Associate Professor, PhD D.D. Dalskiy^{1, 2}
Associate Professor, PhD S.A. Kraev²
Dr.Biol., Professor I.A. Afanasieva¹
PhD E.V. Naumenko^3
1National State University of Physical Culture, Sport and Health n.a. P.F. Lesgaft, St. Petersburg
²General A.V. Khrulev Military Academy for Logistics and Procurement, Saint Petersburg
³Medical Group of Special Service Brigade #45, Moscow

 

Keywords: sport, physical load, forecast index, heart rate, body building.

Introduction. Many years of regular physical loads of high intensity, including sports activities, have a pronounced effect on the cardiovascular system, especially in elite athletes and individuals who have been involved in sport for many years (F.Z. Meyerson, 1988, G. Pavlik, 2010, 2013). However, athletes’ cardiac activity assessment results often appear contradictory. Some research papers present the changes occurring in the heart as pathological (Z.G. Ordzhonikidze, 2007; V.I. Pavlov, 2008), while others, as it usually is, - as physiological (Z.G. Ordzhonikidze, 2008; A.V. Smolensky , 2012).

There is a stark difference between the physiological and functional indicators of cardiac activity in athletes and individuals not doing sport professionally; and thus, specific criteria are used to determine normal values and pathological changes (National recommendations concerning admission of athletes with cardiovascular system deviations to training and competitive process, 2011).

According to the classification proposed by A.G. Dembo (1989), the causes of sudden death in sport can be divided into 3 groups:

1) not directly related to sports activities;

2) directly related to sports activities;

3) injuries (head, chest, abdomen).

In the opinion of Anderson (1986), it is occult, undiagnosed cardiac diseases that are the most common cause of sudden death among athletes.

To date, cardiologists count more than 20 pathological conditions of the cardiovascular system that may cause urgent states in athletes. Nevertheless, it is hypertrophic cardiomyopathy that remains the leading cause of sudden death (M.V. Chashchin, R.V. Konstantinov, 2010).

Objective of the study was to provide a theoretical substantiation for the ischemic heart disease (IHD) forecast rates in application to elite athletes.

Methods and structure of the study. Based on the athletes’ health screening tests, we developed an IHD forecast index applicable to elite athletes that factors in the athlete’s age, anamnesis, genetic predispositions, living and training regime, BMI, biochemical rates, arterial pressure hikes, HR, ECG and Echo-CG rate variations.

Subject to the study were 181 athletes (165 men and 16 women) aged 19 to 41 with at least 5 years of experience in the selected sports.

Athletes engaged in body building were examined at 8 a.m., once a day and on an empty stomach, in a spacious ventilated room at the air temperature of +21°С after 5-min preparation (prior to the study the athletes sat on a couch in a quiescent state, excluding any external stimuli).

Results and discussion. According to the results of the examination, there are four levels of the risk of IHD:

1 – low;

2 – moderate;

3 – high;

4 – potentially fatal (causing sudden death under heavy loads).

The index was determined by 3 sets of criteria and consisted of 14 entries. The first set (10 entries) included a survey and examination, the second one (11th and 12th entries) - interpretation of blood tests (biochemical analysis and coagulation profile) and the third one (13th and 14th entries) - waves and segments of electrocardiogram (ECG) and ultrasound phenomena of the heart (Echo-CG).

1. Age:

•  < 25 y.o. – 0 points;
•  < 30 y.o. – 1 point;
•  < 35 y.o. – 2 points;
•  < 40 y.o. – 3 points;
•  < 45 y.o. – 4 points;
•   > 45 y.o. – 5 points.

2. Smoking:

•  no such addiction – 0 points;
•  less than 1 pack of cigarettes – 3 points;
•  more than 1 pack of cigarettes – 5 points.

3. IHD in father or mother (in both parents):

•  no – 0 points;
•  yes – 1 point.

4. Sleep:

•  quiet sleep, without waking up – 0 points;
•  waking up once or twice per night – 1 point;
•  waking up more than twice per night – 2 points.

5. Motivation for exercises:

•  there is motivation – 0 points;
•  there is no motivation – 1 point.

6. HR:

•  at rest (50–80 1/min) – 0 points;
•  right after load (10 squats or 10 push-ups):

< 100 1/min – 0 points;

> 100 1/min – 1 point;

> 120 1/min – 2 points;

•  1 min after squatting or pushing up:

< 100 – 0 points;

> 100 – 1 point.

7. Arrhythmia:

•  absent during checkup – 0 points;
•  detected during checkup – 2 points.

8. Blood pressure at rest:

< 139/89 – 0 points;

> 140/90 – 2 points;

> 150/100 – 3 points;

> 160/100 (110) – 4 points.

9. Body build features:

•  waist measurement:

in women:

< 80 cm – 0 points;

   80-87 cm – 1 point;

> 88 cm – 2 points.

in men:

< 94 см – 0 points;

   94-101 cm – 1 point;

> 102 cm – 2 points.

•  BMI (body mass index, kg/m²):

< 18.5 – 0.5 points;

   18.5-24.9 – 0 points;

   25.0-29.9 – 1 point;

   30.0-34.9 – 2 points;

   35.0-39.9 – 3 points;

> 40.0 – 4 points.

10. Cardiac pain:

•  no previous history or one occasion – 0 points;
•  once or twice a week, singly – 1 point;
•  more than twice a week – 2 points.

