Cardiovascular system pathologies in elite sports

Фотографии: 

Dr.Med., Professor O.S. Kogan1
Dr.Sc.Hist. S.D. Galiullina1
1Ufa State Petroleum Technological University, Ufa

Keywords: cardiovascular system pathologies, elite sports, training system, physical and mental stresses.

Introduction. Influence of adverse factors in sport activities of elite athletes, in the setting of their chronic fatigue, is often accompanied by the cumulative effects expressed in both adaptation and disadaptation functional shifts and may result in a somatic pathology.

The reasons for most diseases diagnosed in professional physical education and sport workers following their retirement from elite sports may often be traced to the very start of their athletic career.  They include: acute cerebrovascular accident and myocardial infarction, long-term liver fermentemia, glycolytic and gluconeogenic disorders and hepatocirrhosis, as well as infertility, impotence, urolithiasis and, of course, early malignant tumors and premature death [1, 8].

Researchers find undiagnosed cardiac diseases, cardiomyopathy among them, to be highly dangerous.

Objective of the study was to detect cardiovascular system pathologies in elite sports.

Methods and structure of the study. Subject to the study were the cardiovascular system functionality indices in elite athletes engaged in different sports.

Study Group (n=273 including 211 males and 62 females) was made of the athletes doing sports professionally, competing on a regular basis in national and international competitions, qualified as Candidate Masters of Sports, Masters of Sports and International Class Masters of Sports by the Unified Russian Sports Classification System.

Reference Group was composed of 100 amateur athletes (including 51 males and 49 females), having, as a rule, no formal sport qualifications, students and graduates of the Coach Training Department of the state-owned vocational college "Bashkir Physical Culture and Sports Institute" and the relevant sport departments of other universities of the Ufa municipal higher education system.

Results and discussion. Among the adverse factors that can negatively affect athletes’ health are erroneous organization of the training process, irrational use of the training means and methods, lack or insufficient individualization of exercises, which in the end leads to overloads and overstrain of individual body systems and organs. They form the first group. The second and most important group of factors adversely affecting athletes’ health includes the causes directly related to sports activities [8]. V.N. Platonov (2004) indicates that about 50.0% of promising athletes quit "top-class sports" as early as at the age of 18 due to irrational sports training process and serious pathological changes in the body or sports trauma caused by it.

However, a correctly organized training process and methodology can also cause diseases that normally develop in elite athletes if training loads are excessive. In addition, similar diseases may result from incorrect and uncontrolled actions taken by athletes themselves with regard to the regime and prescriptions of their doctor or coach.

In fact, in terms of occupational medicine, in both cases we are talking about rather hard training work, including irrational work-rest regimen of professional athletes.

Most authors range the combination of intensive training and hard work or study in the same group of factors affecting athletes, but it seems expedient to single out one more group of factors that influence professional athletes in the course of work. What is meant here is psychosocial factors, which include the level of the athlete’s mental fitness for competitions, conflicts in interpersonal relations with the coach and within the team, increased chance of formation of mental and behaviour disorders against the background of tough competition and specifics of sports motivation, athlete’s quality of life, as well as his/her family interaction, original ("home") team and so on [4].

Depending on the nature of exercises and level of development of physical qualities, corresponding to different sports specializations, changes in the functional and pathological conditions may also vary. At the same time, athletes, grouped according to the chosen sport and orientation of the training process, demonstrate similar adaptive reactions, to a greater or lesser extent.      

Circulatory system diseases should be attributed to the most important causes of physical disability of athletes upon their retirement from elite sports. At the same time, special attention is to be paid to the fact that sports medicine analyzes in detail different circulatory system functionality disorders, rather than actual circulatory system diseases. This is fully justified indeed, since clinically expressed circulatory system diseases in athletes actually indicate in fact that athletes can no longer continue their sports activities. In this case, this means not only retirement from elite sports, but also physical disability.

Functional disorders most often include the symptoms, found during the ECG study, not accompanied by complaints or clinical manifestations of the disease. The detected cardiac disorders in athletes can be conditionally divided into three groups: 1) prenosological symptoms and signs (episodic ventricular arrhythmia, sinus tachycardia, myocardial dystrophy); 2) indications of vegetative instability, which can be deemed as dynamic, possibly, transient signs of adaptation of the heart muscle to the corresponding loads (episodic sinus arrhythmia, incomplete right bundle-branch block; impairments in the intra-ventricle and intra-atrium conductivity, re-polarizing processes and metabolic processes in myocardium); 3) signs of stage-wise adaptation of the cardiac muscle to increased loads (left ventricular hypertrophy).

