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Fitness risk after 50: Did Jackson do too much?

Early reports suggest that Jackson, 50, suffered a heart attack or sudden cardiac arrest on June 25, amid weeks of intense physical rehearsals for a 50-show gig starting in London next month. While there’s some question about possible drug abuse, doctors say launching an arduous exercise program causes problems for older people every day.

“After age 40, the frequency of sudden cardiac arrest goes up dramatically under the stress of exercise,” said Dr. Mark Estes, past president of the Heart Rhythm Society based in Washington, D.C.

“Among the worst offenders are famous athletes who still consider themselves in shape.”

It’s vital for older exercisers, even those who were very fit when they were young, to be screened for underlying heart conditions and to build up the intensity and duration of any fitness program gradually — if at all.

“Regular moderate exercise is good for you,” Estes said. “It’s not clear that intense exercise does much more for you.”

Jackson worked out hours every day

Estes and several other cardiologists emphasized that they can’t speak directly to Jackson’s health or his fitness regime. Dancers working with Jackson have said in press reports that he was practicing choreography and working out several hours a day, keeping up with the 20-year-olds in his entourage.

But the doctors said what’s been lost in the discussion of the pop star’s health, and his death, is the fact that he was an aging man, a Baby Boomer with all of the health baggage that that implies.

“He’s 50 years old and 50-year-old people die every day,” said Dr. Bruce Wilkoff, an expert in cardiac arrhythmia at the Cleveland Clinic.

About 325,000 people in the United States died of sudden cardiac arrest every year, succumbing when their hearts unexpectedly and abruptly stop beating. It’s an electrical problem that disrupts the rhythm of the heart, different from a heart attack, which is more like a plumbing problem caused by a blockage in an artery. About 500,000 people a year in the U.S. die after heart attacks.

The cause of cardiac arrest is often unknown, although medication — and exercise — can be a factor in the interruption of the rhythm that causes the heart to shudder and stop.

“If you have underlying coronary disease and you suddenly start to exercise, you can have problems,” said Dr. Alfred Bove, chief of cardiology at Temple University Medical Center and president of the American College of Cardiology.

At age 50, cholesterol build-ups called plaques are likely to accumulate in arteries, causing narrowing and even blockage. If pieces of the plaque break off during exercise, they could cause a heart attack or trigger sudden cardiac arrest, said Dr. Vincent Mosesso, an associate professor of emergency medicine at the University of Pittsburgh and medical director of the Sudden Cardiac Arrest Association.

He advises everyone to get a thorough heart check-up at about age 50, or earlier if there are risk factors such as a family history of heart disease.

Watch out for dangerous symptoms

Anyone who starts an exercise program ought to pay attention to any symptoms of heart trouble while they’re working out, including discomfort, tightness or pressure in the chest; discomfort in one or both arms, the back, neck or jaw; shortness of breath; cold sweat or nausea.

“It’s very easy to make excuses for symptoms,” he said.

There are other, more rare factors that could contribute to a sudden death during or after exercise, including cardiomyopathy, a disease in which the heart muscle becomes inflamed and becomes more prone to disrupted rhythm.

Screening tests would detect that condition and others. It’s unlikely that someone with Jackson’s resources hadn’t been screened for such problems, Bove said, raising the possibility of a random, unexplained death.

“He could have had a heart attack out of the blue,” Bove said. “Many people do.”