WEBVTT 00:00:00.000 --> 00:00:02.040 The biggest problem is that most adults aren't 00:00:02.040 --> 00:00:04.500 actually doing enough exercise and so rather 00:00:04.500 --> 00:00:07.080 than worrying about the athlete's heart for those 00:00:07.080 --> 00:00:09.359 who are doing a good job I guess we really need 00:00:09.359 --> 00:00:12.140 to remember that guidelines recommend both cardiovascular 00:00:12.140 --> 00:00:16.219 and strength training and really you've got to 00:00:16.219 --> 00:00:18.199 find something you love and make sure you're 00:00:18.199 --> 00:00:22.780 doing enough of it I think. Hi, Jessica. It's 00:00:22.780 --> 00:00:25.219 my pleasure to have you on Evidence Strong Show. 00:00:25.320 --> 00:00:27.239 If you could briefly introduce yourself. Thanks 00:00:27.239 --> 00:00:29.339 so much, Alex. It's a pleasure to be here. So 00:00:29.339 --> 00:00:31.399 my name's Jessica Rorchard. I'm an associate 00:00:31.399 --> 00:00:33.700 professor in the School of Public Health at the 00:00:33.700 --> 00:00:36.340 University of Sydney. And my research focus is 00:00:36.340 --> 00:00:39.679 on cardiac screening, particularly cardiac screening 00:00:39.679 --> 00:00:42.340 of athletes and people who are doing high -level 00:00:42.340 --> 00:00:45.880 elite exercise with a view to prevention of major 00:00:45.880 --> 00:00:49.679 sudden cardiac events and just promotion of athlete 00:00:49.679 --> 00:00:52.060 health in a cardiac sense as well. Okay. And 00:00:52.060 --> 00:00:55.859 part of your job is directing ARENA. So could 00:00:55.859 --> 00:00:58.179 you just speak a little bit about that too? Yeah, 00:00:58.200 --> 00:01:01.859 of course. So ARENA is a registry of athletes 00:01:01.859 --> 00:01:04.560 screening ECGs. So the Australasian registry 00:01:04.560 --> 00:01:06.959 of ECGs in national athletes, because we had 00:01:06.959 --> 00:01:09.239 to have an acronym. And that's really collecting 00:01:09.239 --> 00:01:12.060 and centralizing all the records of elite athletes 00:01:12.060 --> 00:01:14.519 who undergo cardiac screening in Australia and 00:01:14.519 --> 00:01:16.980 hopefully New Zealand as well. We'd like to include 00:01:16.980 --> 00:01:19.140 their data. And that's really saying a lot of 00:01:19.140 --> 00:01:21.260 sports are doing cardiac screening. of athletes. 00:01:21.540 --> 00:01:24.079 But let's have a look at the data and see what 00:01:24.079 --> 00:01:26.019 we're finding. What are the rates of diagnosis 00:01:26.019 --> 00:01:28.700 of major cardiac conditions? What are the clinical 00:01:28.700 --> 00:01:31.500 outcomes in terms of long -term events? And importantly, 00:01:31.680 --> 00:01:34.439 are there any differences in certain types of 00:01:34.439 --> 00:01:37.180 sporting disciplines in athletes or between male 00:01:37.180 --> 00:01:39.879 and female athletes that we need to take better 00:01:39.879 --> 00:01:41.939 account of? So really looking at some of those 00:01:41.939 --> 00:01:44.099 more underrepresented groups as well. Could you 00:01:44.099 --> 00:01:47.299 give us a general idea what athletes heart is? 00:01:47.560 --> 00:01:50.280 Yeah, absolutely. So we know that excess is really 00:01:50.280 --> 00:01:53.379 good for you in so many ways. And it has a powerful 00:01:53.379 --> 00:01:56.400 effect on cardiac structure and function really. 00:01:56.519 --> 00:01:59.079 So in the long term, sort of regular exercise 00:01:59.079 --> 00:02:02.140 promotes what we would call structural, functional 00:02:02.140 --> 00:02:05.379 and electrical remodeling of the heart. And that's 00:02:05.379 --> 00:02:08.580 exactly what we often call athlete's heart. So 00:02:08.580 --> 00:02:12.560 how much that happens depends on XSO's dose and 00:02:12.560 --> 00:02:15.060 intensity and a whole range of other factors 00:02:15.060 --> 00:02:19.469 like sex, genetics, environmental things. But 00:02:19.469 --> 00:02:22.270 in general terms, we talk about those types of 00:02:22.270 --> 00:02:24.830 changes. And we know that electrical changes 00:02:24.830 --> 00:02:27.849 are often visible on an electrocardiogram or 00:02:27.849 --> 00:02:30.909 ECG. So they're things like sinus bradycardia, 00:02:30.949 --> 00:02:33.629 a slow resting heart rate under 60 beats per 00:02:33.629 --> 00:02:36.110 minute, an increase in voltage criteria, perhaps, 00:02:36.250 --> 00:02:38.569 so chamber enlargement, and also things like 00:02:38.569 --> 00:02:41.750 repolarization anomalies. So there's actual changes 00:02:41.750 --> 00:02:44.930 in the function of the ion channels and really 00:02:44.930 --> 00:02:47.909 these changes, much more the electrical ones. 00:02:48.270 --> 00:02:51.069 on ECG. When we talk about functional changes, 00:02:51.210 --> 00:02:53.889 that's things like an enhanced feeling and an 00:02:53.889 --> 00:02:56.349 increase in stroke volume. And structural changes 00:02:56.349 --> 00:02:59.310 are changes in cavity size and wall thickness, 00:02:59.650 --> 00:03:02.189 particularly on the left side. And that really 00:03:02.189 --> 00:03:04.750 does depend a little bit on the type of exercise 00:03:04.750 --> 00:03:07.250 you do, what sorts of changes you see there. 