Heart, sport, risk, and freedom

THE EXPERT’S OPINION

Sport has been a form of competition since ancient times and sometimes it also contains an ethnic or religious component. It has even been related to certain social classes and popular traditions, but only recently has it been the subject of observation and health intervention. Recovering the idea of Olympism has marked a flex point. This change relates to professionalization and linked to it, the emergence of sport as a mass spectacle. Sport as a spectacle has been a seed to spread among the general non-professional public, the sport of risk or high physical demand.

Sport has also begun to be considered a health value, as preventive and curative in a long series of diseases. Medicine increasingly effective and affordable to society has made health “trendy”, and sport has become a way of expressing it, inspired by the beneficial effects of physical exercise. Society applauds “sports fashion” and “sports health” and, meanwhile, medical science is interested in physical exercise. This medical interest has transcended the bone-muscle-joint component, also delving into the physiological fact of adaptation to effort and its consequences. At the end of the nineteenth century, Dr. Salomon-Eberhard Henschen of the Swedish University of Uppsala published the first article on the heart of the sportsman Schilauf und Schiwettlauf. Eine medizinische Sportstudie (in current German, the original in *1).

More recently, the work of Dr. Barry J. Maron draws attention to the relationship between certain heart diseases and sudden deaths of athletes (*2), which social media publish with a certain sense of scandal. Surprising that a “healthy” activity could “kill” presumably “healthy” individuals, especially if the athlete was famous. The Medical-Sports Examination (or Sports Pre-participation, RMD) emerges as a hinge between the health value of sport and the evaluation of diseases as a cause of risk when practicing it. In a way, the RMD is the bridge between the freedom to exercise and the limitation, in some emotional way, of a previous and periodic medical check-up. That well-being that comes from following a fashion, joining the flow, and at the same time feeling the protection of something that improves health is emotionally irreproachable. In the same way, it represents the balance that will level the risks and calm both the athlete and the authorities.

Finally, we must assume, both doctors and athletes, that physical exercise is a coin with heads and tails. It is common knowledge that it can cause injuries to bones, joints, and muscles, but it is less widely reported that it also has some medical consequences that we should not forget, such as immunity problems, certain anemias, overtraining or some cardiac arrhythmias (fortunately infrequently, although they should not be forgotten). So, sport is health, freedom, and life, but it also represents injury and risk. A human activity that satisfies, that protects, but that we must take in the right “dose” and with due precautions.

Dr. Emilio Luengo-Fernández

Specialist in Cardiology. Director of the School of Sports Cardiology. Spanish Society of Sports Medicine, Zaragoza. 1. 2.

Sources:

(1) Henschen SE. Skidlauf und Skidwettlauf. Eine medizinische Sportsstudie. Mitt Med Klin Upsala 1899:2 (in scientific German at the time).

(2) Maron BJ, Epstein SE, Roberts WC. Hypertrophic cardiomyopathy: a common cause of sudden death in the young competitive athlete. Eur Heart J . 1983;Suppl F:135