The biggest problem is that most adults aren't
actually doing enough exercise and so rather
than worrying about the athlete's heart for those
who are doing a good job I guess we really need
to remember that guidelines recommend both cardiovascular
and strength training and really you've got to
find something you love and make sure you're
doing enough of it I think. Hi, Jessica. It's
my pleasure to have you on Evidence Strong Show.
If you could briefly introduce yourself. Thanks
so much, Alex. It's a pleasure to be here. So
my name's Jessica Rorchard. I'm an associate
professor in the School of Public Health at the
University of Sydney. And my research focus is
on cardiac screening, particularly cardiac screening
of athletes and people who are doing high -level
elite exercise with a view to prevention of major
sudden cardiac events and just promotion of athlete
health in a cardiac sense as well. Okay. And
part of your job is directing ARENA. So could
you just speak a little bit about that too? Yeah,
of course. So ARENA is a registry of athletes
screening ECGs. So the Australasian registry
of ECGs in national athletes, because we had
to have an acronym. And that's really collecting
and centralizing all the records of elite athletes
who undergo cardiac screening in Australia and
hopefully New Zealand as well. We'd like to include
their data. And that's really saying a lot of
sports are doing cardiac screening. of athletes.
But let's have a look at the data and see what
we're finding. What are the rates of diagnosis
of major cardiac conditions? What are the clinical
outcomes in terms of long -term events? And importantly,
are there any differences in certain types of
sporting disciplines in athletes or between male
and female athletes that we need to take better
account of? So really looking at some of those
more underrepresented groups as well. Could you
give us a general idea what athletes heart is?
Yeah, absolutely. So we know that excess is really
good for you in so many ways. And it has a powerful
effect on cardiac structure and function really.
So in the long term, sort of regular exercise
promotes what we would call structural, functional
and electrical remodeling of the heart. And that's
exactly what we often call athlete's heart. So
how much that happens depends on XSO's dose and
intensity and a whole range of other factors
like sex, genetics, environmental things. But
in general terms, we talk about those types of
changes. And we know that electrical changes
are often visible on an electrocardiogram or
ECG. So they're things like sinus bradycardia,
a slow resting heart rate under 60 beats per
minute, an increase in voltage criteria, perhaps,
so chamber enlargement, and also things like
repolarization anomalies. So there's actual changes
in the function of the ion channels and really
these changes, much more the electrical ones.
on ECG. When we talk about functional changes,
that's things like an enhanced feeling and an
increase in stroke volume. And structural changes
are changes in cavity size and wall thickness,
particularly on the left side. And that really
does depend a little bit on the type of exercise
you do, what sorts of changes you see there.
But essentially, as you start to exercise, your
heart will contract faster and your circulation
will increase. And that's get oxygenated blood
to your muscles quicker. So as the demand increases,
your heart rate increases and it contracts with
more force. So your heart rate and stroke volume
increase, creating increased cardiac output.
So all these changes of athlete's heart are really
to help your heart perform in the way you need
it to for the exercise that you're doing. Okay.
So this is in general. Now, if we speak about
power athletes or strength athletes, many of
my viewers or listeners will be related to Olympic
weightlifting. Are there specific adaptations
that this group of athletes will likely experience?
Yeah, definitely. That's a really good question.
And so we now know based on lots of evidence
that there are quite different changes that you
see in a strength training athlete, sometimes
called static sports and very commonly weightlifting
versus sort of the other end of the spectrum,
which is endurance athletes. And then of course,
there's all sorts of combinations in between.
But when you're looking at strength trained athletes,
that commonly leads to what they call concentric
hypertrophy of the left ventricle. So that's
thickening of the walls, but not so much a change.
in left ventricular chamber size. So the changes
in strength athletes are caused by pressure overload,
I guess, accompanying the sort of high systemic
arterial pressure found in this type of exercise.
So that sort of blood pressure goes up and that's
the sort of training you do in that type of a
sport. And so strength trained athletes are really
showing this concentric left ventricular hypertrophy
and an increased ratio of wall thickness to radius.
