Expert interview about the athlete's heart - Heart problems: What amateur racing cyclists need to consider

Isn't the number of professional cyclists with heart problems alarmingly high?
That doesn't scare me. The strain on professional athletes is extreme. For a healthy heart, this is manageable, but the athletes who had to end their careers due to heart problems obviously have a completely different problem. It must be assumed that the cases mentioned have a pre-existing condition - the heart problems are therefore genetic. Only in the case of endurance athletes aged 40 and over can we speak of heart problems acquired through sport.

In view of the numerous heart problems in top athletes, many amateur cyclists naturally also ask themselves what risks the heart is exposed to when riding a road bike?
A major risk factor, especially for top athletes, is cardiomyopathy (heart muscle disease, editor's note). This can either be an enlargement of the heart or, even more dangerous, a thickening of the heart muscle. This leads to cardiac arrhythmia, which can result in sudden cardiac death. Cycling is a special case in terms of sports medicine, as it uses particularly large muscles. They have to be supplied with enormous amounts of oxygen. When cycling uphill and sprinting, the need for blood flow increases even more. The heart then has to pump more and is therefore exposed to greater stress. This is not a problem for a healthy heart - but many athletes already have certain pre-existing conditions. Intensive exertion then becomes a problem.

Is endurance sport healthy or dangerous for the heart and circulation?
There is no doubt that endurance sport is the only sensible way to prolong life. A well-trained 60-year-old has fewer heart problems than an untrained one. Dietary changes, vitamins and all other fitness tips are relatively ineffective; endurance sport alone has a life-prolonging effect. All organs benefit from sports such as cross-country skiing, jogging or cycling, not just the heart. Endurance sports also contribute to muscle building and immune defence. Last but not least, working out also has a mentally liberating effect. However, the stresses and strains experienced by professional athletes have nothing to do with normal recreational sport.

Does this mean that popular sport is healthy, but professional endurance sport is dangerous?
In principle, endurance sports have a normalising effect on blood pressure. A combination of sporting exertion and genetic predisposition is dangerous, especially in younger athletes. However, if organs are already damaged, they cannot withstand the stress of professional sport. However, this can only be recognised during regular examinations. The most common case among ambitious athletes, however, is trained myocarditis. It often accompanies a normal viral illness that has not been properly cured.

Does that mean you recommend a driving ban in the event of illness?
It depends on the symptoms and their severity. The biggest danger is getting back on your bike too soon after a viral illness. Sticking rigidly to wattages and average speeds is the wrong thing to do. Even well-trained and experienced riders can quickly become dangerous. Intensity and training volume should be increased bit by bit. A little cold is often fine. But a fever and other viral illnesses mean that cycling is off limits.

Many racing cyclists, especially licensed athletes and professionals, take antibiotics for such illnesses to avoid having to interrupt their racing calendar or training cycle.
Taking antibiotics is irresponsible - and also useless against viral diseases, as antibiotics only fight bacteria, not viruses. Anti-inflammatory drugs such as aspirin and ibuprofen, which athletes often take, do not affect the heart. Nevertheless, the principle still applies that cycling under the influence of medication is not recommended.

What role does doping play for the heart?
Testosterone in low doses usually does nothing to the heart at least. Growth hormones, taken once or twice a year, may have side effects, but these do not affect the cardiovascular system. Clenbuterol and the like are a different matter: they can cause lasting damage to the heart muscle. This leads to a stress reaction of the entire body. And anabolic steroids are highly dangerous: serious heart damage in bodybuilders, for example, is well known. However, the side effects of doping are difficult to assess because there are hardly any reliable studies.

And what about cycling in old age?
A well-trained 60-year-old can certainly cope with much more than an untrained person of the same age. Nevertheless, this positive effect of endurance sport in old age must be viewed in a differentiated manner. That is why endurance athletes should undergo regular medical examinations from their mid-40s at the latest. However, only very basic heart defects such as a hole in the septum can be recognised with simple examinations. To detect anomalies in the coronary arteries, on the other hand, a computerised tomographic examination is required.

How much exercise can you do in old age without damaging your heart?
If you've been riding a road bike since you were young, you don't need to worry about this - you're used to the strain. Unless, of course, they develop illnesses as they get older. However, these are not related to sport. On the other hand, anyone who starts endurance sports at an advanced age should definitely undergo a medical check-up. Intensive interval training is certainly not a question of age, but of health - regardless of age. A higher risk of heart attack cannot be deduced from this. After all, most people who suffer a heart attack have never done any sport in their lives.