A (2:52)

Absolutely. Well, you're inspiring me to get back to running and prioritizing exercise. And good luck. I'm going to be thinking of you so much on marathon day.

B (3:00)

Thanks.

A (3:00)

Very exciting.

B (3:01)

Fingers crossed.

A (3:02)

So the training you're doing is called cardio. Can you explain what cardio is and what kind of exercise is good for your heart?

B (3:12)

We consider cardio any sort of aerobic exercise. You know, so walking, jogging, playing basketball, playing tennis, where you're kind of moving all of your parts, you're getting your heart rate up. And we classify exercise in three major categories. Mild effort, moderate effort, and vigorous effort. So moderate effort is what we're trying to go for for heart health. That's a level where you could have a conversation, but you couldn't sing a song. And then a vigorous effort would be where it would be hard for you to have a conversation, but you're not dizzy or lightheaded. And those are the exercises that we target for cardiovascular fitness. And that's to distinguish it between sort of strength training. Strength training is going to be more your weightlifting, Pilates, yoga, things that are working on your core, your body strength, your stability. And those are very important for a lot of aspects of your health. But when we talk about heart health, we're often focusing on that aerobic, you know, raising your heart rate type of exercise.

A (4:21)

And so today, in addition to the everyday athlete, we also want to get into what happens to athlete hearts. People who do more than moderate exercise. Right. So the big picture, what makes sports cardiology different from the other work that you do?

B (4:35)

Well, you know, there's a lot of different types of sports cardiologists. At Newark Presbyterian, the real focus of our sports cardiology program is helping to sort through issues that may come up in a athlete's training that would help distinguish whether they're safe to continue to exercise or they're not safe to continue to exercise. Assessing their risk and trying to determine if whether some of the quote, unquote, abnormalities that might be noted on a cardiac test is normal for an athlete or something that needs to be addressed. So going back to the concept of two types of exercise, right, so we have more of an endurance athlete that's going to be your rower, your runner, where it's really cardio the bulk of the time versus a strength training athlete. And that's going to be more like Your power lifters, where it's really a lot of strength and short bursts of powerful activity rather than a long sustained. And then there's mixed sports, so maybe we would throw. Basketball is probably an endurance sport, but it has some strength properties. So there are some sports that sort of lie in between. Different types of athletes then will have different cardiac remodeling.

A (6:01)

So.

B (6:02)

So the heart does change with regards to the type of exercise we're doing. And we're talking about elite athletes. And what happens for an endurance athlete is because the cardiac output that they need increases so much, their heart can actually grow in size. It can be bigger.

A (6:22)

Wow.

B (6:23)

Their heart rates often are much lower. And those are all parts of the athletic changes that would be normal. Now, a power athlete, such as, say, like a power lifter, what happens in that type of sport is because it's a load that you're pushing against all the time, the muscle of the heart can get thicker just like any other muscle in your body. And those two different types of remodeling, depending on the sport, can be normal. There are some changes, and there are some differences that we note. But there's a point where if athletes go beyond that, we do have to do our due diligence to make sure that there's not something else going on with them. And that's where we delve into additional cardiac testing, sophisticated testing like cardiac mri. We delve into family history, we look at other types of tests to come up with whether or not this is an athletic change or whether or not this is a cardiac problem. There are gonna be people who we will unfortunately find to have, you know, very serious heart conditions that they've inherited, that based on their risk, we do think it's not safe for them to continue to play at an elite level. Right. And I think then there's a majority of people are moving into this discussion with the athlete and saying, hey, listen, you have some abnormality. The best that we could tell you is that you're at higher risk than if you didn't have this. Right. We don't think your risk is so extreme that we would tell you, no, no play. You know, do we have that life or death decision with people every day? No, but that's part of what we do in sports cardiology.

A (8:08)

So let's talk more about the screenings that you do that give people these information to have these conversations. You describe when you're doing a screening. What are you looking for, and what kinds of things do the results tell

B (8:19)

you the risk of sudden cardiac death? In athletes is actually very low. You know, it's dependent on the sport ethnicity, there's other things that go into it, but overall it's exceedingly low. But obviously nobody wants it to ever happen. Right, right. But the issue is what are we going to be able to identify on that screening to prevent? So depending on different leagues, different levels, there may be certain screening involved or not. What we recommend for every sports Physical is a 12 point questionnaire where we go through very specific things. Family history, do they have symptoms, have they ever fainted? There's certain features on physical exam that we look for. So that questionnaire might be the only screening process at a college or a high school. And any positives may then lead to an ekg. Every league has its sort of own screening protocol and if you look at the causes for sudden cardiac death in athletes in different studies, it varies widely depending on the population that they're looking at, the age, the type of sport, et cetera. They're going to be, as I said, right. There's some athletic changes that may happen. Right. If you're not a sports cardiologist and you look at an ekg, you're going to be like, that looks crazy.

A (9:39)

So is this cardiac remodeling to the heart, is it the kind of thing that might happen to other muscles when we exercise them, say with lifting or calisthenics?

B (9:48)

It's not just like, you know, if I start lifting weights, my biceps gonna get bigger. It's not as simple as that. It has to do with amount of blood flow and your cardiac output, which is determined by your heart rate and how much blood you're pumping and what type of sport you're doing. I mean, look in the news at some of the athletes. Like I know these athletes in these leagues have been screened, right. But there's still things happen they were not picked up obviously on a screening. We don't know what the cause of it was. Could be like a cardiac anomaly that may not show up on some of these tests that we do. But if we have a good emergency response, right. We know how to deal with an event on the field.

A (10:29)

Can you tell me what that looks like? Can you talk about that emergency response?

B (10:33)

Sure. We recommend, and again, every single professional league, each team, and in the colleges that we take care of at New York Presbyterian, each college, university should have an emergency response plan. And that response plan includes knowing what to do, having the equipment and having trained personnel. I think having defibrillators available at all the games is really important. Now, not all programs are going to be resourced to do that. But I think that is an ideal situation. What determines whether someone survives a cardiac arrest is how quickly they get resuscitated. So hands only CPR can buy time until a defibrillator comes. So really good hands only cpr and having everybody, everybody on the team trained to do that, all the pt, all the trainers, all the players, all the people that are going to be part of that staff should be trained. And then knowing how to use the defibrillator, which is really easy, and having it on hand. So sometimes you see these videos and it's terrible and everybody's running around in circles, you know what I mean? And it's because they haven't practiced that, because you have to practice too. So part of the emergency plan is having regular practices. Just like anything else, you got to have a drill to run through it. To be honest, all of us should know cpr, you know, because this could happen on a plane, this could happen at a family event. You know what I mean? It's such an easy thing. Hands only cpr. And that's. That just buys time until equipment can come.

A (12:27)

Yeah. It can save lives.

B (12:28)

Absolutely.

A (12:29)

Dr. Talani, this has been such a wonderful conversation and good luck to you on your run. Coming up in a few days.

B (12:36)

Thanks, guys. This has been great.

A (12:48)

Our many thanks to Dr. Talani.

B (12:50)

Courtney.

A (12:50)

I'm Courtney Allison. Health Matters is a production of New York Presbyterian. For more stories of science, care and wellness, visit healthmatters.nyp.org the views shared on this podcast solely reflect the expertise and experience of our guests. New York Presbyterian is here to help you stay amazing at every stage of your life.