London - Struggling to fasten the buttons on a waistband, the glimpse of an emerging paunch, or a sudden realisation that climbing the stairs feels like taking on Everest - whatever the catalyst, an increasing number of flabby, fortysomething men are shaking off their sedentary lifestyles and embracing a programme of high-intensity exercise.
Researchers Mintel found the biggest growth in bike sales in Britain was among men approaching middle age - more than half of men aged 35 to 44 have one.
Known as MAMILs - Middle-Aged Men In Lycra - they exchange nights in front of the TV for frantic sessions on the treadmill in an attempt to get fit, lose weight and reduce the risk of a heart attack.
Dr Glyn Thomas, a consultant cardiologist at the Bristol Heart Institute, says: ‘Sometimes men in their 40s may find themselves having a routine medical or health check and will discover their blood pressure or cholesterol is on the high side. This acts as a wake-up call and they throw themselves into exercising and taking on challenges such as 5k or 10k runs.’
However, an excessive, vigorous and unsupervised exercise routine might not be as healthy as it seems. Emerging science suggests there is a threshold of distance, intensity or duration for even the hardiest fitness fanatic, and overshooting this can have a serious impact, particularly on cardiovascular health.
A study presented at the American Academy of Family Physicians found middle-aged men who run marathons are at significantly greater risk of cardiac arrest.
This was tragically highlighted by the death of Michael McErlain, a 45-year-old Army surgeon, as he competed in a 44-mile charity D-Day run along the Normandy beaches in France last June. The seemingly super-fit Lieutenant-Colonel, from Hindhead, Surrey, died from undiagnosed heart disease.
So why does intense exercise put even fit men at risk?
As we get older the efficiency with which the heart pumps blood round the body and the way both the heart and the muscles use oxygen in the blood changes and becomes less efficient, says Eddie Chaloner, a consultant vascular surgeon at Lewisham Hospital, South-East London.
‘The arteries start to fur up and narrow as part of the ageing process,’ he adds.
Undertaking vigorous exercise without building it up in a calm fashion can cause a dramatic rise in blood pressure, leading to an imbalance between the demand of the heart muscle for oxygen and the ability of the coronary arteries to supply it. All of which could trigger a heart attack, says Dr Thomas.
‘I see a lot of middle-aged men in my clinic who have taken up excessive exercise because they have hit 40,’ he adds. ‘They have panicked because they have put on weight or got high blood pressure and may have been referred to me for further investigations.
‘But people don’t realise that, aside from the risk of a heart attack, taking up exercise this way can actually lead to heart problems. Excessive exercise in middle-aged men can trigger atrial fibrillation - a heart condition that causes an irregular and often abnormally fast heart rate.
‘One in five strokes is caused by this - and the kind of stroke caused by atrial fibrillation is more likely to be fatal.’
In a review published in the journal Heart, two leading US cardiologists looked at the heart health of 50,000 people over 30 and found that the 14,000 runners in the study were likely to live longer than non-exercisers, but only if they ran between five and 20 miles a week, not more.
The cardiologists concluded that exercising intensely for more than an hour or two may damage the heart, causing its tissue to stretch, tear and scar and raising the odds of dangerous changes in heart rhythm.
Taking up intensive exercise can also have an effect on joints, says Professor Tony Kochhar, consultant orthopaedic surgeon at South London Healthcare NHS Trust and BMI The Sloane Hospital.
‘Cycling, for example, can be a particular problem for the hips,’ he says. ‘The body is no longer designed to deliver the way it could in our youth, so we have to adapt.’
There’s no doubt the right level of exercise for middle-aged men is hugely beneficial for health - in terms of heart muscle strength, blood pressure and circulation.
By the time they hit their 40s, men start to lose muscle and gain fat. Meanwhile, loss of muscle and bone density, caused by dropping levels of the male hormone testosterone, can make muscles and ligaments stiff and tight, and more prone to injury.
Hugh Montgomery, professor of intensive care medicine and director of the Institute for Human Health and Performance at University College, London, says: ‘Exercise can help reduce the risk of so many health conditions from obesity and depression to diabetes and bowel cancer - which is the second most likely disease after heart disease to kill middle-aged men.’
Exercising at this life stage can also give a man’s sex life a boost. A Dublin study of 900 men in their 50s found those who shed their spare tyres through exercise had a higher sperm count and stronger erections, as exercise prevents levels of the male sex hormone testosterone from dropping. Meanwhile, a study by the University of Montreal of overweight middle-aged men who exercised regularly for just a few months found that as their waists shrunk, their mental agility grew.
This was thought to be down to exercise improving arterial health, making the body more efficient at using oxygen pumped in the blood to the brain.
So how should a middle-aged man go about exercising safely?
It’s advisable to find out if you are already at an increased risk of heart disease through diabetes or high blood pressure - both of which can be assessed through blood tests organised by your GP.
Tell your doctor of any family history of heart disease and stroke. It’s then important to start by spending several weeks simply becoming more active during the day, perhaps by using the stairs or walking to the shops, says John Dearing, a sports injury surgeon at Carrick Glen Hospital in Ayr.
After that, build up your fitness level slowly, perhaps walking 20 to 40 minutes, three times a week.
‘You should walk, cycle or whatever you choose to do with enough exertion to become mildly breathless, but you should still be able to talk in sentences,’ adds Professor Montgomery.
It’s not just your heart you need to protect. Warming up is very important to avoid muscle strain - this should take up about 10 per cent of the time of your session, says John Miles, the medical head at Cardiff Blues rugby club.
This could include basic movements such as lunges, squats and stretches for the lower limb muscles.
Once you feel as if fitness has improved, and you want to start speeding up then do this gradually.
Dr Dearing adds: ‘If you take up, say, jogging, start by doing ten to 15 minutes. If you manage that without a problem, then do 20 minutes the following day.’
Establish distance before you think about speed.
Once you can jog a mile-and-a-half, you can vary your run with ten seconds of sprinting, followed by slowing down for a minute and then repeating three times - a system known as Fartlek training (from the Swedish for ‘speed play’, it means varying exercise with periods of intensity).
It’s important to keep note of any symptoms that could suggest a strain on your cardiovascular system.
Dr Thomas warns: ‘If you have any chest pain or discomfort when exercising, you must get it checked out.
‘Heart pain occurs as a crushing pain across the chest, not just on the left side as people mistakenly think. Nausea and breathlessness when exercising can also be a sign of heart issues.’
Unfortunately, there is no cast-iron guarantee that your heart will be fine. But as Dr Dearing points out: ‘Increasing physical activity has huge benefits - and some exercise is always better than none.
‘But take a sensible approach, otherwise you run the risk of doing more harm than good.’ - Daily Mail