00:03:07.409 --> 00:03:09.490 But essentially, as you start to exercise, your 00:03:09.490 --> 00:03:11.629 heart will contract faster and your circulation 00:03:11.629 --> 00:03:14.289 will increase. And that's get oxygenated blood 00:03:14.289 --> 00:03:16.889 to your muscles quicker. So as the demand increases, 00:03:16.930 --> 00:03:18.979 your heart rate increases and it contracts with 00:03:18.979 --> 00:03:21.020 more force. So your heart rate and stroke volume 00:03:21.020 --> 00:03:23.439 increase, creating increased cardiac output. 00:03:23.560 --> 00:03:25.860 So all these changes of athlete's heart are really 00:03:25.860 --> 00:03:28.020 to help your heart perform in the way you need 00:03:28.020 --> 00:03:30.199 it to for the exercise that you're doing. Okay. 00:03:30.240 --> 00:03:33.400 So this is in general. Now, if we speak about 00:03:33.400 --> 00:03:35.819 power athletes or strength athletes, many of 00:03:35.819 --> 00:03:39.479 my viewers or listeners will be related to Olympic 00:03:39.479 --> 00:03:41.780 weightlifting. Are there specific adaptations 00:03:41.780 --> 00:03:45.080 that this group of athletes will likely experience? 00:03:45.500 --> 00:03:47.199 Yeah, definitely. That's a really good question. 00:03:47.300 --> 00:03:50.280 And so we now know based on lots of evidence 00:03:50.280 --> 00:03:52.659 that there are quite different changes that you 00:03:52.659 --> 00:03:55.580 see in a strength training athlete, sometimes 00:03:55.580 --> 00:03:58.319 called static sports and very commonly weightlifting 00:03:58.319 --> 00:04:00.219 versus sort of the other end of the spectrum, 00:04:00.340 --> 00:04:02.860 which is endurance athletes. And then of course, 00:04:02.860 --> 00:04:04.740 there's all sorts of combinations in between. 00:04:04.939 --> 00:04:07.099 But when you're looking at strength trained athletes, 00:04:07.300 --> 00:04:10.319 that commonly leads to what they call concentric 00:04:10.319 --> 00:04:13.020 hypertrophy of the left ventricle. So that's 00:04:13.020 --> 00:04:15.780 thickening of the walls, but not so much a change. 00:04:15.919 --> 00:04:18.639 in left ventricular chamber size. So the changes 00:04:18.639 --> 00:04:21.540 in strength athletes are caused by pressure overload, 00:04:21.879 --> 00:04:24.379 I guess, accompanying the sort of high systemic 00:04:24.379 --> 00:04:26.899 arterial pressure found in this type of exercise. 00:04:26.980 --> 00:04:29.600 So that sort of blood pressure goes up and that's 00:04:29.600 --> 00:04:31.879 the sort of training you do in that type of a 00:04:31.879 --> 00:04:34.579 sport. And so strength trained athletes are really 00:04:34.579 --> 00:04:37.379 showing this concentric left ventricular hypertrophy 00:04:37.379 --> 00:04:40.519 and an increased ratio of wall thickness to radius. 00:04:40.819 --> 00:04:43.120 So if you look at the other side of the coin, 00:04:43.240 --> 00:04:46.189 the endurance athletes, they... tend to get mild 00:04:46.189 --> 00:04:48.790 to moderate, but sort of eccentric left ventricular 00:04:48.790 --> 00:04:51.209 hypertrophy, but then they get right ventricular 00:04:51.209 --> 00:04:54.410 dilation and biatrial enlargement as well. So 00:04:54.410 --> 00:04:56.850 it definitely is a bit different, particularly 00:04:56.850 --> 00:04:59.850 in the sort of structural changes that you might 00:04:59.850 --> 00:05:02.430 see if you were to image a whole lot of athletes, 00:05:02.569 --> 00:05:04.490 though you would see those different sorts of 00:05:04.490 --> 00:05:06.649 changes. And then of course, all the things in 00:05:06.649 --> 00:05:09.069 between and the sports that involve really a 00:05:09.069 --> 00:05:11.389 combination of the two, you might see really 00:05:11.389 --> 00:05:14.509 quite profound remodeling in some athletes. If 00:05:14.509 --> 00:05:18.410 we know that some level of adaptation is