So if you look at the other side of the coin,
the endurance athletes, they... tend to get mild
to moderate, but sort of eccentric left ventricular
hypertrophy, but then they get right ventricular
dilation and biatrial enlargement as well. So
it definitely is a bit different, particularly
in the sort of structural changes that you might
see if you were to image a whole lot of athletes,
though you would see those different sorts of
changes. And then of course, all the things in
between and the sports that involve really a
combination of the two, you might see really
quite profound remodeling in some athletes. If
we know that some level of adaptation is expected,
how do athletes and coaches and parents should
be thinking about, oh, is this normal or did
we cross the line and this is better? It's a
really good question. And I guess a lot of it
depends on the context. So most of the time,
if everything's going fine and you've got no
symptoms, no family history and nothing to worry
about, you won't actually know how much your
heart's adapted because you might not, unless
you've been going to cardiac screening or something
like that. So you'll just maybe feel like you're
getting fitter at your run or like what you're
trying to do is a little bit easier as part of
your training. If you're getting cardiac screening,
it might be evident on the ECG because you might
see some of those athlete heart changes. And
we've got a lot better at distinguishing between
what's normal and what's not in an ECG because
we've just got so much more data now that's available
to us. And so that's now much easier. a few not
not as many as there used to be, always a few
where you're not quite sure. And that's where
a lot of clinical context might come in. So if
that person says, you know what, I have suddenly
been feeling, I've got a sudden loss of a cylinder
or something when I'm training. It just, it doesn't
feel like if there's anything like that, that's
when you might be more suspicious that there's
something wrong. Whereas if somebody just said,
no, I'm completely normal. The only reason I'm
here is my ECG looks like this. I don't have
any family history. I don't have anything else.
then you'd be less worried in your testing. But
sometimes for a very small number of people,
it's a bit harder to make that decision. And
I guess if you are in one of those situations,
it's really important to be as informed as you
can be about family history. I keep talking about
that because a lot of the conditions you might
be worried about or looking for are cardiomyopathies
or things like that that can be inherited. And
so if you've got a family member that's died
suddenly under the age of 40, even if you don't
know what it's from, perhaps... are drowning
on their own, but it was unexpected or even a
single vehicle car accident can be caused by
something like that if there was no other potential
cause. So knowing something about your family
history can be useful. And of course, if you
are seeing a doctor about something to do with
your heart, being very honest about whether you
think you've had any symptoms or if you're perhaps
taking any medication or supplement that could
be an issue. While we're on the supplements,
are there any supplements athletes should be
avoiding? or can influence heart. There definitely
are some, and there are other medications just...
pharmaceuticals and things that can affect your
heart. I think one of the things that we probably
should mention if we're talking about strength
training athletes is that we do know that the
slight elephant in the room is that some people
perhaps do take supplements and maybe anabolic
steroid or similar sort of agents, and they absolutely
can have very serious side effects on the heart.
And I'm not sure if people always realize that
there could be a bit of a risk there. So there
are cases of people who've taken anabolic steroids
and ended up with steroid -induced cardiomyopathy.
where they've had a normal heart before because
they've had some kind of imaging and their steroids
have actually caused changes in the heart muscle
structure because they change your other muscles.
So why not the heart, I guess? It's thought to
be through androgen receptors expressed on cardiac
myocytes, sort of really right down into the
cellular changes. And those changes show that,
you know, you can permanently weaken the heart.
by having taken steroids like that. And you can
have major heart failure and other problems that
come with that. So I think for anyone who either
has taken or is considering taking something
like that, it's very important to understand
that those can bring significant risks that were
not there before. So we do know that. There are
other things, I mean, party drugs like cocaine,
things like that, certainly. not great for your
heart. But I guess that's in a slightly different
category because you're probably not taking that
for a performance reason. But if you're taking
something purely for performance, it's very important
to understand that. I have a question, follow
-up question on steroids. So you said they, in
the long term, they weaken the heart. The reason
to take them is to get stronger or possibly bigger,
bigger muscles. So why at the end, after prolonged
use, we end up with weaker heart instead of stronger
heart? Yeah, I guess. that's a really interesting
question and I probably don't know the exact
details of that. It's actually something that's
quite hard to study because you need people to
tell you that they've been taking steroids for
a long time and you need to get an ethics approval
to sort of really investigate what's a little
bit of an edgy topic. There certainly are a few
studies that show the cardiomyopathy because
that's something you can document if somebody
comes in with something. The idea that they weaken
the heart is I guess that they can sort of lead
to heart. failure and the heart being too thick
means it can't pump in the way that it needs
to is sort of the summary of that. So the risks
of heart failure are certainly things that can
go. I think that sort of thing we're talking
sort of prolonged use and pain. potentially higher
doses and the other thing I suppose with steroids
is perhaps it's not always clear exactly what
you're getting if you're getting it from someone
or you might be trying a different one and it
may not be perfectly known what the impact of
being on that particular one is versus that one
and at that dose for that period because this
is a lot of this would be a bit hidden and so
that lack of knowledge is part of the picture
as well. Thank you for that. How long does it
take for the heart to adapt if I do if I prepare
for marathon? for three months, am I getting
some adaptations towards the endurance athlete
heart or do I have to do it for you? What is
the timeframe? Yeah, that's a really good question.