11. Biochemical blood test:

•  glucose (3.8-6.3 mmol/L) – above 6.3 mmol/L or below 3.5 mmol/L – 1 point;
•  creatine phosphokinase-MB (10-110 IU) – icrease above 110IU – 1 point;
•  total cholesterol (3.1-5.2 mmol/L) – above 5.2 mmol/L – 1 point;
•  high density lipoprotein (above 1.68 mmol/L) – below 1.68 mmol/L – 1 point;
•  low density lipoprotein (below 3.9 mmol/L) – above 4.0 mmol/L – 1 point;
•  thyroglobulin (0.14-1.82 mmol/L) – above 1.82 mmol/L – 1 point;
•  C-reactive protein (up to 0.5 mg/L) – above 0.5 – 1 point;
•  potassium (3.5-5.5 mmol/L) – decrease below 3.5 mmol/L – 1 point;
•  sodium (136-145 mmol/L) – increase above 145 mmol/L – 1 point.

12. Coagulation profile (blood viscosity):

•  fibrinogen level (2-4 g/L) – more than 4 g/L – 1 point;
•  aPTT (normal value - 24-35 sec) – more than 36 sec – 1 point;
•  prothrombin index 80-105% – above 105 % – 1 point.

13. ECG features:

•  Р-wave (conduction of excitation in atria) – wave flattening and increase of amplitude above 0.10-0.12 sec – 1 point;
•   РQ-segment (atrial excitation) – extension over 0.2 sec – 1 point;
•  ST-segment (ventricular excitation) – elevation above baseline – 1 point;
•  QRS-segment (conduction of excitation in ventricles) – extension over 0.12 sec – 1 point;
•  Т-wave (repolarization phase) – wave flattening and decrement of wave amplitude – 1 point.

14. Echo features:

•   left atrium size (1.85-3.3 cm) – more than 3.5 – 1 point;
•  left ventricular wall thickness (1.1-1.5 cm) – more than 1.5 cm – 1 point;
•  interventricular septum thickness (0.75-1.1 cm) – more than 1.1 cm – 1 point;
•  ejection fraction (55-60%) – below 55% – 1 point;
•  stroke volume (60-100 ml) – less than 60 ml – 1 point.

 

IHD risk in athletes (points):

Low – 5 points or less

Moderate – 6 to 9 points

High – 10 to 13 points

Potentially fatal – 14 points or more

Based on the examination results, we can conclude the following:

At low risk - sports activities are not contraindicative, athletes are subject to follow-up examination only.

At moderate risk - additional load indicators are to be estimated to determine level load feasibility (reduction, inclusion of rehabilitation measures).

At high risk - compulsory and thorough medical examination, rehabilitation measures, sports events quality control. Training sessions are no more conducted in the same training mode, physical load is reduced.

At potentially fatal risk - athletes are examined strictly stationary, with the possibility of sports reorientation or career termination.

Conclusion. The study showed that the increased levels of atherogenic lipid fractions (total cholesterol, low-density cholesterol and triglycerides) contribute to the risks of ischemic heart disease (IHD) and myocardial infarction as its complication. Sport physicians are recommended to give more attention and time to targeted actions to prevent and detect predictors of the cardiac pathologies that put athletes at potentially fatal risk.

References

1. Dal'skiy D.D. Praksismalnaya proba v sisteme otsenki funktsionalnogo sostoyaniya pauerlifterov [Paroxysmal test in functional status evaluation system for powerlifters]. Teoriya i praktika fiz. kultury, 2013, no.10, pp. 32-34.
2. Meyerson F.Z., Pshennikova M.G. Adaptatsiya k stressovym situatsiyam i fizicheskim nagruzkam [Adaptation to stress and physical stress]. Moscow: Meditsina publ., 1988, 252 p.
3. Chashchin M.V., Konstantinov R.V. Professionalnye zabolevaniya v sporte. Nauchno-prakticheskie rekomendatsii [Occupational diseases in sports. Guidelines]. Moscow: Sovetskiy sport publ., 2010, 176 p.

Corresponding author: ddfond@mail.ru

 

Abstract

As demonstrated by a few recent studies by European and American sport medicine specialists, most of the sudden deaths of athletes could be prevented if the fatal cardiac diseases or overtraining conditions were diagnosed in a timely manner. The relevant national governments have made decisions to perform obligatory health screenings of beginner athletes (aged 12-14 years which is the traditional beginner age for most of the sport disciplines) (M.V. Chashin, R.V. Konstantinov, 2010).

Objective of the study was to provide a theoretical substantiation for the ischemic heart disease (IHD) forecast rates in application to elite athletes. Based on the athletes’ health screening tests, the authors developed an IHD forecast index applicable to elite athletes that factors in the athlete’s age, anamnesis, genetic predispositions, living and training regime, body mass index (BMI), biochemical rates, arterial pressure hikes, HR, ECG and Echo-CG rate variations.

The study showed that the increased levels of atherogenic lipid fractions (total cholesterol, low-density cholesterol and triglycerides) contribute to the risks of ischemic heart disease (IHD) and myocardial infarction as its complication. Sport physicians are recommended to give more attention and time to targeted actions to prevent and detect predictors of the cardiac pathologies that put athletes at potentially fatal risk.