expected, 00:05:18.670 --> 00:05:21.490 how do athletes and coaches and parents should 00:05:21.490 --> 00:05:24.930 be thinking about, oh, is this normal or did 00:05:24.930 --> 00:05:27.009 we cross the line and this is better? It's a 00:05:27.009 --> 00:05:29.050 really good question. And I guess a lot of it 00:05:29.050 --> 00:05:31.649 depends on the context. So most of the time, 00:05:31.670 --> 00:05:33.790 if everything's going fine and you've got no 00:05:33.790 --> 00:05:36.089 symptoms, no family history and nothing to worry 00:05:36.089 --> 00:05:38.629 about, you won't actually know how much your 00:05:38.629 --> 00:05:40.629 heart's adapted because you might not, unless 00:05:40.629 --> 00:05:43.029 you've been going to cardiac screening or something 00:05:43.029 --> 00:05:45.959 like that. So you'll just maybe feel like you're 00:05:45.959 --> 00:05:48.259 getting fitter at your run or like what you're 00:05:48.259 --> 00:05:50.879 trying to do is a little bit easier as part of 00:05:50.879 --> 00:05:53.300 your training. If you're getting cardiac screening, 00:05:53.600 --> 00:05:56.560 it might be evident on the ECG because you might 00:05:56.560 --> 00:05:59.379 see some of those athlete heart changes. And 00:05:59.379 --> 00:06:01.600 we've got a lot better at distinguishing between 00:06:01.600 --> 00:06:04.800 what's normal and what's not in an ECG because 00:06:04.800 --> 00:06:08.000 we've just got so much more data now that's available 00:06:08.000 --> 00:06:13.300 to us. And so that's now much easier. a few not 00:06:13.579 --> 00:06:15.639 not as many as there used to be, always a few 00:06:15.639 --> 00:06:17.360 where you're not quite sure. And that's where 00:06:17.360 --> 00:06:19.720 a lot of clinical context might come in. So if 00:06:19.720 --> 00:06:22.860 that person says, you know what, I have suddenly 00:06:22.860 --> 00:06:26.379 been feeling, I've got a sudden loss of a cylinder 00:06:26.379 --> 00:06:28.939 or something when I'm training. It just, it doesn't 00:06:28.939 --> 00:06:31.339 feel like if there's anything like that, that's 00:06:31.339 --> 00:06:33.480 when you might be more suspicious that there's 00:06:33.480 --> 00:06:35.540 something wrong. Whereas if somebody just said, 00:06:35.660 --> 00:06:37.839 no, I'm completely normal. The only reason I'm 00:06:37.839 --> 00:06:40.220 here is my ECG looks like this. I don't have 00:06:40.220 --> 00:06:42.379 any family history. I don't have anything else. 00:06:42.860 --> 00:06:44.779 then you'd be less worried in your testing. But 00:06:44.779 --> 00:06:47.199 sometimes for a very small number of people, 00:06:47.360 --> 00:06:50.060 it's a bit harder to make that decision. And 00:06:50.060 --> 00:06:52.639 I guess if you are in one of those situations, 00:06:52.860 --> 00:06:55.060 it's really important to be as informed as you 00:06:55.060 --> 00:06:57.240 can be about family history. I keep talking about 00:06:57.240 --> 00:06:59.459 that because a lot of the conditions you might 00:06:59.459 --> 00:07:03.079 be worried about or looking for are cardiomyopathies 00:07:03.079 --> 00:07:05.259 or things like that that can be inherited. And 00:07:05.259 --> 00:07:07.860 so if you've got a family member that's died 00:07:07.860 --> 00:07:10.639 suddenly under the age of 40, even if you don't 00:07:10.639 --> 00:07:12.500 know what it's from, perhaps... are drowning 00:07:12.500 --> 00:07:15.500 on their own, but it was unexpected or even a 00:07:15.500 --> 00:07:18.279 single vehicle car accident can be caused by 00:07:18.279 --> 00:07:20.720 something like that if there was no other potential 00:07:20.720 --> 00:07:23.240 cause. So knowing something about your family 00:07:23.240 --> 00:07:26.160 history can be useful. And of course, if you 00:07:26.160 --> 00:07:27.959 are seeing a doctor about something to do with 00:07:27.959 --> 00:07:30.240 your heart, being very honest about whether you 00:07:30.240 --> 00:07:33.220 think you've had any symptoms or if you're perhaps 00:07:33.220 --> 00:07:35.360 taking any medication or supplement that could 00:07:35.360 --> 00:07:37.459 be an issue. While we're on the supplements, 00:07:37.819 --> 00:07:40.399 are there any supplements athletes should be 00:07:40.399 --> 00:07:44.170 avoiding? or can influence heart. There definitely 00:07:44.170 --> 00:07:47.509 are some, and there are other medications just... 00:07:48.149 --> 00:07:49.709 pharmaceuticals and things that can affect your 00:07:49.709 --> 00:07:52.029 heart. I think one of the things that we probably 00:07:52.029 --> 00:07:54.089 should mention if we're talking about strength 00:07:54.089 --> 00:07:56.709 training athletes is that we do know that the 00:07:56.709 --> 00:07:58.629 slight elephant in the room is that some people 00:07:58.629 --> 00:08:01.589 perhaps do take supplements and maybe anabolic 00:08:01.589 --> 00:08:04.810 steroid or similar sort of agents, and they absolutely 00:08:04.810 --> 00:08:07.290 can have very serious side effects on the heart. 