Do You Think Exercise and Jogging are All Health Beneficial? Think Again and Read On

 A WhatsApp participant sent me this news last night about Dr Jeremy Ng, Head of the Dept of General Surgery at Singapore General Hospital who collapsed and died while jogging. He was said to have died of cardiac arrest. It is understood that he collapsed after he went jogging at East Coast Park on Saturday.

https://www.straitstimes.com/singapore/health/sghs-head-of-general-surgery-dies-aged-48

This prompted me to write an essay on this health problem today.

It is often said there are health benefits of exercise such as jogging. But there are also health risks with exercises like jogging as in Dr Jeremy Ng case.

First, let me guide you to have a look at some of the health benefits of exercise like jogging as believed and advocated by many people, especially health freaks and health extremists.  Let’s look at the health benefits of exercise before we talk about its great risks like in Dr Jeremy Ng case and many other cases I have come across during my few years dealing with medical emergencies or have read elsewhere.  

First, there are physical health benefits, especially in cardiovascular health as it is believed to reduce the risk of heart disease, hypertension, and stroke. Then exercises help in maintaining a healthy weight by burning calories, enhancing muscle strength, tone, and endurance. Exercise may also increase bone density and reduce the risk of osteoporosis and may play a part in bone health. This may improve joint flexibility and balance, reducing the risk of falls.

We may also consider exercise strengthening mental health such as mood enhancement by boosting endorphin levels, reducing stress, anxiety, and depression. It may also benefit cognitive function by improving memory, concentration, and overall cognitive function besides improving sleep quality.  Enhancing the quality of sleep and helps with insomnia.

Exercise may also have a role with managing chronic disease and their prevention as such in diabetes by helping in managing blood sugar levels. There is some evidence exercise reduces the risk of certain cancers, such as breast and colon cancer.

Other benefits of exercise are, enhancing the immune system, contributes to a longer lifespan, apart from improving the overall quality of life and daily functioning.

The types of exercises are normally aerobic exercises such as running, jogging, walking, cycling, swimming, dancing, aerobic classes, strength training, weightlifting, bodyweight exercises (push-ups, pull-ups, squats), resistance band exercises.

There are also flexibility exercises such as stretching, yoga, and balance exercises like Tai Chi, balance drills, stability ball exercises and high-intensity interval training (HIIT), not forgetting short bursts of intense exercise followed by rest or low-intensity exercise. But these are the normal exercises most people understand.

But to me, there are also the common normal physical activities which too are exercises such as walking, daily commuting to work, walking pets, strolling, household chores such as cleaning, gardening, mowing the lawn.

We also consider occupational activities such as physical tasks at work, standing, manual labour as exercise. Besides, there are also recreational activities like playing with children, hiking, casual biking, and also incidental activities like taking stairs instead of elevators, and parking further away.

There are also advantages and disadvantages with normal physical activities. The

advantages are accessibility where they are easily integrated into daily life without special equipment or planning. They can be done consistently and regularly and effortlessly. There is also variety involving different types of movements, reducing monotony.

But there are also disadvantages. Normal physical activities may or may not provide sufficient intensity for significant cardiovascular or strength benefits. There is also a lack of structured progression that can limit fitness improvements.

In structured exercise there are advantages. It has specific goals that can be tailored to target specific fitness goals, such as strength, endurance, or flexibility. It also has higher intensity, often more intense, leading to greater health benefits (perhaps?). Structured exercises are easier to track progress and set measurable goals.

But there are also disadvantages with time and resources, meaning they may require dedicated time, gym memberships, or equipment.

There is also injury risk if not performed correctly or without proper guidance. It also requires a certain level of motivation and discipline to maintain regularly.

Both normal physical activities and structured exercises have their unique benefits and potential drawbacks. Normal physical activities are essential for overall daily movement and maintaining a baseline level of fitness, while structured exercises are crucial for achieving specific fitness goals and maximizing health benefits. Incorporating a mix of both into your routine can provide a comprehensive approach to health and wellness.

Having explained all those health advantages and disadvantages there were also a significant number of cases where people suddenly collapsed while jogging in the parks or elsewhere, and also the same for many who suddenly collapsed and died while running a race or in the middle of some sports activities. An example is Dr Jeremy Ng here in the above link who suddenly died of a cardiac arrest while jogging in Singapore.

 Another recent example was a 17-year-old Zhang Zhijie, a singles badminton player from China who collapsed on the court during a match against a Japanese opponent at the Badminton Asia Junior Championships in Yogyakarta, Indonesia, here:

https://www.nbcnews.com/news/world/17-year-old-chinese-badminton-player-collapses-court-dies-medical-resp-rcna160014

Let us now look at the sudden health risks with jogging and other forms of exercises.

