Are You at Risk for a Heart Attack After Exercise?

Dying during or immediately after physical activity occurs rarely. But the exercise-related death of a prominent Wall Street executive last week nevertheless raises concerns for people who want to keep active during middle age and later years. Regular exercise is a cornerstone of good health, and its long-term benefits for both longevity and protection against heart attacks, cancer and other ailments are supported in many studies. Doctors say there are strategies to reduce the already low likelihood of a workout turning into a tragedy.

“Exercise is not a vaccine against heart disease,” says Michael Joyner, an exercise physiologist at Mayo Clinic, in Rochester, Minn. Dr. Joyner noted that risk factors such as high blood pressure and high cholesterol are increasingly common as people age. “You need to get them treated,” he says. “Middle-aged men in high-stress jobs need to get a checkup once in a while.”

Growing numbers of people are moving through middle age determined to stay active with competitive sports and regular exercise. Doctors urge others who are on the sidelines to join in to improve their health. “There is unequivocal evidence that regular physical activity and exercise have multiple benefits that far outweigh any risk of the exercise itself,” says Jonathan A. Drezner, director of the Center for Sports Cardiology at the University of Washington, in Seattle.

heartriskBut, while a person is doing it, rigorous exercise, whether on a treadmill, a road race or a basketball court, does elevate risk for sudden cardiac arrest, a typically fatal event that can be triggered by a heart attack but is the immediate result of an out-of-control arrhythmia that causes the heart to stop beating. The majority of sports-related sudden cardiac arrests occur among people above 35 years old. Most victims are men and most already have heart disease whether they know it or not.

“The risk is much greater for people who don’t exercise on a regular basis,” Dr. Drezner says. “The weekend warrior who goes out to crush it once a week” or less often is much more vulnerable than the person who gets three to five cardio workouts a week. For a sedentary middle-age person who wakes up one morning and suddenly decides to become a “lean, mean fighting machine in a month, that’s a bad idea,” says Sumeet Chugh, associate director of the Heart Institute at Cedars Sinai Medical Center, in Los Angeles. “You should make fitness a goal, but a gradual goal,” slowly increasing intensity over several weeks or more.

Another worry is that heart disease often goes undetected. In as many as half the cases, a heart attack is a person’s first symptom of significant coronary artery disease. That raises the stakes on controlling cholesterol, blood pressure and other risk factors. A potentially troublesome aortic aneurysm, a bulging in the main blood vessel that carries blood away from the heart, rarely causes symptoms and poses a challenge for early detection. Dr. Chugh, co-author of a recent article titled “Sudden Cardiac Death in the Older Athlete” in the Journal of the American College of Cardiology, lists these markers for high risk: a 10-year risk of coronary artery disease greater than 5%; very high cholesterol; diabetes; a strong family history of sudden cardiac death or early heart disease; or a body-mass index, a measure of obesity based on height and weight, over 28.

A sedentary person who checks any of these boxes should get a thorough cardiac evaluation before participating in sports or embarking on an exercise program, he says. Victims of sudden cardiac arrest often miss or ignore signals of heart risk, researchers say. A recent study found more than one-third of people experienced typical heart symptoms in the week before the event.

“Everyone who is exercising needs to be aware of symptoms that don’t feel right,” says Dr. Drezner. A little chest pain or shortness of breath, a heart palpitation or feeling more fatigued than usual might seem trivial, but they are warning signs that should prompt people to “definitely see a physician to be evaluated,” Dr. Brezner says.

Fitness experts also point to studies showing the benefits of physical activity come from frequency, not intensity. People get more than 50% of the payoff of rigorous exercise just by walking, says Michael Roizen, chief wellness officer at the Cleveland Clinic. A gradual warm-up and a cool-down period are important components of a more rigorous workout, he says. And he especially cautioned against being too competitive on a workout. “A guy will say, ‘If I can do 30 minutes, why can’t I do 40 minutes,’ ” Dr. Roizen says. “Every guy will go too far, too fast unless you yell at them.”

A recent study Dr. Chugh led of cardiac-arrest cases in the Portland, Ore., area illustrates how rare such events are. It examined 1,247 sudden cardiac arrests that occurred among people ages 35 to 65 during an 11-year period ending in 2013. Researchers found that just 5%—63 cases—were associated with sports activity, including 17 arrests during jogging, seven during gym exercise and others during such activities as basketball, cycling, golf, volleyball and soccer. The analysis, published in April in the journal Circulation, said the incidence of sports-associated sudden cardiac arrests was 21.7 per million residents per year, compared with 555 per million for arrests not associated with sports. Extrapolating the findings to the entire U.S. population, researchers estimated that 2,269 men and 136 women suffer a sudden cardiac arrest associated with physical activity each year.

“You can’t really use the risk of sudden death as an excuse not to exercise,” says Dr. Chugh.

By Ron Winslow for The Wall Street Journal

How Does Strength Training Compare With Body Weight in Reducing Risk Factors for Cardiometabolic Disease in Overweight-Obese Young Men?