00:08:07.389 --> 00:08:09.509 And I'm not sure if people always realize that 00:08:09.509 --> 00:08:11.790 there could be a bit of a risk there. So there 00:08:11.790 --> 00:08:14.009 are cases of people who've taken anabolic steroids 00:08:14.009 --> 00:08:17.009 and ended up with steroid -induced cardiomyopathy. 00:08:17.129 --> 00:08:18.790 where they've had a normal heart before because 00:08:18.790 --> 00:08:21.149 they've had some kind of imaging and their steroids 00:08:21.149 --> 00:08:23.889 have actually caused changes in the heart muscle 00:08:23.889 --> 00:08:26.149 structure because they change your other muscles. 00:08:26.189 --> 00:08:28.470 So why not the heart, I guess? It's thought to 00:08:28.470 --> 00:08:30.949 be through androgen receptors expressed on cardiac 00:08:30.949 --> 00:08:33.250 myocytes, sort of really right down into the 00:08:33.250 --> 00:08:36.549 cellular changes. And those changes show that, 00:08:36.570 --> 00:08:39.190 you know, you can permanently weaken the heart. 00:08:39.470 --> 00:08:42.409 by having taken steroids like that. And you can 00:08:42.409 --> 00:08:45.029 have major heart failure and other problems that 00:08:45.029 --> 00:08:47.570 come with that. So I think for anyone who either 00:08:47.570 --> 00:08:50.350 has taken or is considering taking something 00:08:50.350 --> 00:08:52.909 like that, it's very important to understand 00:08:52.909 --> 00:08:55.450 that those can bring significant risks that were 00:08:55.450 --> 00:08:57.789 not there before. So we do know that. There are 00:08:57.789 --> 00:09:01.190 other things, I mean, party drugs like cocaine, 00:09:01.350 --> 00:09:03.730 things like that, certainly. not great for your 00:09:03.730 --> 00:09:05.750 heart. But I guess that's in a slightly different 00:09:05.750 --> 00:09:08.250 category because you're probably not taking that 00:09:08.250 --> 00:09:10.429 for a performance reason. But if you're taking 00:09:10.429 --> 00:09:12.750 something purely for performance, it's very important 00:09:12.750 --> 00:09:14.970 to understand that. I have a question, follow 00:09:14.970 --> 00:09:17.490 -up question on steroids. So you said they, in 00:09:17.490 --> 00:09:20.149 the long term, they weaken the heart. The reason 00:09:20.149 --> 00:09:23.269 to take them is to get stronger or possibly bigger, 00:09:23.429 --> 00:09:26.730 bigger muscles. So why at the end, after prolonged 00:09:26.730 --> 00:09:30.909 use, we end up with weaker heart instead of stronger 00:09:30.909 --> 00:09:33.379 heart? Yeah, I guess. that's a really interesting 00:09:33.379 --> 00:09:36.059 question and I probably don't know the exact 00:09:36.059 --> 00:09:38.039 details of that. It's actually something that's 00:09:38.039 --> 00:09:40.659 quite hard to study because you need people to 00:09:40.659 --> 00:09:42.740 tell you that they've been taking steroids for 00:09:42.740 --> 00:09:45.100 a long time and you need to get an ethics approval 00:09:45.100 --> 00:09:47.759 to sort of really investigate what's a little 00:09:47.759 --> 00:09:50.559 bit of an edgy topic. There certainly are a few 00:09:50.559 --> 00:09:53.360 studies that show the cardiomyopathy because 00:09:53.360 --> 00:09:54.759 that's something you can document if somebody 00:09:54.759 --> 00:09:57.899 comes in with something. The idea that they weaken 00:09:57.899 --> 00:10:00.580 the heart is I guess that they can sort of lead 00:10:00.580 --> 00:10:03.759 to heart. failure and the heart being too thick 00:10:03.759 --> 00:10:06.000 means it can't pump in the way that it needs 00:10:06.000 --> 00:10:09.500 to is sort of the summary of that. So the risks 00:10:09.500 --> 00:10:12.320 of heart failure are certainly things that can 00:10:12.320 --> 00:10:14.740 go. I think that sort of thing we're talking 00:10:14.740 --> 00:10:17.990 sort of prolonged use and pain. potentially higher 00:10:17.990 --> 00:10:20.450 doses and the other thing I suppose with steroids 00:10:20.450 --> 00:10:22.990 is perhaps it's not always clear exactly what 00:10:22.990 --> 00:10:24.990 