Popular ball games: football, tennis, golf

Transcription

1 ESC Congress 2011 Paris, August 29 th Clinical Seminar: How to advise patients about resuming sports activity Popular ball games: football, tennis, golf Tim Meyer (no conflict of interest) Institute of Sports and Preventive Medicine Saarland University Saarbrücken Germany

2 What s most dangerous? France (n = 35 MIs; Francois/Monpere, Arch Mal Coeur Vaiss 1989): football > tennis Croatia (n = 5 SCDs in physicians; Durakovic et al., Coll Antropol 2002): football = tennis Japan (n = 30 MIs; Fujiwara et al., J Cardiol 1995): golf > tennis; no football

3 36th Bethesda Conference Football (soccer): high dynamic, low static; danger of bodily collision Tennis: high dynamic, low static Golf: low dynamic, low static Mitchell et al. JACC 2005

4 Veteran football (40-63) cardiac stress during training ± 5 years n = Heart rate (min -1 ) ±6 % HR max ( %) ±7 % HR max (62-96 %) 120 HRmean HRmax Meyer et al.: unpublished observations 2010

5 Veteran football (>40) cardiac stress during competition ± 5 years n = Heart rate (min -1 ) ±6 % HR max ( %) ±8 % HR max (52-97 %) HRmean HRmax Meyer et al.: unpublished observations 2010

6 Football: cardiovascular stress Blood pressure response: no data Heart rate response: up to 100% HRmax Catecholamines: no data

7 Football: Health benefits Study n Subjects Training Dura -tion Blood press. Cholesterol Body mass/fat VO2max Knoepfli- Lenzin et al (2010) 47 Moderately trained, years, mild hypertension Football Running (80% HRmax) 12 wk 2-3 x 1h Andersen et al (2010) 25 untrained, years, hypertension football 12 wk 2 x 1h Krustrup et al (2009) 36 healthy, untrained, years Football 82% Running HRmax 12 wk 2-3 x 1h LDL HDL Randers et al (2010) 54 wk 1.3 x LDL HDL

8 Properties of tennis Work-to-rest-ratio: 1 : 2.5 (Fernandez et al. 2006; review), 1 : 5.0 (Docherty 1982) 45 ± 5 years Fernandez-Fernandez et al. J Strength Cond Res 2009

9 Tennis: match observations n = 21 men 50 ± 7 years Jetté et al. Can J Sport Sci 1991 Therminarias et al. Int J Sports Med 1991

10 Urine Catecholamines Blood 47 ± 6 years 2 h of tennis 47 ± 2 years 1 tennis match Ferrauti et al. EJAP 2001 Therminarias et al. Int J Sports Med 1991

11 Tennis: cardiovascular stress Blood pressure response: syst. RR mean 168 ± 19 mmhg; syst. RR max 198 ± 30 mmhg (Jetté et al. 1991) Heart rate response: up to 80% HR max (sometimes 100%) HR max 163 ± 26 bpm (Jetté et al. 1991), 176 ± 4 bpm (Therminarias et al. 1991), 142 ± 16 bpm (Ferrauti et al. 2001); independent from skill level (Docherty 1982) Catecholamines: considerable increase (larger than running at the same VO 2, Ferrauti et al. 2001)

12 Effect of 6 weeks tennis training on cardiovascular risk factors 44 ± 6 years 45 ± 6 years Ferrauti et al. Br J Sports Med 1997

13 Golf: HR and catecholamines 50 ± 19 years n = 8 Hayes et al. Int J Sports Physiol Perform ± 6 years n = 20 5 beta-blockers 62 ± 5 years n = 8 Unverdorben et al. Med Sci Sports Exerc 2000

14 Golf: cardiovascular stress Blood pressure response: small RR mean 142 ± 18 / 89 ± 10 mmhg (Unverdorben et al. 2000), syst. RR mean 137 ± 31 mmhg (lower than rest; Stauch et al. 99) Heart rate response: 60% HR Res, 75% HR Max HR mean 105 ± 11 bpm (Unverdorben et al. 2000), 108 bpm ( 38% VO 2max ; Murase et al. 1989), HR mean 113 ± 18 bpm, HR max 135 ± 21 bpm (50-74% HR Res ; Stauch et al. 1999) Catecholamines: considerably smaller than tennis (Unverdorben et al. 2000)

15 Effect of 6 weeks golf training on cardiovascular risk factors 55 ± 4 years age-matched Parkkari et al. Am J Med 2000

16 Risk Football > Tennis >> Golf Potential benefit Football > Tennis > Golf

17 Suitability for cardiac rehab Football and tennis: partly suitable due to difficult dosage Golf: suitable but little training effectiveness Suitable: walking, jogging, cycling, rowing, circuit training (strength endurance), swimming, c-c skiing Not Suitable: weight lifting, high-intensity team sports, combative sports, climbing Urhausen/Kindermann 2007

18 Conclusion (hardly evidence-based) Very few studies in diseased cardiac patients!! Football (soccer): preserved left ventricular systolic function, no ischemia during exercise testing, sufficient work capacity (> 1.5 W/kg; VO 2max > 25 ml/min*kg), no exercise-induced tachyarrhythmias, no ICD (Heidbüchel et al. Eur J Cardiovasc Prev Rehabil 2006) Tennis: like football; avoid extreme arm movements (ICD); pacemaker implantation on the side of the non-dominant arm Golf: very few restrictions; most common cause of lead damage in ICDs (Lampert et al. J Cardiovasc Electrophysiol 2006)

19 And what about the TV spectators? And no But effect no effect on cerebrovascular on mortality events (Jauss (Wilbert-Lampen et al. 2009) et al. 2011) Wilbert-Lampen et al., N Engl J Med 2008