In the United States, about one-third of adults are obese. The lack of exercise that contributes to obesity has led to confusion about whether fitness or body weight is more important to health. This study looks at at the fitness vs. body weight “controversy” in young men, but in a different way. The innovative aspect of this study is comparing two groups who had habitually been doing similar amount of weight training (and had similar strength levels) and two groups with similar body weights. The overweight/obese and normal-weight strength-trained individuals had similar levels of measures of disease risk and both were better on these measures than overweight/obese individuals who did not have a history of regular strength training. These findings are important because they challenge the existing view of the importance of body weight classification and suggests that regular weight training strength fitness may be more critical to health. Furthermore, strength fitness may be an alternate therapeutic target, especially in those unable to normalize body weight. Ultimately, it may be time for us to shift the focus to changing lifestyles as opposed to just focusing on body weight and weight loss.

View the study’s abstract


A concussion is considered a traumatic brain injury (TBI). More than 400,000 kids in the U.S. go to the emergency room every year with a TBI. The Centers for Disease Control and Prevention estimates up to 3.8 million people will suffer from a concussion this year alone. According to the 2012 Midwest Orthopaedics at Rush/Illinois Athletic Trainers Association survey of Illinois certified athletic trainers, concussions ranked among the top five most common high school sports injuries.

Select one of the links below to learn more about concussion symptomsdiganosis, and treatment strategies from Midwest Orthopaedics at Rush sports medicine physicians.

How do athletes get concussions?
What athletes are more prone to concussions?
What are the symptoms of a concussion?
How is a concussion diagnosed?
What is the recommended treatment for a concussion?

How can concussions be prevented?

PDF Download the Concussion: Prevention Tips and Exercise Guide

Physicians at Midwest Orthopaedics at Rush who treat concussion include:

Muscle inactivity behind the health risks of prolonged sitting even if you exercise

Over recent years, there has been considerable interest in the health hazards of prolonged sitting. However, it has been largely unknown what actually makes sitting so dangerous.

In this study, 150 healthy and physically active individuals wore special shorts which recorded their thigh muscle activities while they went about their normal daily life. The muscles were said to be inactive when the amplitude was less than what was measured during standing. In other words, already standing up was counted as activity. The investigators found out that even though the participants fulfilled the current exercise recommendations, their muscles were inactive for 65% of the time. People who had the least muscle activity had worse HDL cholesterol and triglyceride levels. However, already during standing the muscle activity was 200% higher than during sitting. The act of standing up to break up long periods of muscle inactivity might be beneficial for health – even if people exercise regularly.

View the study’s abstract

How does being sedentary negatively impact your health?

Multiple studies have reported that excessive sedentary behavior, or spending a great deal of your day sitting, is detrimental for your health. However, the physiology by which a sedentary behavior negatively impacts health is largely unknown and understudied. Recently, scientists with expertise in physical activity and exercise research came together to discuss what is known and unknown about the underlying physiological effects of sedentary time on health outcomes. The goal of this meeting was to make recommendations for future research. Conclusions from the meeting indicate that research should: 1) focus on the central and peripheral mechanisms that govern high or low sedentary behavior; 2) determining the physiological effects caused by a lack of movement rather than sitting per se; and 3) establishing new research strategies that can lead to better understanding of the mechanisms induced by chronic sedentary behavior.

View the study’s abstract

The ‘Posture Guru’ Shares Her Tips to Relieve Back Pain

alignUSABack pain is an epidemic. It could be caused by our more sedentary lifestyle, a few extra pounds around the middle or looking at the phone for hours each day. But Silicon Valley posture guru Esther Gokhale says in non-industrial cultures, back pain is practically non-existent. Why?

Watch the full interview on Good Morning America

She thinks is because our spines have recently changed shape, so she has created an entire method to change that shape and reduce pain. Gohkale says it’s a method for sustainable posture that could lead to a reduction in back pain. Her fans are legion and the medical community has taken note as it searches for alternatives to pain pills, surgery and braces.

She says children natively have this posture and before the industrial age, so did our great-great-grandparents. But then something changed: Activity alignUSA2lessened, our gaze moved to small tasks with our hands and our idea of sitting and standing properly morphed to something more erect. Gokhale channels my grandmother: “’Sit up straight.’ That’s what moms have been telling their kids for decades; usually in a frustrated way, because it clearly doesn’t work. Maybe for 10 seconds and then the kid goes back to slumping.”

So Gokhale says “Sit up smart.” She has seminars, videos and books that espouse her techniques and the traditional medical community is taking note. Dr. Praveen Mummaneni, neurosurgeon and co-director of the UCSF Spinal Center says that while no studies of non-industrial populations have been done to directly support Esther Gokhale’s research, the techniques resonate. “It’s a very good visual. The J-shape is a very good visual that I think a lot of people will recognize, looking at that from the side and in thinking about their own posture, and it’s straight forward to remember,” Mummaneni says.

In our posture session, Gokhale taught me some basic ideas that have helped me focus on my posture. As she says, “My methods are simple, but not easy.” I agree: in the days following our session, I try to put her ideas into practice; posture is a discipline!

