A few weeks ago, a tragic incident in the world of sports caught everyone’s attention. People were appalled as a 17-year-old badminton player collapsed on court in the middle of the game. The officials ascertained that the athlete had died of cardiac arrest (the entire details are not available). This incident sparked uproar throughout the world. Rightly so, it wasn’t the first episode in this field, thus giving rise to an age-old debate yet again:
Table of Contents
Overview
These incidents did happen suddenly, but were they unexpected? To be precise. could we have foreseen these events and could these deaths have been prevented?
Before we dive into this topic, it would be interesting to have a look at the paradox of exercise and sports. Hippocrates had once said, “Our food should be our medicine and our medicine should be our food”. However, as food alone cannot keep a man healthy, he must exercise. If we provide the right amount of nutrition coupled with exercise, we can achieve the highest or safest form of health. Not to mention, it would be wiser to add ‘adequate mental health’ as one of the factors as well.
Now comes the paradox. Due to exercise, you can lower the risk of dying prematurely, but it could also increase the risk of dying which is a response to acute exercise or overdose of an exercise. So, should athletes stop training? I hardly think so. With rapid advancements in the field of medical sciences, a roadmap is definitely available to tackle the risks associated with exercise: of paramount importance being cardiac arrest and sudden cardiac death.
Let’s have a look at the definitions:
Sudden cardiac death (SCD) is defined as natural, sudden and unexpected death occurring due to a cardiac cause. Eg: suddenly out of the blue the person just dropped dead, massive heart attack or death in sleep.
Sudden cardiac arrest (SCA) is when there is unexpected collapse due to a cardiac cause. CPR and/or defibrillation may be provided here.
Sports related SCD: occurs during or within one hour after exercise. This will be our focus for the current blog.
Sports related SCD is the leading cause of death in young athletes. Epidemiological studies say that SCD are more frequent in elite athletes. In contrast, absolute incidence of SCD in this group is extremely low; though this could be attributed to immense variability in research when it comes to measuring and reporting. Research says that an underlying cardiac condition is the most common cause of unexpected deaths in young athletes on field.
This cardiac disease is usually congenital (also called silent SCA, where an underlying cardiac pathology is present). However, consumption of different substances such as steroids, hormones etc has also led to the development of acquired heart diseases in this cohort. As against this, coronary artery disease due to atherosclerosis is responsible for sudden deaths in master athletes (older athletes).
The first incident in most athletes is SCA. Furthermore, it has been well documented that exercise is the trigger during these events as the risk of SCA or a non-fatal myocardial infarction is 5-10 times higher during exercise compared to during rest. It has also been seen that the risk increases with older age. But above all an important factor to be considered is the intensity of exercise; especially sports with sudden short bouts of high intensity namely, tennis, badminton, football etc. This holds true for marathon runners as well. Although they run at a steady pace, towards the end of the marathon the demands placed on the cardiac system are high leading to increased heart rate.
It should be well noted that high intensity exercise is the trigger for such incidents of SCA, not sports. The diagram below provides a good explanation.
After going through this information, some people might have doubts, fears; should I exercise? How much should my child exercise? The answer: of course yes! Although exercise acts as a trigger for SCA or SCD , it also acts as a preventive measure. People who don’t exercise are at a five times higher risk to develop SCA than those who do. Thus a sedentary lifestyle is more detrimental than an active one. On the one hand, high intensity exercise acts as a trigger to develop SCA, on the other, physical activity is a protective response in those who have been exercising for a long time.
How do we ideally deal with this major problem? First and foremost, something that is protective should not be dangerous. To be more precise, our exercise strategy chosen should cause no harm. Hence, a tailor made approach is essential. Here comes in picture the importance of primary and secondary prevention.
Primary prevention:
- Medical professionals, especially team doctors and sports physiotherapists involved should have a thorough knowledge of all the pathologies associated with these events so that a proper screening can be done. Again, to screen or not to screen is a different debate; However , in this case it can help us apparently healthy adults and young athletes.
- Exercise prescription for athletes with an underlying condition should be done after thorough screening and following the exercise and sports recommendations (wherever necessary).
- Athletes and Coaches should be educated about the prodromal symptoms, so that they can seek medical help.
Secondary Prevention:
- This comes into picture once the incident has taken place. In this scenario, the team doctors, physios, and staff should be well trained to recognize the condition and administer the treatment, ultimately to prevent death.
- Exercise programs, volume and intensity, vitals should be well monitored and modified on a regular basis for those who have active cardiac conditions.
Conclusion
Recent reports have confirmed that 98% of the Indians don’t know how to administer cardio-pulmonary resuscitation (CPR). They are not trained to act in such situations. It is our duty to spread awareness regarding CPR. Regular training should be conducted at school and university level. Companies should make it mandatory for their employees to undertake CPR courses. We, as the educated citizens of this country, should take the responsibility to bring about a change. After all Life matters! Be the change you want to see.