Sudden collapses during physical activities like jogging, running races, or sports can be alarming and often involve complex medical reasons. Some potential causes are sudden cardiac arrest (SCA) due to coronary artery disease (CAD). Blocked arteries can limit blood flow to the heart, causing a heart attack. hypertrophic cardiomyopathy (HCM) due to thickened heart muscles that can obstruct blood flow and lead to irregular heartbeats such as abnormal heart rhythms, ventricular fibrillation that can cause the heart to stop pumping effectively.

I have also come across school children who have congenital heart defects who took part in a school long distance race who suddenly collapsed and died. Conditions present from birth that affect the heart's structure or function are myocarditis that causes inflammation of the heart muscle, often due to a viral infection, which can impair the heart's ability to pump blood.

Other medical causes may be dehydration and electrolyte imbalance. Intense physical activity, especially in hot weather, can lead to severe dehydration and imbalances in electrolytes like sodium and potassium, affecting muscle and heart function. There is also the problem with heat stroke. Overheating during exercise, especially in hot and humid conditions, can cause a dangerous rise in body temperature, leading to collapse.

We also consider asthma and respiratory issues where exercise-induced asthma or other respiratory conditions can cause severe breathing difficulties. We also look at the risk of low blood sugar (hypoglycaemia). Low blood sugar levels, particularly in individuals with diabetes or those who have not eaten adequately before exercise, can lead to fainting.

Other factors for collapse are overexertion by pushing the body beyond its limits, especially in untrained individuals or those not accustomed to intense exercise, can result in collapse. Besides these, there are also pre-existing medical conditions. Undiagnosed medical conditions, such as aortic aneurysms or other vascular abnormalities, can suddenly become critical during exertion.

Consumption of stimulants, such as caffeine or performance-enhancing drugs, can increase the risk of cardiovascular events.

What about the possibilities that a person may already have some loose blood clots or other tissues fragments existing somewhere in the vascular system that suddenly get dislodged when the heart rate and blood flow increases during these exercises. The dislodged clog may travel to the heart coronary vessels and to one of the cerebral vessels in the brain to cause a heart attack, and a stroke

This scenario is both logical and possible. Loose blood clots or tissue fragments can indeed become dislodged during physical activity when the heart rate and blood flow increase. This can lead to serious cardiovascular events such as heart attacks and strokes. Let me briefly explain its mechanisms.

First there may be embolism. These may be thromboembolism in which a blood clot (thrombus) that forms in a blood vessel and breaks loose, called an embolus. When an embolus travels through the bloodstream, it can lodge in a smaller vessel, obstructing blood flow.

We also consider the risk of fat embolism where fat droplets from bone fractures or surgery can enter the bloodstream and block blood vessels. There is also air embolism where air bubbles entering the bloodstream, often due to certain medical procedures, can also obstruct blood flow. This leads to dislodgement during exercise. An increase in heart rate and blood pressure during exercise can dislodge clots or tissue fragments that were previously stable. Vigorous physical activity can cause mechanical stress on blood vessels, potentially dislodging plaques or clots.

Possible outcomes will be a heart attack (myocardial infarction) If an embolus lodges in one of the coronary arteries, it can block blood flow to the heart muscle, causing a heart attack. Symptoms include chest pain, shortness of breath, and light-headedness.

Then we also consider the possibility of a stroke occurring during an exercise or even during normal physical activities. An embolus traveling to the brain can block a cerebral artery, causing an ischemic stroke. Symptoms include sudden numbness or weakness, confusion, trouble speaking, and loss of coordination.

The risk factors are atherosclerosis caused by build-up of plaques in the arteries increases the risk of embolism, as these plaques can rupture and form clots.

Atrial fibrillation from irregular heartbeats can cause blood to pool and clot in the heart, particularly in the left atrium.

We also consider the possibility of deep vein thrombosis (DVT). Clots in the deep veins of the legs can travel to the lungs (pulmonary embolism) or, less commonly, to other parts of the body. Then we also have to look at previous surgeries or trauma

Surgery or injuries, especially those involving bones, can increase the risk of fat embolism or other types of embolism.

We need to look at prevention and management before exercise. Perhaps medical screening may be necessary. Regular check-ups and screenings for cardiovascular health can help identify risk factors such as atherosclerosis or atrial fibrillation. Medications using anticoagulants or antiplatelet medications can reduce the risk of clot formation in high-risk individuals. Prevention and safety measures such as regular medical check-ups and health screenings, may be useful especially for those with risk factors like a family history of heart disease, can help detect potential issues early. Proper training and conditioning by gradual increase in exercise intensity and proper conditioning can help prevent overexertion.

Having said that, this does not mean a medical check-up showing good health with no underlying morbidity will exempt us from sudden death. It does not matter what your doctor told you.  Disease and death have absolutely no respect for any man.

