Issue 2 • 2022
© 2022 The Royal Australasian College of Physicians
College journal makes headlines with new research on heart health
A new study highlights the risks posed to over-35s undertaking regular strenuous exercise and the important role that education plays in recognising cardiac symptoms and mitigating risks during physical activity.
Earlier this year, cardiac health was topical as a result of high-profile incidences of cardiac arrest around Australia, starting with the tragic death of famous Australian cricketer, Shane Warne at age 52. What followed was the sudden salience of reports on prominent Australians passing away or suffering from heart attacks over a number of weeks, including Victorian Labor Senator Kimberley Kitching, One-Day-International cricketer Ryan Campbell, former Essendon AFL player Don Wallis, and more recently, Burnie Dockers football player Tobi Mcinnes, who went into sudden cardiac arrest while on the field. Most were aged in their fifties.
In March, the College Internal Medicine Journal published an article on 'Masters age football and cardiovascular risk', with new research showing that. amongst a cohort of 153 Masters-age Football players aged over 35, almost half (49.6 per cent) were not confident in their ability to recognise symptoms of a heart attack in themselves, and only 32.7 per cent expressed confidence in recognising one in others. Despite this, one in five participants reported experiencing one or more potential cardiac symptoms during physical activity in the preceding 12 months.
Most common symptoms associated with cardiac arrest:
  • Chest pain/pressure/tightness
  • Shortness of breath/difficulty
  • breathing
  • Chest discomfort
  • (heaviness/tenderness/burning)
  • Pale, ashen, loss/change of colour
  • Palpitations/rapid heart rate
  • Arm or shoulder pain
  • Jaw pain
  • Neck pain
  • Back pain
  • Dizziness/light-headedness        
  • Loss of consciousness/fainting
  • Weakness/fatigue
  • Sweating
  • Heartburn/indigestion/stomach problems  
  • Nausea/vomiting
When given a hypothetical scenario of experiencing chest pain while playing football, 46.6 per cent of participants said they would leave the field immediately, however a concerning 49 per cent would continue playing for 5 to 10 minutes to see if the pain eased, and several would continue playing further.
According to one of the authors of the paper, Professor Geoffrey Tofler – senior author of the paper RACP Fellow, and Cardiologist at University of Sydney and Royal North Shore Hospital – research is important because awareness of heart attack symptoms can be the difference between life and death.
“These are worrying statistics, especially when the risk increases with age. This risk is even greater in those who exercise infrequently or not at all.
“Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. Being able to recognise the warning signs of an impending cardiac event is critical to mitigating those risks during exercise.
“The risks are elevated when accounting for participants with pre-existing risk factors like hypercholesterolaemia, hypertension, smoker status, weight issues, and family history of heart disease,” said Professor Tofler.
The research made headlines across The Daily Telegraph, The Australian, The National Tribune, Retail Pharmacy Magazine, and News Medical. Professor Tofler also gave a live interview with ABC News Radio delving further into how people can be more in tune with their heart health.
Professor Tofler emphasises that cardiac education and training can be vital in preventing or mitigating cardiac events – not just on the football field, but in everyday life.
With 67.3 per cent of study participants trained in administering CPR, most agreed that CPR training and the use of external defibrillators were important and should become staples at football fields during all games, or in any location where there are large crowds of people. Evidence shows that the immediate implementation of one or both of these methods in the event of cardiac arrest can mark the line between life and death, with the patient’s survival rate decreasing by 7 to 10 per cent for every minute without the use of either method.
“Education strategies should focus on giving players clear instructions to assist rapid symptom recognition and management of cardiac events. These instructions should be made available to players electronically and onsite through posters for easy access. This will be vital to taking prompt action and increasing the rate of survival.”
So, should this stop over-35s from engaging in exercise? In most cases, probably not. Although it’s important to factor in existing medical conditions, or family history of certain health issues.
“While it is important to note that the benefits of exercise still far outweigh cardiac risk overall, these measures may further increase the benefit to risk,” Professor Tofler said.
You can read the full research paper here.