Garth Rattray | Fit and unhealthy

Because we always associate fitness with health, the term “fit and unhealthy” seems incongruous. Those states of being certainly appear to be mutually exclusive. However, they can exist in the same individual, at the same time. And, sadly, I have found that quite a number of people who are ‘fit’ are sometimes totally unaware that they are also unhealthy.

Fitness is the ability to execute optimal performances of speed, endurance, and strength. However, health is a “state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity”. The two are not necessarily concomitant. I see several fit people with poorly managed health issues, and some are unaware that they have non-communicable diseases.

Hypertension

Sometimes I see young to middle-aged men who are lean and fit looking, trying to fulfil the requirements for employment. They are usually involved in very demanding physical labour. Some are seasoned tradesmen – masons, welders, carpenters, plumbers, painters, and similarly skilled professionals. The most common adverse finding is hypertension; this is followed by diabetes.

Some of these ‘fit’ men are walking around with blood pressure readings with a systolic of over 200 mm/Hg and a diastolic of over 100 mm/Hg. They are asymptomatic and work very hard, long hours without feeling sick in any way. Our number of hypertensives is rising, currently, a little over one-third of Jamaicans are hypertensive and four out of ten are totally unaware that they have the ‘silent killer’ lurking within them. Unfortunately, many people erroneously believe that headaches will alert them to hypertension, but this is far from true. There are no warning signs until there is a catastrophic event like a stroke, heart failure, heart attack, kidney failure, visual problems, poor circulation, an aneurysm, or dementia.

Additionally, almost 18 per cent of Jamaicans are diabetic, but one in four are unaware of their status. I often find people with elevated blood glucose readings who have no symptoms whatsoever. In many individuals, it is only when the blood glucose level is extremely high that the symptoms of excessive urination, thirst, increased appetite, weight loss, tiredness, blurred vision, and perhaps itching appear. Many patients erroneously assess their glucose levels by how quickly they heal after a wound, like a cut or scrape. They wrongly assume that, if the wound heals, all is well with their ‘sugar’.

About 12 per cent of Jamaicans have high cholesterol levels, and it is more common in hypertensives and diabetics. Since high [‘bad’ as opposed to ‘good’] cholesterol levels are totally asymptomatic, many people forget about dyslipidaemia. However, it can cause an unusual build-up of plaque within our blood vessels. Aside from effectively narrowing the arteries, plaques can rupture or peel off and cause clot formation that can produce strokes or heart attacks. The plaques can also lead to poor circulation to the limbs and tiny blood vessels. Brain disease, including dementia, can ensue. Being physically active does not necessarily control our levels of [bad] cholesterol; sometimes the level is too high for fitness alone to control it.

Other incidental findings in fit and unhealthy individuals include malignancies. That feel-good feeling that one gets with being fit can be very deceptive. Only 2 malignancies are preventable, and treatment for the rest is usually amenable to early detection. Fitness reduces the risk of several malignancies, but it does not negate them. The only way for ‘fit’ people to ensure that they are also healthy is for them to do regular physical checks, which sometimes include various investigations.

SEEN IN YOUNG

Being fit and unhealthy may also be seen in our young. Every now and then we see school-aged competitive athletes collapsing on the field; some may even die. This prompted the movement to have preparticipation health examinations of athletes. This was initiated by the Italians. The idea caught on, especially in Europe, and the testing of athletes is now practised across the globe. This was modified into the periodical preparticipation evaluation, and then into the more apt, periodic health evaluations. This allowed for health baselines to be recorded and for repeated evaluations aimed at tracking health and/or picking up emerging [hidden] health issues.

The Jamaica Association of Sports Medicine is a voluntary organisation of physicians, psychologists, physical therapists, nurses, nutritionists/dieticians, massage therapists, trainers, coaches, and fitness enthusiasts. Under the initiative of the current president, Dr Rhonda Hutson, and PRO chair, Dr Wendi Peart-Brissett, the association has taken on the mammoth task of evaluating competitive athletes from [underserved] high schools. Since September 2022, several such high schools were invited to send their athletes for assessment. This includes thorough history taking, complete physical examination, musculoskeletal assessment, functional testing/fitness assessment, and detailed cardiovascular examinations with each child receiving an ECG.

Special care is taken to look out for congenital or acquired structural and electrical heart abnormalities that could lead to catastrophic events, including serious or fatal arrhythmias. So far, of the four sessions carried out by the organisation, health problems were identified in child athletes in three of those sessions. Although those athletes appeared to be fit and healthy, they had [as yet] undetected health issues.

Adult professional/elite athletes should also be periodically evaluated. Their health status can change over time (especially with age), or because of overtraining, chronic injuries, the taking of performance-enhancing drugs, stress, and even clinical depression. Only by regular check-ups can our health be properly evaluated and maintained.

Garth A. Rattray is a medical doctor with a family practice. Send feedback to columns@gleanerjm.com and garthrattray@gmail.com.