 I know of cases of sudden illness and death of people who apparently were in good health from all the tests done earlier by their doctors. 

There was also one or two cases I remember reading in the newspaper a few years ago of young people who collapsed and died during their morning jogging. The wife or the relatives of the deceased told the newspaper that the deceased went for a medical check-up only days earlier and was told by the doctor he was in "good health" but unfortunately died from jogging or exercise days later. Let this be a lesson not to trust all these medical check-ups, or what the doctor told us. Dr Jeremy Ng was a very good example. He was a great surgeon and a clinician being the head of surgery at the Singapore General Hospital, but ironically, he could not foresee his own death.

 There was also another example of a world-renowned liver transplant surgeon Tan Kai Chah, who performed a life-saving liver transplant on former actress Andrea De Cruz, but he died on Sunday morning on December 05, 202 on the island of Hainan.

The 68-year-old Malaysian, popularly known as Dr K.C. Tan, is believed to have died of a heart attack here:

https://www.straitstimes.com/singapore/health/renowned-liver-surgeon-who-performed-transplant-on-celebrity-andrea-de-cruz-dies-at#:~:text=SINGAPORE%20%2D%20World%2Drenowned%20liver%20transplant,died%20of%20a%20heart%20attack.

Although Dr Tan did not do any exercise but was all out to make money in China with his liver transplant ambition, he still died of heart attack far away from home.  Death is absolutely no respecter of any person, doctor or no doctor

 Continuing on this subject, I think importantly we should consider hydration and nutrition by maintaining adequate hydration and proper nutrition before, during, and after exercise. This is crucial. Also, listen to your body by paying attention to warning signs such as chest pain, shortness of breath, dizziness, or palpitations and stopping exercise immediately if they occur.

Use of heart rate monitors to measure heart rate during exercise to ensure it stays within a safe range.

I think we need also to look at the availability of Emergency Response such as immediate CPR. In case of sudden collapse, immediate cardiopulmonary resuscitation (CPR) and use of an automated external defibrillator (AED) can be lifesaving.

Then prompt medical attention with quick access to medical care and emergency services is crucial in improving outcomes in such events.

Then we also need to consider the risk of osteoarthritis with vigorous exercises such as jumping up and down especially for those who are overweight and obese. Various exercises such as jumping up and down, running, jogging is not too kind to the weight-bearing joints such as the hip bones and knee joints

The joints between the pelvic bones and the thigh bones are the hip joint. The hip joint is also known as the acetabulofemoral joint. It is a ball-and-socket joint formed by the acetabulum of the pelvis and the head of the femur (thigh bone).

The anatomical name of the joints on the knees is the knee joint. The knee joint is also known as the tibiofemoral joint. It is a hinge joint formed by the femur (thigh bone) and the tibia (shin bone), with the patella (kneecap) situated in front of the joint.

There are cartilages between these joints to bear the weight of the body. If we start to jump up and down especially when we are overweight, worse if we are pathologically obese, this will bear on all these weight-bearing joints on the hip bones and knees causing wear and tear, resulting in osteoarthritis. We have to consider these as well, not just the risk of cardiovascular events, heart attacks, or cerebral vascular accident (CVA) or a brain attack where there is an interruption in the flow of blood to cells in the brain. When the cells in the brain are deprived of oxygen, they die.

I always emphasize lifestyle modifications for all diseases, not just for sudden events associated with exercises.

By this, I mean maintaining a healthy weight, managing blood pressure, and controlling diabetes through health-protective nutrition. Always consult a competent and qualified nutritionist for his or her professional expertise. Medical doctors have very little training or none at all in nutrition.  This can reduce not just the risk of developing atherosclerosis and other conditions that predispose to embolism, but all chronic lifestyle diseases, all those diseases that overcrowd hospitals today that have no cure.

Finally, to cap up my health and medical essay for today, we need to adopt a gradual increase in exercise intensity. Gradually increasing the intensity of exercise can help the cardiovascular system adapt and reduce the risk of dislodging clots.

While regular exercise is beneficial for overall health, it is crucial to be aware of the potential risks, especially for individuals with pre-existing cardiovascular conditions. Medical evaluations, appropriate management of risk factors, and a cautious approach to increasing exercise intensity can help mitigate these risks.

Even though exercise generally provides numerous health benefits as I earlier mentioned, it is essential to be aware of the potential risks as well, particularly for individuals with underlying health conditions. Regular medical evaluations, proper training, and awareness of one's physical limits are vital for safe physical activity.

I hope my explanation is useful for my Gentle Readers. Be not like Dr Jeremy Ng here who was the Head of General Surgery at the Singapore General Hospital who may not be aware of all these medical issues even though he was a super doctor and went ahead with his jogging.

 Take Care!

Ju-boo lim