you're getting if you're getting it from someone 00:10:24.990 --> 00:10:27.289 or you might be trying a different one and it 00:10:27.289 --> 00:10:30.789 may not be perfectly known what the impact of 00:10:30.789 --> 00:10:33.169 being on that particular one is versus that one 00:10:33.169 --> 00:10:35.769 and at that dose for that period because this 00:10:35.769 --> 00:10:38.309 is a lot of this would be a bit hidden and so 00:10:38.309 --> 00:10:40.809 that lack of knowledge is part of the picture 00:10:40.809 --> 00:10:42.870 as well. Thank you for that. How long does it 00:10:42.870 --> 00:10:45.830 take for the heart to adapt if I do if I prepare 00:10:45.830 --> 00:10:48.149 for marathon? for three months, am I getting 00:10:48.149 --> 00:10:51.690 some adaptations towards the endurance athlete 00:10:51.690 --> 00:10:54.710 heart or do I have to do it for you? What is 00:10:54.710 --> 00:10:56.870 the timeframe? Yeah, that's a really good question. 00:10:57.049 --> 00:11:00.710 So yes is the short answer to the example you 00:11:00.710 --> 00:11:03.009 gave. So usually we talk about an athlete as 00:11:03.009 --> 00:11:05.490 someone who's exercising about four or five hours 00:11:05.490 --> 00:11:07.909 a week of decent exercise. And that's not just 00:11:07.909 --> 00:11:10.250 strolling down to the bus sort of thing, but 00:11:10.250 --> 00:11:12.789 decent level exercise. And so some studies suggest 00:11:12.789 --> 00:11:15.309 that about even three hours a week for three 00:11:15.309 --> 00:11:17.240 months. you might start to see some of those 00:11:17.240 --> 00:11:20.600 changes. Yeah. Three hours of maybe quite decent 00:11:20.600 --> 00:11:23.159 level intensity, but three hours of running is 00:11:23.159 --> 00:11:26.899 not nothing, for example, or other things that 00:11:26.899 --> 00:11:29.179 you might be doing like intense cycling or things 00:11:29.179 --> 00:11:31.419 like that. And so one of the easiest ways that 00:11:31.419 --> 00:11:33.299 people can tell is a lot of people might have 00:11:33.299 --> 00:11:35.379 a smartwatch or something now, and you can see 00:11:35.379 --> 00:11:37.779 your resting heart rate go down. So you might, 00:11:37.840 --> 00:11:40.600 before you start exercising, be somewhere in 00:11:40.600 --> 00:11:43.539 the 60s or 70s, and then you might drop down 00:11:43.539 --> 00:11:45.809 to be what? we would call bradycardic, so below 00:11:45.809 --> 00:11:47.730 60 beats a minute. And that's just your heart 00:11:47.730 --> 00:11:49.549 getting fitter and more efficient. It sort of 00:11:49.549 --> 00:11:51.490 doesn't have to do as much as it did before. 00:11:51.649 --> 00:11:54.070 So that's one of the very easy ways you can tell. 00:11:54.169 --> 00:11:56.570 We talked a little bit about timeframe. Are there 00:11:56.570 --> 00:12:01.110 any other factors that may influence heart adaptations? 00:12:01.590 --> 00:12:04.480 Yeah, I guess, as we mentioned. We know that 00:12:04.480 --> 00:12:08.139 sex, genetics and exercise dose and intensity 00:12:08.139 --> 00:12:11.679 are really the major factors. We know that female 00:12:11.679 --> 00:12:15.019 athletes definitely get athletes' heart changes 00:12:15.019 --> 00:12:17.860 as well. They're also related to the sport. A 00:12:17.860 --> 00:12:20.120 lot of the time in cardiology, we don't have 00:12:20.120 --> 00:12:23.279 enough. data on females despite they make up 00:12:23.279 --> 00:12:27.440 a big proportion and so as we've gone on we've 00:12:27.440 --> 00:12:29.580 had more and more data particularly of really 00:12:29.580 --> 00:12:32.279 top level female athletes and they certainly 00:12:32.279 --> 00:12:34.759 get those changes as well some of them might 00:12:34.759 --> 00:12:38.159 be slightly different or you know in the context 00:12:38.159 --> 00:12:39.799 of perhaps a slightly smaller heart compared 00:12:39.799 --> 00:12:42.179 to males so we do know that's something as well 00:12:42.179 --> 00:12:45.360 there is Some thought that there might be some 00:12:45.360 --> 00:12:47.840 conditions that are a little bit exercise induced. 00:12:48.120 --> 00:12:51.500 So exercise induced arrhythmogenic cardiomyopathy 00:12:51.500 --> 00:12:54.759 has been described. And that's, I guess, some 00:12:54.759 --> 00:12:57.519 people wonder whether there's an underlying genetic 00:12:57.519 --> 00:13:00.019 predisposition that when you combine it with 00:13:00.019 --> 00:13:02.980 the environment and some very high level training 00:13:02.980 --> 00:13:06.460 can almost sort of switch that on in some people. 