Some researchers indicate increased number of cardiac rhythm disorders in athletes, especially in strength and endurance sports. A certain part of these cardiac disorders can be reflective of prenosological stages of cardiovascular system disorders, a kind of indicator of the developing disadaptation of the body being influenced by unfavorable external and internal factors, and in some cases - the only sign of cardiomyopathy. Athletes are often diagnosed with arrhythmias due to deteriorations in the processes of automatism, excitability and conductivity [3].

The detected tendency to arterial hypertension in athletes (so-called hyperreactive individuals ) in certain cases can be deemed as a pre-stage of essential hypertension. According to L.A. Butchenko and N.I. Volnova (1974), the percentage of people with high blood pressure among the representatives of various sports can range from 13.6% in rowers to 21.2% in weightlifters. Arterial hypertension and resulting complications remain one of the main problems of modern medicine. Herewith, one of the main target organs is the heart, which largely determines the unfavorable prognosis and leads to coronary heart disease and cardiac insufficiency, arrhythmias, etc.

The phenomenon of sudden death in young athletes remains an extremely important aspect of elite athletes’ health. Recently, there has been significant progress in diagnostic activities and prevention of sudden death among athletes. During the analysis of numerous cardiac deaths of athletes at a young age, circulatory shock developing hypertrophic cardiomyopathy, aortic rupture, mitral valve prolapse were found to be among the leading causes [7, 6].

The study failed to find any clinically expressed circulatory system diseases as verified by comprehensive medical examinations, albeit most of the athletes were diagnosed with different ECG changes indicative of the autonomic system imbalances including sinus arrhythmia, incomplete right bundle-branch block; impairments in the intra-ventricle and intra-atrium conductivity, re-polarizing processes and metabolic processes in the myocardium.

The above disorders collectively amounted to 68.9% of the examined athletes and were found virtually gender-nonspecific as they were diagnosed in 69.7% of males and 66.1% of females. 

Incidence rates of the above mentioned disorder were the highest in the cyclic sports group (84.5%) followed by team sports (73.5%), speed-strength sports (61.3%), complex-coordination sports (57.6%) and single combat sports (52.8%).

In addition, the study considered separately a group of the negative ECG indications of myocardial dystrophy due to physical overstress (MDPOS) that was left beyond the list of diagnosed diseases albeit may point to severe changes in the cardiac muscle metabolism commonly acknowledged as unfavourable prognostic evidence for the circulatory system functionality. The MDPOS incidence rate for the elite athletes’ group made up 4.7% in total with 6.4% and 4.4% in the women and men’s subgroups, respectively. The highest MDPOS incidence rates were found in the cyclic (6.8% of 100 subjects) and speed-strength sports (6.5% of 100 subjects), with the women found to have higher MDPOS rates (11.1% to 12.5% of the examined females), i.e. one of ten female athletes was diagnosed with this health condition in fact.

We assume that it is comprehensive and maximally informative preliminary and periodic medical examinations that can help reduce the risk of medical issues in elite athletes, which can cause their disability not only as professional athletes, but also as coaches or employees in any other sphere due to increasing incapacity for work in the future.

Conclusion. Constant improvement of sports results requires special efforts to be taken to preserve and strengthen health of athletes, national team members and reserve, future participants of top-ranking regional, national and international competitions, including the Olympic Games.

There is a need to strictly monitor timely in-depth medical examination for the admission of athletes to participate in competitions.

References

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Corresponding author: oskogan@mail.ru

Abstract

Modern elite (Olympic) sports are supported by long-term training systems designed to secure top competitive accomplishments in top-ranking international events. However, elite athletes are increasingly vulnerable to diseases due to the extreme physical and mental loads in the modern professional sports or erroneous/ mismanaged actions of the athletes in violation of the team physician’s or coach’s instructions. There is a wide variety of factors of negative effect on the athletes’ health including extreme physical and mental stresses, highly competitive race for the records and negligent attitudes to the natural limitations of the human organism. Today it is commonly acknowledged by the sport communities that even new world champions are not always healthy and often diagnosed with symptoms of one or another serious pathology.