Middle-aged men are more fit than ever, and though that's the good news, the bad news is they may be putting themselves at risk of having a heart attack.
According to the National Institutes of Health, the risk of sudden cardiac arrest, which occurs when the heart suddenly stops beating, can be brought on by extreme physical stress, increases with age, and affects men two to three times more often than women.
Although daily physical activity has benefits and can prevent and treat many diseases, including heart disease and obesity, researchers now suspect there may be a point at which too much exertion can become dangerous, even deadly, especially for middle-aged men.
The reason: By middle age, most men have early-stage vessel disease such as hardening of the arteries. Activities such as long-distance bike races, marathons and triathlons can cause structural changes to the heart and large arteries, and can permanently trigger rhythm problems and permanent damage, according to a study.
The study, published in The New England Journal of Medicine, states that a person is seven times more likely to have heart problems while exercising than at rest.
In addition, intense exercise for periods longer than one or two hours can cause overstretching of the heart's tissue, according to Dr. James O'Keefe, lead author of the study as well as a sports cardiologist and head of preventive cardiology at the Mid America Heart Institute in Kansas City, Mo.
What to look for
Lifelong vigorous exercisers do have lower death rates than those who don't exercise, the study notes, but detecting those who may be at risk for cardiac arrest is becoming more important.
The authors also said the study is not meant to undermine the importance of exercise, but 30 to 60 minutes per day is plenty.
Though there is no good test to determine if a person is at risk of sudden death, consulting a physician and discussing an exercise routine is important.
"The key is to work smart and listen to your body," said Mark Hupp, a registered nurse and cardiology resource coordinator at Ogden Regional Medical Center. "Build up, (practice) good nutrition, (drink) lots of water and get some professional advice if your body is not responding like you think it should, or you are having symptoms. Most people write off the vague symptoms as 'I'm just getting older' -- and in reality it is your body trying to warn you."
In addition to pacing themselves, men should be eating a healthy, moderate diet that is high in vegetables and fruits and low in red meat and processed starches.
When to worry
Hupp said heart attack risk factors for men include being over the age of 45, having a family history of cardiovascular disease, having untreated high blood pressure and cholesterol levels, being overweight, eating a poor diet and having diabetes.
"Some people, in hindsight, can say they were more fatigued or low-energy or some had indigestion," Hupp said, about heart attack warning signs. "But it never occurred (to them) that it was their heart until they had a major event. Others come in and the first warning is a big heart attack."
Some of the most common heart attack symptoms in men include pressure, crushing or squeezing pain in the chest, pain that radiates down one or both arms and up into the jaw and into the back, shortness of breath, sweating and nausea.
Hupp said the best treatment is prevention, but if you do end up in the ER, the best proven path of treatment involves quick intervention by the ER and an angiogram, followed by appropriate use of modern balloons and stents to open a blocked artery.
"Time is muscle," he said. "But diet and exercise are still the magic pill."
Next week: The dangers of restless leg syndrome in men