Football, by many measures, is America’s favorite sport. Over the holidays, many people spent their time rooting for their favorite college or professional football team. While cheering for your team's 300-pound linemen to protect your quarterback and pick up the pass rush, consider the effects of playing the sport on an athlete's heart health. It is known that obesity and hypertension (high blood pressure) cause heart disease.  Can a world-class athlete, such as a football player at the peak of his conditioning, be at risk for obesity, hypertension and heart disease?

A recent study of over 2,000 high school and middle school athletes from Philadelphia surprisingly showed that a significant number of these asymptomatic, very active students were obese or had high blood pressure. The pre-participation physical evaluation for theses students showed that 24 percent were obese and 15 percent had high blood pressure.   The two often went hand in hand; those who were obese also had hypertension.  This study was confirmed by one examining 7,000 high school students in Mississippi.  These students also had a high rate of obesity (23 percent) and hypertension (21 percent). The obese student athletes were twice as likely to have hypertension as the nonobese ones. In addition, it was felt that athletes who participated in a single sport, such as football, were at higher risk for high blood pressure. Those who played multiple sports or running sports had lower rates of hypertension.  

Another study looked at Division I college football players before and after the football season, comparing linemen with nonlinemen (for example, receivers and running backs).  Before the season, linemen were more overweight than the nonlinemen.  Both groups had similar blood pressure readings. After the season, the weight of linemen went up, but not the weight of the nonlinemen.  The blood pressure went up more in the linemen as well.  In addition, the hearts of these football players were examined before and after the season. The linemen showed a thicker heart muscle and worse heart mechanics than the nonlinemen.  The changes seen in the linemen are similar to the adverse remodeling of the heart seen in patients with longstanding hypertension.  These changes were seen after only a single season, it is not known if the adverse heart remodeling gets even worse after more seasons of playing and training.

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The reason linemen are more susceptible to heart disease is related to the demands of and the training for the position.  In general, sports and exercise can be divided into two broad types: dynamic (isotonic, aerobic) or static (isometric).  Dynamic exercise results in an increased heart rate and a lower diastolic blood pressure, favorable conditions for both the heart and the muscles.  Repeated bouts of dynamic exercise over time leads to improvement in the heart’s performance. Classic dynamic exercises include running, cycling, and swimming. Many studies have shown that dynamic exercisers live longer and have less heart disease than the general population. On the other hand, static exercise, such as weight lifting, results in a marked increase in both systolic and diastolic blood pressure and adverse heart remodeling over time. With static exercise, the heart is constantly pumping against a very high blood pressure, causing the heart to work harder. This causes a thickening of the heart muscle. Thickening of the heart muscle is not good and can lead to congestive heart failure, irregular heart rhythms and cardiac death. By virtue of their position, linemen inherently have larger body sizes and engage in static exercise.  Since they start off bigger and heavier, it is no surprise that they can end up obese. The position requires less running and more pushing and moving weight. Therefore, their training requires more static exercise and weightlifting, leading to adverse remodeling of the heart.

The idea that football players, particularly linemen, can develop obesity, hypertension and heart disease is not new. However, the recent studies do shed new light.  We now see that obesity and hypertension occur in players at a young age. In addition, after only one season, there is a worrisome decrease in the heart's mechanics. What are the lessons to be learned? For young athletes, pre-participation sports physicals should be done to assess both the athlete's risk for sudden cardiac death as well as obesity and hypertension. If identified, weight and blood pressure should be addressed early, before heart disease develops. For football players, once they retire, they must work to reverse the adverse effects on their hearts from their years of playing and training.  For the causal exerciser, the type of sport and the type of training is vitally important.  For example, going to the gym and only lifting weights is not a good strategy. Dynamic (aerobic) activity must be worked in as well for better overall heart health.  So, root for your team to win the Rose Bowl or the Super Bowl. Then root for the players to adopt heart healthy lifestyles.