00:13:06.639 --> 00:13:08.639 And that's a really interesting concept, I think. 00:13:08.740 --> 00:13:10.860 So previously you would think of arrhythmogenic 00:13:10.860 --> 00:13:13.240 cardiomyopathy as being much. more of a genetic 00:13:13.240 --> 00:13:16.100 thing, but perhaps it's sort of, there's a bit 00:13:16.100 --> 00:13:18.919 of a curve and beyond a certain point and in 00:13:18.919 --> 00:13:21.740 some people under some conditions, perhaps. that's 00:13:21.740 --> 00:13:23.799 something that can occur. So I think there are 00:13:23.799 --> 00:13:26.799 some things we don't know at the same time. And 00:13:26.799 --> 00:13:30.080 most of the time, to be honest, the slight issues 00:13:30.080 --> 00:13:32.759 that you can get as a result of too much exercise 00:13:32.759 --> 00:13:35.980 or a lot of overtraining, perhaps, they are things 00:13:35.980 --> 00:13:38.580 you tend to see more in the endurance athletes. 00:13:38.700 --> 00:13:42.059 And that's something that I guess is just a function 00:13:42.059 --> 00:13:44.279 of the time and the amount you're pushing your 00:13:44.279 --> 00:13:46.980 heart. So things like atrial fibrillation or 00:13:46.980 --> 00:13:50.379 perhaps other supraventricular tachycardias are 00:13:50.379 --> 00:13:52.480 something. that definitely we know the risk is 00:13:52.480 --> 00:13:55.500 a bit higher in endurance athletes. But something 00:13:55.500 --> 00:13:58.909 like... Atrial fibrillation, for most people, 00:13:58.970 --> 00:14:01.269 it's a bit annoying, but it's not a terrible 00:14:01.269 --> 00:14:03.230 thing that's going to cause you to have a cardiac 00:14:03.230 --> 00:14:06.690 arrest. And so people who absolutely love going 00:14:06.690 --> 00:14:09.289 out and doing a 200 -kilometer ride every weekend 00:14:09.289 --> 00:14:11.769 up the highest mountain they can find, perhaps 00:14:11.769 --> 00:14:14.450 that's just another risk along with falling off 00:14:14.450 --> 00:14:16.870 your bike, if that makes sense. So it's really 00:14:16.870 --> 00:14:19.590 interesting. We do know a few of the things that 00:14:19.590 --> 00:14:22.289 influence how your heart changes according to 00:14:22.289 --> 00:14:24.470 exercise, and really there's probably a few more 00:14:24.470 --> 00:14:27.200 that we don't know. still looking at data for 00:14:27.200 --> 00:14:30.279 do you have a lot of in the arena registry do 00:14:30.279 --> 00:14:33.320 you have a lot of strength and power athletes 00:14:33.320 --> 00:14:37.100 we the majority at the moment in there are mixed 00:14:37.100 --> 00:14:40.019 sport athletes which is a catch -all term for 00:14:40.019 --> 00:14:42.379 a lot we definitely have a few and the ones we 00:14:42.379 --> 00:14:45.330 do have the very top level. So they're from the 00:14:45.330 --> 00:14:47.269 Australian Institute of Sport, Victorian Institute 00:14:47.269 --> 00:14:50.289 of Sport. And so range of ages, and hopefully 00:14:50.289 --> 00:14:52.750 what we'll be able to get is interesting data 00:14:52.750 --> 00:14:55.289 over time. So where an athlete gets screened 00:14:55.289 --> 00:14:57.309 multiple times across their career, we'll be 00:14:57.309 --> 00:14:59.309 able to sort of follow some of those changes. 00:14:59.750 --> 00:15:02.370 Obviously, it might be a little bit different 00:15:02.370 --> 00:15:05.870 in recreational or other competitions. We did 00:15:05.870 --> 00:15:08.350 mention anabolic steroids. So presuming anyone 00:15:08.350 --> 00:15:11.230 in the Olympics is sort of subject to very careful 00:15:11.230 --> 00:15:14.559 drug testing and perhaps would not be taking 00:15:14.559 --> 00:15:17.620 that risk anywhere so we may not be able to answer 00:15:17.620 --> 00:15:21.240 some of those questions without specific data 00:15:21.240 --> 00:15:23.960 on sort of groups that are doing that but we 00:15:23.960 --> 00:15:26.679 will be able to as we gather more data really 00:15:26.679 --> 00:15:28.799 look at more of the changes in strength athletes 00:15:28.799 --> 00:15:31.289 because I think you just often need Quite a big 00:15:31.289 --> 00:15:34.330 data set and quite a length of time to properly 00:15:34.330 --> 00:15:37.909 look in some of those ways. Awesome. So fingers 00:15:37.909 --> 00:15:41.789 crossed it's coming in the next few years. Yes. 00:15:41.950 --> 00:15:45.490 Okay. The main question, I guess, is, is the 00:15:45.490 --> 00:15:50.169 athlete's heart adaptation good or bad? And should 00:15:50.169 --> 00:15:53.419 we be preventing it? Well. I think you'd have 00:15:53.419 --> 00:15:55.539 to say it's generally good. So most of these 00:15:55.539 --> 00:15:58.299 changes, benign most of the time, they increase 00:15:58.299 --> 00:16:00.480 the heart's ability to pump blood effectively, 00:16:00.659 --> 00:16:03.340 enhancing stroke volume to meet performance demands. 