How to sit in a chair: the behind goes behind
Gokhale says we were taught to tuck our pelvis when we sit, “imagine you have a tail. The way we’ve been instructed to sit is to tuck that tail under our behinds. But I want you to push the tail out and let it go out the back of the chair.” I find this pelvic tilt is freeing, and Gokhale says you can reinforce it if you sit for long periods by using a pillow to wedge your pelvis forward and force your behind, behind.

Power your posture from the rear
Gokhale coaches her students to access the muscles of the gluteus maximus to hold the ”J” shape in their backs and stack their spine in vertically. “Make every step a rep.”

Gokhale says strengthening the posterior chain of muscles in the gym is good, but if you can recruit those muscles with every step, clenching the upper outside quadrant of your backside as you walk, you will do much more for your overall posture and pain reduction.

Lengthen the spine and hook your mid-back on a support
Whether it’s typing at a keyboard or holding the steering wheel of a car, when our arms go forward, our shoulders follow and we end up in a “C” shape. Gokhale says to use a towel, a jacket or she sells tethered pillows that fasten on. She says lean forward, use your arms to push down and lengthen the spine as you then lean back and hook your mid-back onto that cushion.

This move was enlightening for me. I felt like it created a stacked spine that rested comfortably. More than traditional good posture, I found this easier to maintain over time.

Roll the shoulders back
As I spoke with Gokhale the first thing I noticed was that every five minutes or so she would roll her shoulders back, one at a time. In the past I thought of good posture as lifting the entire rib cage and pushing it forward.

In truth, my posture came slouching down seconds later when my attention turned elsewhere. But if I just focus on my shoulders, I find that I have a little more hold time before they drop forward again.

Gokhale has free videos on her website demonstrating some of these techniques and she also sells her book, pillows and chairs there.

If there’s one thing I learned doing this assignment on posture, it’s that improper posture can lead to pain, but the feedback loop is delayed: The pain occurs too long after the bad posture happens to truly influence our behavior. So I also tried a few devices that provide more immediate feedback for bad posture.

Posture Shirt Alignmed: $95
The Posture Shirt looks like a cycling jersey: fitted to the body with short, tight sleeves. It costs $95 and it’s a biofeedback device to help you sit up straight. One of the biggest problems of poor posture is we lose focus, slouch and forget our goals. I wore the posture shirt for three days and this was a consistent cycle:Sit properly, unconsciously slouch, wonder why my shirt felt tight on my shoulders and arms, remember that it feels good when I sit up straight, correct posture. If you suffer from pain and have been trained in proper posture, I found this to be a helpful biofeedback mechanism to remind you of your goals. That said, I would have to be in serious pain to want to wear this shirt habitually. Alignmed also has a bra version if the shirt is too much to wear under tailored clothing.

Fruit: Friend or Foe?


If ever there was a starring season for fruit, summer is it. Farmer’s markets are overflowing with ripe cherries, berries, melons, peaches, and plums – all bursting with juicy sweetness! It’s surprising that when it comes to nutrition, fruit can be divisive: There are people who deny themselves the pleasure for fear of ingesting too much sugar.And there are also those at the other end of the spectrum who eat nothing BUT fruit (these people are called Fruitarians). In this newsletter, we’ll unpeel how to healthily enjoy summer’s stars.

Should you cut out fruit?

No way! You definitely don’t need to ban fruit from your diet altogether. When you consume fruit, you are indeed consuming fructose. But you are also getting potassium, fiber, vitamins, minerals, enzymes, beneficial antioxidants, and phytonutrients along with the fructose.

These help mitigate the negative metabolic effects (e.g., sugar spikes) of fructose. This is why it isn’t good to eat a lot of candy or other foods high in fructose – they don’t contain fiber and all the other great things that help your body process sugar!

However, if you suffer with health issues such as insulin resistance, metabolic syndrome, heart disease, obesity, or cancer, you’ll want to moderate your total daily fructose consumption (from all sources).

If you are not insulin resistant, you can—and should!—enjoy at least 3–4 servings per day of fruit. When selecting fruit to eat, the best choices are fruits with a lower glycemic load. A glycemic load of 20 or more is considered high; 11–19 is considered average, and less than 11 is low. Here are some good choices:

  • Apples, pears
  • Blackberries, blueberries, cherries, raspberries, strawberries
  • Grapefruit (pink), oranges
  • Grapes (red)
  • Nectarines, peaches, plums
  • Pomegranates
  • Watermelon

The glycemic load—as opposed to the glycemic index—of a fruit more accurately represents how you will metabolize that fruit as it takes into account the portion sizes. Watermelon is a great example of a fruit that is known to have a high glycemic index, but in reality, the glycemic load is much lower because the fruit is dense with water. For more information on glycemic load, click here.

In honor of summer, enjoy the delicious, quick recipe  that celebrates the sweet flavors of the season.

Are you ready for your summer Transformation?

In my 14-Day Back-to-Basics Transformation, you’ll shed habits that bring you down and emerge feeling as energetic as the summer season itself. We’ll incorporate lots of easy lifestyle tips to get you on track for the remaining weeks of the summer season.

During this 2-week experience, you’ll receive 1:1 support from me as well as a wellness bag of nutritional products and superfoods to help you along with way.

Will you join us? Sign up here.