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Regular cycling can protect you from plaque ruptures in your heart’s piping. Getty Images<\/p>\nRegular exercise is a wondrous defence against many health conditions \u2013 cancer, dementia, diabetes and depression to name just a few. Missing from that list is heart disease. <\/p>\n
To be clear, for many people the link between exercise and cardiovascular health will be overwhelmingly positive.<\/p>\n
But the relationship between the two is nuanced and needs careful consideration. We need to look at how cardiac conditions intersect with cycling for riders of different ages and at varying levels of intensity. <\/p>\n
The cardiac landscape is obviously different for young adults and Masters (over-40) cyclists. Unless known from childhood, heart conditions are uncommon in young people.<\/p>\n
In fact, severe and lethal conditions are so rare that the clinical value of screening for them is outweighed by the logistics. <\/p>\n
In contrast, heart conditions are more common in middle age and beyond, so the potential benefits and risks of long-duration and high-intensity cycling for the master\u2019s athlete group need to be evaluated.<\/p>\n
Note that the authors of this article, Dr Nigel Stephens and Phil Cavell, are both midlife cyclists. To help explain it all, we\u2019ve used case studies from real patients who have been cared for by Dr Stephens.<\/p>\n
Heart attacks, angioplasty and bypass surgery
\nRegular cycling can protect you from plaque ruptures in your heart’s piping. Getty Images<\/p>\n
The most common cause of a heart attack is a blockage to a coronary artery. We all have three arteries that supply blood to the heart\u2019s muscle.<\/p>\n
If one contains fatty plaques (atherosclerosis), there\u2019s a risk of rupture and immediate blockage of blood flow to the myocardium. This is a heart attack.<\/p>\n
Endurance exercise and statins both exhibit the useful property of making fatty plaques less viscous and more stable over time. <\/p>\n
In the long term, cyclists are therefore better protected from plaque ruptures than those who are new to cycling and exercise.<\/p>\n
Case study 1<\/p>\n
A keen club rider was midway through the regular Sunday ride on rural lanes. Without warning, he veered into a ditch and was found to be in a state of cardiac arrest. <\/p>\n
His clubmates performed CPR (cardiopulmonary resuscitation) and called for help. An air ambulance arrived and the man was resuscitated. His ECG (electrocardiogram) showed he\u2019d suffered a heart attack. <\/p>\n
He was taken to a cardiac centre, where he had emergency angioplasty (a procedure to widen a restricted artery). <\/p>\n
Three months later, the man asked if he was safe to return to riding and, if so, how much and how hard he could ride.<\/p>\n
Cyclists often consult a cardiologist with this question, be it after angioplasty or bypass surgery (grafting a blood vessel from elsewhere in the body to \u2018bypass\u2019 a blocked artery). <\/p>\n
We evaluate how much heart damage is still present and whether the heart\u2019s blood supply is back to normal. <\/p>\n
In this case, despite the drama of our patient\u2019s initial illness, his heart was functioning normally and was undamaged. Detailed testing showed its blood supply wasn\u2019t reduced either.<\/p>\n
He followed a structured return to training \u2013 with increasing volumes of gentle, zone 1 and 2 riding \u2013 that allowed him to rejoin his clubmates and return to normal life.<\/p>\n
It\u2019s possible that his cycling and resulting fitness helped him to survive the heart attack, and also accelerated his recovery back to full fitness and activity levels.<\/p>\n
Leaking heart valves, surgery and high forces in the heart
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High-intensity cycling puts your heart under huge pressure. Getty Images<\/p>\n
Wear and tear in the heart valves is a common issue in cardiology. Explosive efforts place huge forces through our heart and raise concern that they may cause or aggravate this degenerative process.<\/p>\n
Case study 2<\/p>\n
A high-standard track sprinter came to us because of breathlessness. This was initially attributed to lung disease. <\/p>\n
However, listening to the heart revealed a leakage of the inlet (mitral) valve between the left atrium and ventricle (two of the heart\u2019s chambers), allowing blood to flow back into the atrium. <\/p>\n
An ultrasound confirmed this. While the scan showed the leak wasn\u2019t particularly severe, when we got the cyclist to perform a ramp test on a static bike (where you gradually increase workload), it became torrential during the high-intensity effort, causing him to become short of breath. The valve was repaired surgically and this fix has remained robust for years.<\/p>\n
It remains a moot point whether we can aggravate heart-valve decay through cycling. Encouragingly, it appears surgical techniques (and artificial valves) are able to deal with what we can throw at them while pedalling.<\/p>\n
Atrial fibrillation (AF)
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Atrial fibrillation is far more common in frequent cyclists than those who don’t exercise. Getty Images<\/p>\n
Sportspeople over 40 have five times the risk of the common heart-rhythm abnormality atrial fibrillation. The biological reason isn\u2019t understood properly, but it may be linked to chronic stretch in the heart\u2019s left atrium \u2013 which collects oxygen-rich blood from the lungs \u2013 due to thousands of hours in the saddle.<\/p>\n
It often starts as brief episodes while riding, seen as an abrupt rise in heart rate with chaotic variation. Riders must slow down, and feel a loss of leg strength and power output. <\/p>\n
Untreated, these episodes become more frequent, of longer duration and constant. Nobody likes being told they shouldn\u2019t ride, and it may well make no difference in any case. <\/p>\n
For most, medication can safely suppress the AF, but if this is ineffective, ablation works well. This is a keyhole procedure, done under general anaesthetic, which aims to electrically isolate the areas inside the heart that are responsible for generating the abnormal rhythm. <\/p>\n
Being male, a Masters athlete, drinking alcohol, stress and experiencing an AF episode are all factors that have been linked to increases in the prevalence of AF.<\/p>\n
Hypertension (high blood pressure)<\/p>\n
When we exercise, our blood pressure rises by 50% and doesn\u2019t cause any harm. But for some, dangerous hypertension is mainly (or only) seen during sustained exercise. <\/p>\n
And if we ride for 10 to 20 hours a week \u2013 5% to 10% of our life \u2013 there\u2019s an appreciable risk. Modern blood-pressure medication is safe and, for the most part, free of side-effects, and can effectively mitigate this risk.<\/p>\n
Covid and Long Covid
\n![\"\"](\"https:\/\/www.newsbeep.com\/il\/wp-content\/uploads\/2026\/04\/GettyImages-1401563953.jpg\")
Cardiologists are continuing to observe a burden on the body \u2013 and heart \u2013 from Covid. Getty Images<\/p>\n
In 2020, the cardiology community held its breath \u2013 would we see an epidemic of myocarditis (heart muscle inflammation) and damaged hearts? The answer six years down the line is a definite no. But issues certainly exist.<\/p>\n
Case study 3<\/p>\n