00:16:03.799 --> 00:16:05.639 The heart's a muscle and you're wanting it to 00:16:05.639 --> 00:16:07.620 grow stronger and more efficient. So most of 00:16:07.620 --> 00:16:09.879 the time, it's a really good thing. Just like 00:16:09.879 --> 00:16:12.860 a lot of things, occasionally in a small subset 00:16:12.860 --> 00:16:15.799 of athletes, as we said, higher levels of endurance 00:16:15.799 --> 00:16:19.080 exercise in particular can lead to sort of electrical 00:16:19.080 --> 00:16:21.860 remodeling, which can lead to rhythm problems. 00:16:22.059 --> 00:16:23.940 like atrial fibrillation, and we know that there 00:16:23.940 --> 00:16:26.240 are some associations. If anyone's interested 00:16:26.240 --> 00:16:28.299 in that, there's a great book called The Haywire 00:16:28.299 --> 00:16:31.179 Heart by John Mandrola and a couple of other 00:16:31.179 --> 00:16:33.080 excellent endurance athletes where they look 00:16:33.080 --> 00:16:35.639 at that in detail. But I really think it's important 00:16:35.639 --> 00:16:37.879 to say the biggest problem is that most adults 00:16:37.879 --> 00:16:40.460 aren't actually doing enough exercise. And so 00:16:40.460 --> 00:16:42.559 rather than worrying about the athlete's heart, 00:16:42.700 --> 00:16:45.200 for those who are doing a good job, I guess we 00:16:45.200 --> 00:16:47.659 really need to remember that guidelines recommend 00:16:47.659 --> 00:16:50.440 both cardiovascular and strength training and 00:16:50.440 --> 00:16:53.710 really... You've got to find something you love 00:16:53.710 --> 00:16:56.549 and make sure you're doing enough of it, I think. 00:16:57.230 --> 00:16:58.909 That would be the best thing you can do for your 00:16:58.909 --> 00:17:01.210 heart is to make sure you are following the guidelines 00:17:01.210 --> 00:17:05.130 at least and doing some good exercise. So the 00:17:05.130 --> 00:17:08.150 follow -up question on this is weightlifters 00:17:08.150 --> 00:17:12.049 and powerlifters don't particularly enjoy running. 00:17:12.190 --> 00:17:15.950 Is lifting heavy weights repeatedly considered 00:17:15.950 --> 00:17:21.549 cardio or should the athletes do more? Should 00:17:21.549 --> 00:17:24.369 they add running or some other modality that 00:17:24.369 --> 00:17:27.910 is more lower intensity? longer in time? I guess 00:17:27.910 --> 00:17:30.390 it depends what you're training for is the answer. 00:17:30.670 --> 00:17:33.430 And so my personal trainer sometimes comments 00:17:33.430 --> 00:17:35.769 on what certain athletes are doing, like a cricketer 00:17:35.769 --> 00:17:38.269 who's just run a half a marathon in a quite fast 00:17:38.269 --> 00:17:40.410 time. He would say, yeah, but does he need that 00:17:40.410 --> 00:17:42.690 for what he's trying to do? I guess so that's 00:17:42.690 --> 00:17:44.349 one question. And the other question is just 00:17:44.349 --> 00:17:46.750 for general health. So I think you would probably 00:17:46.750 --> 00:17:50.569 call all sorts of weightlifting that that's really 00:17:50.569 --> 00:17:52.769 under the heading of strength resistance training. 00:17:53.049 --> 00:17:54.829 And if you're looking at the guidelines, you 00:17:54.829 --> 00:17:57.279 probably do. need a reasonable amount of moderate 00:17:57.279 --> 00:18:00.279 to vigorous physical activity. It doesn't have 00:18:00.279 --> 00:18:02.339 to be running, could be swimming, could be cycling, 00:18:02.559 --> 00:18:04.900 could be brisk walking and many other things. 00:18:05.019 --> 00:18:07.640 It's probably for your health is good to add 00:18:07.640 --> 00:18:09.720 that as well. Whether it helps you perform better 00:18:09.720 --> 00:18:11.900 as a weightlifter is probably a separate question, 00:18:11.940 --> 00:18:13.599 if that makes sense. All right, fair enough. 