So yes is the short answer to the example you
gave. So usually we talk about an athlete as
someone who's exercising about four or five hours
a week of decent exercise. And that's not just
strolling down to the bus sort of thing, but
decent level exercise. And so some studies suggest
that about even three hours a week for three
months. you might start to see some of those
changes. Yeah. Three hours of maybe quite decent
level intensity, but three hours of running is
not nothing, for example, or other things that
you might be doing like intense cycling or things
like that. And so one of the easiest ways that
people can tell is a lot of people might have
a smartwatch or something now, and you can see
your resting heart rate go down. So you might,
before you start exercising, be somewhere in
the 60s or 70s, and then you might drop down
to be what? we would call bradycardic, so below
60 beats a minute. And that's just your heart
getting fitter and more efficient. It sort of
doesn't have to do as much as it did before.
So that's one of the very easy ways you can tell.
We talked a little bit about timeframe. Are there
any other factors that may influence heart adaptations?
Yeah, I guess, as we mentioned. We know that
sex, genetics and exercise dose and intensity
are really the major factors. We know that female
athletes definitely get athletes' heart changes
as well. They're also related to the sport. A
lot of the time in cardiology, we don't have
enough. data on females despite they make up
a big proportion and so as we've gone on we've
had more and more data particularly of really
top level female athletes and they certainly
get those changes as well some of them might
be slightly different or you know in the context
of perhaps a slightly smaller heart compared
to males so we do know that's something as well
there is Some thought that there might be some
conditions that are a little bit exercise induced.
So exercise induced arrhythmogenic cardiomyopathy
has been described. And that's, I guess, some
people wonder whether there's an underlying genetic
predisposition that when you combine it with
the environment and some very high level training
can almost sort of switch that on in some people.
And that's a really interesting concept, I think.
So previously you would think of arrhythmogenic
cardiomyopathy as being much. more of a genetic
thing, but perhaps it's sort of, there's a bit
of a curve and beyond a certain point and in
some people under some conditions, perhaps. that's
something that can occur. So I think there are
some things we don't know at the same time. And
most of the time, to be honest, the slight issues
that you can get as a result of too much exercise
or a lot of overtraining, perhaps, they are things
you tend to see more in the endurance athletes.
And that's something that I guess is just a function
of the time and the amount you're pushing your
heart. So things like atrial fibrillation or
perhaps other supraventricular tachycardias are
something. that definitely we know the risk is
a bit higher in endurance athletes. But something
like... Atrial fibrillation, for most people,
it's a bit annoying, but it's not a terrible
thing that's going to cause you to have a cardiac
arrest. And so people who absolutely love going
out and doing a 200 -kilometer ride every weekend
up the highest mountain they can find, perhaps
that's just another risk along with falling off
your bike, if that makes sense. So it's really
interesting. We do know a few of the things that
influence how your heart changes according to
exercise, and really there's probably a few more
that we don't know. still looking at data for
do you have a lot of in the arena registry do
you have a lot of strength and power athletes
we the majority at the moment in there are mixed
sport athletes which is a catch -all term for
a lot we definitely have a few and the ones we
do have the very top level. So they're from the
Australian Institute of Sport, Victorian Institute
of Sport. And so range of ages, and hopefully
what we'll be able to get is interesting data
over time. So where an athlete gets screened
multiple times across their career, we'll be
able to sort of follow some of those changes.
Obviously, it might be a little bit different
in recreational or other competitions. We did
mention anabolic steroids. So presuming anyone
in the Olympics is sort of subject to very careful
drug testing and perhaps would not be taking
that risk anywhere so we may not be able to answer
some of those questions without specific data
on sort of groups that are doing that but we
will be able to as we gather more data really
look at more of the changes in strength athletes
because I think you just often need Quite a big
data set and quite a length of time to properly
look in some of those ways. Awesome. So fingers
crossed it's coming in the next few years. Yes.
Okay. The main question, I guess, is, is the
athlete's heart adaptation good or bad? And should
we be preventing it? Well. I think you'd have
to say it's generally good. So most of these
changes, benign most of the time, they increase
the heart's ability to pump blood effectively,
enhancing stroke volume to meet performance demands.
