of the heart muscle, coronary artery ligation or malfunctioning cardiac excitation occur far less in this group.

What other risks are athletes exposed to?

: Even athletes are not immune to heart attacks. However, overall they have a significantly lower risk to suffer one versus people who do not exercise at all. Nevertheless, several studies show that too much physical training is potentially harmful. When it is done over many years, it can even promote arteriosclerosis.

What is so-called oxidative stress and what impact does it have on the arterial blood vessels of athletes?

: Oxidative stress occurs, when there is an excess of oxygen free radicals in the blood, which damage the inner layer of the vessels. This can also been seen with physical stress. Athletes however build up an immune system against this stress, which prevents blood vessel damage. However, in people, who do not exercise regularly – for instance playing soccer with friends just once a month – and who do not have this buffering, oxidative stress can damage vessels. Such abnormal stress involves cardiovascular risk, because this exerts too much stress on the blood vessels.
Graphic: Human circulation during jogging; Copyright: Kaulitzki

Too much physical training can damage the vascular health; © Sebastian Kaulitzki

How high is the risk of thrombosis for amateur and competitive athletes?

: It is rather small, because the veins keep being compressed by the muscle pump in the lower legs and thighs, resulting in increased blood circulation in the body. Nevertheless, athletes should also pay attention during long flights or injuries and when bedridden that the muscle pump is being tasked. Anticoagulants may also be injected for flights.

Which methods assist in diagnosing problems with vascular and heart health in athletes?

: Initially it includes a clinical examination by the physician with a stethoscope, a resting ECG, which shows the electrical activity of the heart and a heart ultrasound with which the function of the cardiac muscle and valves can be directly measured. If problems cannot be solved using these methods, continuative diagnostics using nuclear spin or computer tomography of the heart can be performed. These can display coronary arteries and the cardiac muscle in much greater detail. These examinations are supplemented with a stress ECG where the cardiovascular system is being stressed. In doing so, pulse, blood pressure and ECG changes can be highlighted under stress. This can also be supplemented with ultrasonic testing during physical stress.
Photo: Michalina Chrzanowska; Copyright: B. Frommann

©B. Frommann

The interview was conducted by Michalina Chrzanowska and translated from German by Elena O'Meara.