When Hearts Bend It Like Beckham

Football encompasses endurance, strength and high-intensity interval training. The combination of intermittent running, kicking, jumping and competing for the ball are both aerobic and anaerobic exercises. It is therefore not surprising that playing football has been associated with many health benefits including improved aerobic capacity, coordination and agility, muscle building, body fat reduction and bone strengthening. Accordingly, this improves cardiovascular health and blood pressure control.

The cardiovascular benefits of regular exercise extend to all age groups and genders. Regular aerobic exercise, e.g., playing football, of at least moderate intensity improves blood pressure, sugar and lipids profile, thus reducing the chances of hypertension, diabetes, hyperlipidemia and overweight which are risk factors of cardiovascular diseases (CVD).

Being a team sport, football offers the opportunity for social interaction. The camaraderie fostered among teammates can be a tremendous mental boost. This could relieve stress born from our busy urban lifestyles by improving mood and reducing anxiety, leading to better sleep quality. Managing stress is an essential lifestyle modification that prevents CVD.

Like other competitive sports, football requires many hours of intense aerobic physical training. As a result of the intense and prolonged training, structural, geometrical and electrical changes, or remodeling can occur to the heart. This is known as Athlete’s heart. Although it is a not medical condition that requires treatment, researchers are studying how sports changes the heart function and how the different genders and age groups are affected. Recent studies have found that there are differences in the structural and electrical changes to the heart between women and men during exercise.

Female athletes show a relatively larger increase in heart dimensions compared to their male counterparts. Differences in electrical changes are also observed on electrocardiograms. Although the significance of these differences is not yet fully understood, a better understanding of the female heart physiologically could allow us to diagnose heart conditions in women more promptly and accurately, allowing for better early management with less complications.

Even in healthy people, there are structural and physiological differences between the hearts of women and men. Certain heart diseases are more common in women. For example, women are more likely to develop small blood vessel diseases (microvasculature) in the heart which are usually not caused by cholesterol buildup, but by non-obstructive coronary blood vessel disease, i.e., spasm of the coronary arteries.

CVD is the top killer of women worldwide. Yet, many are unaware and regular health screening efforts in women often focus on other aspects of health such as weight and gynaecological conditions. Many physicians also feel unprepared to assess for cardiovascular disease risk in women.

Prevention is vital to reduce deaths and complications from cardiovascular disease. Studies examining sudden cardiac death, in a population study, found women to have lower incidence rate of sudden cardiac death. However, a recent Danish study, looking at differences in characteristics between male and female sudden cardiac death victims, found that despite the male victims died eight years younger than the female victims, they had significantly higher cardiovascular diagnoses prior to their death. This, in the context of a previous Danish study, among a young population, which found cardiovascular comorbidity evenly distributed between the male and female patients, raises the question of whether cardiovascular disease was underdiagnosed in the female victims.

Lack of recognition and delayed diagnosis of CVD among women is a common scenario worldwide. This could be due to a less aggressive approach in managing cardiovascular conditions in women or failure to recognise atypical cardiovascular risk factors and mechanisms i.e., microvascular coronary artery disease when physicians manage female patients.

While we celebrate the greater participation and involvement of women in international sports events such as the FIFA Women’s World Cup, let’s also encourage clinical efforts to screen women for CVD. Early detection and treatment, coupled with strong research efforts will help us better understand and manage women’s heart conditions.

Article is contributed by Dr Chan Wan Xian, Chairperson of the Singapore Heart Foundation’s Go Red for Women Committee and Cardiologist in Private Practice.