The heart's a muscle and you're wanting it to
grow stronger and more efficient. So most of
the time, it's a really good thing. Just like
a lot of things, occasionally in a small subset
of athletes, as we said, higher levels of endurance
exercise in particular can lead to sort of electrical
remodeling, which can lead to rhythm problems.
like atrial fibrillation, and we know that there
are some associations. If anyone's interested
in that, there's a great book called The Haywire
Heart by John Mandrola and a couple of other
excellent endurance athletes where they look
at that in detail. But I really think it's important
to say the biggest problem is that most adults
aren't actually doing enough exercise. And so
rather than worrying about the athlete's heart,
for those who are doing a good job, I guess we
really need to remember that guidelines recommend
both cardiovascular and strength training and
really... You've got to find something you love
and make sure you're doing enough of it, I think.
That would be the best thing you can do for your
heart is to make sure you are following the guidelines
at least and doing some good exercise. So the
follow -up question on this is weightlifters
and powerlifters don't particularly enjoy running.
Is lifting heavy weights repeatedly considered
cardio or should the athletes do more? Should
they add running or some other modality that
is more lower intensity? longer in time? I guess
it depends what you're training for is the answer.
And so my personal trainer sometimes comments
on what certain athletes are doing, like a cricketer
who's just run a half a marathon in a quite fast
time. He would say, yeah, but does he need that
for what he's trying to do? I guess so that's
one question. And the other question is just
for general health. So I think you would probably
call all sorts of weightlifting that that's really
under the heading of strength resistance training.
And if you're looking at the guidelines, you
probably do. need a reasonable amount of moderate
to vigorous physical activity. It doesn't have
to be running, could be swimming, could be cycling,
could be brisk walking and many other things.
It's probably for your health is good to add
that as well. Whether it helps you perform better
as a weightlifter is probably a separate question,
if that makes sense. All right, fair enough.
What would be your take -home message or the
main advice for coaches and athletes of strength
and power sports in terms of the heart? Well,
I think... It's great that you're doing exercise
and if you've found something you love, make
sure you're doing plenty of it and enjoy it.
Equally, if you've got a symptom that's worrying
you about your heart. get it checked. So just
because you're very fit, very strong, doesn't
mean you can't have a problem. So if you've got
an arrhythmia or you've got sort of fainting
associated with exercise, a worrying family history,
or any change that is worrying you, it's really
important to get that checked. Remember that
some supplements and anabolic agents can have
really important and serious cardiac risks. And
certainly if you have been taking them and then
you're seeing someone about your heart, it's
important to disclose that so that they can treat
you. properly and the other one I guess is that
while exercise is enormously beneficial for your
health just because you're an athlete doesn't
give you a free pass with other modifiable risk
factors especially as we get older and so you
still got to think about your diet perhaps if
you're a smoker your overall weight, blood pressure,
cholesterol, these things are all still really
important to watch. And then the one last one
is a final word about emergency response. We
shouldn't ever really talk about heart health
without mentioning it. So everyone should aim
to be trained in CPR and the use of a defibrillator.
If you're at a gym or a sporting venue, many
of these venues do have defibrillators and that's
a really, really good thing. So if somebody around
you was to collapse suddenly, it would be really
nice if you know where it is and if you could
be part of helping run to get it. And so I guess
the final word on this is to say that any collapse
should be treated as cardiac. until it's proven
otherwise. And that's a really important message.
Awesome. Thank you so much. Two short questions
to finish. The first one is what is your favorite
exercise? I love to run. And I also love to see
my personal trainer for all the strength -based
stuff that I can't do at home. So I do know that
sometimes he brings out the bigger weights for
other people, but I really felt like that strength
trainings help my running, but also just good
to be a bit stronger. So I, and I love doing
that outside in the park. So that's been really
nice. Yeah. Okay. And The last question is where
people can find you if they want to follow your
work or keep up with your research? Yeah, definitely.
I've got a profile page at the University of
Sydney. So if you just search my name and the
University of Sydney, the Arena Project also
has a profile page. So if you search Arena University
of Sydney, one of those results will be the Arena
Gym and the other one will be the Arena Project,
which is our work. And that's a nice similarity.
I'm also on Google Scholar and X and Blue Sky.
Awesome. Thank you. much, Jessica. It was a pleasure.
Thank you so much, Alex. Pleasure.