00:18:13.799 --> 00:18:17.559 What would be your take -home message or the 00:18:17.559 --> 00:18:20.539 main advice for coaches and athletes of strength 00:18:20.539 --> 00:18:23.799 and power sports in terms of the heart? Well, 00:18:23.859 --> 00:18:26.119 I think... It's great that you're doing exercise 00:18:26.119 --> 00:18:28.259 and if you've found something you love, make 00:18:28.259 --> 00:18:30.619 sure you're doing plenty of it and enjoy it. 00:18:30.839 --> 00:18:33.039 Equally, if you've got a symptom that's worrying 00:18:33.039 --> 00:18:35.630 you about your heart. get it checked. So just 00:18:35.630 --> 00:18:38.069 because you're very fit, very strong, doesn't 00:18:38.069 --> 00:18:40.250 mean you can't have a problem. So if you've got 00:18:40.250 --> 00:18:43.250 an arrhythmia or you've got sort of fainting 00:18:43.250 --> 00:18:46.869 associated with exercise, a worrying family history, 00:18:46.950 --> 00:18:49.950 or any change that is worrying you, it's really 00:18:49.950 --> 00:18:51.869 important to get that checked. Remember that 00:18:51.869 --> 00:18:54.569 some supplements and anabolic agents can have 00:18:54.569 --> 00:18:57.329 really important and serious cardiac risks. And 00:18:57.329 --> 00:18:59.470 certainly if you have been taking them and then 00:18:59.470 --> 00:19:01.269 you're seeing someone about your heart, it's 00:19:01.269 --> 00:19:03.490 important to disclose that so that they can treat 00:19:03.490 --> 00:19:05.619 you. properly and the other one I guess is that 00:19:05.619 --> 00:19:08.119 while exercise is enormously beneficial for your 00:19:08.119 --> 00:19:10.539 health just because you're an athlete doesn't 00:19:10.539 --> 00:19:12.960 give you a free pass with other modifiable risk 00:19:12.960 --> 00:19:15.720 factors especially as we get older and so you 00:19:15.720 --> 00:19:18.259 still got to think about your diet perhaps if 00:19:18.259 --> 00:19:21.150 you're a smoker your overall weight, blood pressure, 00:19:21.190 --> 00:19:23.349 cholesterol, these things are all still really 00:19:23.349 --> 00:19:25.650 important to watch. And then the one last one 00:19:25.650 --> 00:19:27.970 is a final word about emergency response. We 00:19:27.970 --> 00:19:29.809 shouldn't ever really talk about heart health 00:19:29.809 --> 00:19:32.109 without mentioning it. So everyone should aim 00:19:32.109 --> 00:19:35.250 to be trained in CPR and the use of a defibrillator. 00:19:35.329 --> 00:19:37.890 If you're at a gym or a sporting venue, many 00:19:37.890 --> 00:19:40.630 of these venues do have defibrillators and that's 00:19:40.630 --> 00:19:43.109 a really, really good thing. So if somebody around 00:19:43.109 --> 00:19:46.109 you was to collapse suddenly, it would be really 00:19:46.109 --> 00:19:49.049 nice if you know where it is and if you could 00:19:49.049 --> 00:19:51.650 be part of helping run to get it. And so I guess 00:19:51.650 --> 00:19:54.470 the final word on this is to say that any collapse 00:19:54.470 --> 00:19:57.289 should be treated as cardiac. until it's proven 00:19:57.289 --> 00:19:59.529 otherwise. And that's a really important message. 00:19:59.789 --> 00:20:01.569 Awesome. Thank you so much. Two short questions 00:20:01.569 --> 00:20:04.470 to finish. The first one is what is your favorite 00:20:04.470 --> 00:20:07.890 exercise? I love to run. And I also love to see 00:20:07.890 --> 00:20:10.009 my personal trainer for all the strength -based 00:20:10.009 --> 00:20:12.769 stuff that I can't do at home. So I do know that 00:20:12.769 --> 00:20:14.470 sometimes he brings out the bigger weights for 00:20:14.470 --> 00:20:16.690 other people, but I really felt like that strength 00:20:16.690 --> 00:20:19.670 trainings help my running, but also just good 00:20:19.670 --> 00:20:21.869 to be a bit stronger. So I, and I love doing 00:20:21.869 --> 00:20:24.369 that outside in the park. So that's been really 00:20:24.369 --> 00:20:27.250 nice. Yeah. Okay. And The last question is where 00:20:27.250 --> 00:20:30.309 people can find you if they want to follow your 00:20:30.309 --> 00:20:33.529 work or keep up with your research? Yeah, definitely. 00:20:33.630 --> 00:20:36.170 I've got a profile page at the University of 00:20:36.170 --> 00:20:38.289 Sydney. So if you just search my name and the 00:20:38.289 --> 00:20:40.609 University of Sydney, the Arena Project also 00:20:40.609 --> 00:20:43.549 has a profile page. So if you search Arena University 00:20:43.549 --> 00:20:46.250 of Sydney, one of those results will be the Arena 00:20:46.250 --> 00:20:48.029 Gym and the other one will be the Arena Project, 00:20:48.230 --> 00:20:50.430 which is our work. And that's a nice similarity. 00:20:50.789 --> 00:20:54.009 I'm also on Google Scholar and X and Blue Sky. 00:20:54.269 --> 00:20:56.140 Awesome. Thank you. much, Jessica. It was a pleasure. 00:20:56.259 --> 00:20:57.599 Thank you so much, Alex. Pleasure.