A new study assessing the knowledge and confidence in recognizing cardiac symptoms has found that almost half of over-35s were not confident in their ability to recognize symptoms of impending cardiac risk – such as a heart attack or sudden cardiac death – while participating in strenuous exercise.

A paper just published in the RACP's peer reviewed scientific journal The Internal Medicine Journal surveyed 153 Masters Age football players aged ≥35 years playing on a scale of competitive to social football games.

Participants exercised or played sport an average of 3.6 days per week, with a weekly average of 2.6 hours of moderate activity and 2.4 hours of vigorous activity.

Although regular exercise improves health, strenuous exercise causes a transient increase in cardiac risk. Being able to recognize the warning signs of an impending cardiac event is critical to mitigating those risks during exercise.

The risks are elevated when accounting for participants with pre-existing risk factors like hypercholesterolemia, hypertension, smoker status, weight issues, and family history of heart disease."

Professor Geoffrey Tofler, senior author of the paper and a Fellow of the Royal Australasian College of Physicians (RACP), and of University of Sydney and Royal North Shore Hospital

Despite the popularity of Masters football, the prevalence of cardiac risk factors and potential cardiac symptoms in players has not been adequately studied.

"In total, one in five study participants had one or more possible cardiac symptom during a game in the prior year, but only a quarter of them sought medical attention," he said.

"In a hypothetic scenario of participants having chest pain while playing, around half of them said they would keep playing for five to ten minutes waiting for the symptoms to pass.

"Almost half of the participants were unsure whether they would recognize symptoms they might experience during games, such as chest pain, as an indicator of potentially serious cardiac risk.

"These are worrying statistics, especially when the risk increases with age. This risk is even greater in those who exercise infrequently or not at all."

The need for better cardiac education and knowledge has been emphasized as a key solution to preventing or mitigating cardiac events. Most of the cohort surveyed agreed that external defibrillators and CPR training were important and should be staples at football fields during all games.

"Performing CPR and using a defibrillator could be the line between life and death for someone experiencing sudden cardiac arrest, as the survival rate decreases by seven to ten per cent for every minute without the use of either method." says Professor Tofler.

"Education strategies should focus on giving players clear instructions to assist rapid symptom recognition and management of cardiac events.

"These instructions should be made available to players electronically and onsite through posters for easy access. This will be vital to taking prompt action and increasing the rate of survival."

"While it is important to note that the benefits of exercise still far outweigh cardiac risk overall, these measures may further increase the benefit to risk."

Authors: Matthew Francis, Tom Buckley, Alexander Tofler, Geoffrey Tofler

Key findings

Out of the 153 participants:

• 49.6% were not confident in their ability to recognize symptoms of a heart attack in themselves with even less (32.7%) expressing confidence in recognizing one in others.
• 1 in 5 participants reported experiencing one or more potential cardiac symptoms during physical activity in the preceding 12 months.
  • Only 24.4% (one quarter) of those experiencing one or more symptoms sought medical attention
• In a hypothetical scenario of a participant experiencing chest pain while playing
  • 46.6% said they would leave the field immediately however 49% would continue playing for 5-10 minutes to see if the pain eased, and several would continue playing further.
• One third would be embarrassed to go to hospital if they thought they were having a heart attack but were incorrect
• 45.1% said that if they thought they were having a heart attack, they would rather someone drive them to hospital that have an ambulance come to their home"
• Only 39.9% were aware that warning symptoms may precede a heart attack by days or more.
• 67.3% knew how to provide CPR