MAMILs: To run or not to run?

13 June 2016

Interview with

Dr Sanjay Sharma, St George's University of London

One way to keep your heart pumping is to become a MAMIL: a Middle-aged-man-in-lycra! A phenomenon that has men in their 50s getting out and doing lots of running - but there's also a worry that over-exerting can actually be what causes some 'MAMILs' to have a heart attack. Georgia Mills caught up with Sanjay Sharma, from St George's University of London, to find out if running can ever be dangerous...

Sanjay - We all know that exercise is good for you. People who exercise regularly have a favourable lipid and blood pressure profile, they are less likely to be overweight and diabetic. And by controlling all these risk factors for atherosclerosis, which is what causes heart attacks, they reduce their risk of dying from a heart attack by 50% when they reach their 50th or 60th birthday. So everybody knows that exercise is very good for you, and everybody should be doing it to gain an additional 3 to 7 years of life.

But what the MAMILs all about is a 40-60 year old man, gets to middle age and sees the middle age spread around the abdomen and decides I need to do something about this because I've heard that people who don't may die from a heart attack. They often join the gym or a running club and they soon realise they are as good as people who are younger than them.  And the good news for everybody is that as one ages, of course the facial expression changes, the hair changes, but what doesn't change very much is your skeletal muscle and your ability to engage in endurance events. To give you some idea, if we look at the average times of marathon finishes between 20 and 49, there's not much difference.

Georgia - Wow! Is this true of men and women?

Sanjay - This is true of men and women. So, of course, men realise at the age of 40 or 50 that they can actually beat people who are younger than them and being ultra-competitive, this drives them on and that is usually what gives birth to the Middle Aged Man in Lycra who spends most weekends competing and exercising, and this is very, very, good for you. The one thing that everyone worries about a little bit, of course, is that is paradox that although exercise protects from heart diseases it can, in some people, precipitate or trigger a sudden death, usually in someone whose got a silent cardiovascular abnormality. We actually look at the demographics of people that die; they are usually middle aged (between 43 and 55), they're almost always men...

Georgia - So, as you say, there are clues then at who might be more at risk?

Sanjay - Around 55% of people who die have already got established risk factors for coronary heart disease so that's one thing to look for and try and rectify. One can rectify someone's cholesterol, or blood pressure, or even sugar control.

The second thing is that about 15% have a previous cardiac history and, what's worrying, is that about 30% of people have reported symptoms suggestive of cardiac disease such as chest tightness that's brought on by jogging, or breathlessness that disproportionate to the amount of exercise being performed, or palpitations or a feeling of dizziness during exercise. These are all ominous symptoms.

So the things to look for are: am I overweight, have I got a high cholesterol, have I got high blood pressure, am I diabetic, has someone in my family died below the age of 50. These are all warning symptoms and if you've got  those, you do need to be assessed in a professional physician setting.

Georgia - Every now and then on the marathon you do see someone who's dies unexpectedly during it. And maybe it doesn't happen that much but does stick with you and I guess it's worrying. You think should I exercise, are the benefits worth it? What would you say to that?

Sanjay - I think everybody in this country, in fact, everyone in the universe must exercise. There is no medication invented yet that has the benefits of exercise i.e. anti-aging, preventing cardiac diseases, preventing depression, preventing dementia, preventing osteoporosis. If we packaged up exercise into a pill, it would be known as the miracle pill and, unlike medications, exercise is free, it can be performed at any time, and it's usually devoid of some of these side effects that you get with medication, so everyone should be exercising. The amount of exercise that you need to do is about 30 minutes of moderate exercise five times a week. By that, I mean a jog at a 15 minute mile pace, so four miles an hour. That's what you need to do to achieve these benefits. That's not to say that you have to do that, you can do less and still achieve benefits compared to people who don't do anything.

Now in terms of marathon running, I want to allay your anxieties. The death rate in marathons is about 1 in 50,000. The reason why it appears more is because many marathons, such as the London marathon, are under the radar of the media and are televised, so when something does happen to someone who's actually trying to raise money for charity by doing something that's good for them, it does to really, really captivate the audience, it captures the heart of the nations, but these deaths are rare. They're usually due to people who already have predisposing factors to cardiac disease. So I would say that if you've got any of the risk factors I've just talked about, then you should be tested out before you embark on something like marathon running.

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