SPORTS MEDICINE: Exercise Also Can Be A Good Diagnostic Tool
DOUG CUTTER - TIMES-DISPATCH COLUMNIST
Wednesday, March 17, 2004

An exercise prescription provided by your physician is intended to help prevent many chronic disease conditions, such
as obesity, hypertension, coronary heart disease and non-insulin-dependent diabetes.

Exercise also is used as a diagnostic tool by clinicians to uncover problems, such as heart and lung diseases.

However, exercise also stresses other organ systems and can unmask disorders. The physician can then use this
information to make accurate diagnoses that can improve or save lives.

Exercise can help differentiate the many common causes of chronic fatigue. Depressed patients, for example, are tired
when arising in the morning. Patients with viral infections, such as mononucleosis, feel fine in the morning but tire
as the day goes on and may need a nap. Chronic fatigue syndrome patients are tired all day long and may become totally
exhausted with minimal effort.

However, patients with mild or moderate anemia usually feel normal at rest and are aware of fatigue only with exertion.
And, for those patients with mild anemia, all-out exercise may be the only experience that unmasks the problem. There
are many examples of athletes who felt tired only with ex treme effort or may have experienced a subtle impairment in
athletic performance who eventually were shown to have abnormally low hemoglobin due to some factor that either caused
the loss of blood and/or iron or impaired the production of blood cells. Even such apparently benign symptoms as "heart
beating too fast," "breathing too hard" or "dizziness" with exercise may have anemia as the root cause. Some people
even get evaluated for exercise-induced asthma when they actually may have a mild case of anemia. Fortunately, this is
usually treated easily with increased iron in the diet or some other remedy that leaves no lasting effects. A good
point to remember is that the milder the anemia, the more likely it is that strenuous exercise will be the only
unmasker.

Athletes and active people may suffer from headaches related to their exercise. The most common type of headache
associated with exercise is termed benign exertional headache. Others may include effort migraine, cervicogenic
headache, goggle headache, diver's headache and altitude headache. Recently, there have been published reports about
"cardiac cephalgia" seen in middle-aged men. This is a headache brought on by exercise and later found to be the result
of coronary artery disease. These patients do not have the typical chest pain associated with coronary insufficiency,
but instead experience an exertional headache. Sometimes the patient will have undergone multiple neurologic work-ups
that are all negative. The patients reported in this study were treated with coronary bypass surgery and had complete
resolution of their exertional headaches after returning to full activity.

A seizure in an athlete, exercise-related or not, may be a sign of epilepsy. Seizurelike activity also may be witnessed
in someone who becomes severely hypoglycemic due to insulin-dependent diabetes. But not all seizures in athletes signal
epilepsy or hypoglycemia. An exercise-induced seizure can be the presenting sign of a curable brain mass. Exercise can
unmask other subtle neurologic symptoms. I have read about a case in which a 72-year-old man, who was an avid softball
player, complained of "slowing down when I sprint to first base." This later proved to be the first sign of Parkinson's
disease.

Hypothyroidism is a common disorder that usually presents with fatigue. However, it can be manifested by recurring
overuse injuries that seem out of proportion to the level of activity. These are people who are always pulling muscles
or often experiencingtendinitis. Once diagnosed and treated properly, these patients lead a normal life without the
bothersome tendinitis.

Exercise is a wonderful tool to help prevent many chronic disease processes; however, it is not a shield against all
illnesses. Remember that symptoms experienced during activity are not always benign. Exercise can be a useful stress
test for many organs of the body, but you must be aware of these possibilities in order to reap the opportunities for
early diagnosis and treatment.

Dr. Doug Cutter is director of the Sports Medicine Center at CJW Medical Center (Chippenham). Look for his column on
the third Wednesday of each month. Contact him at [log in to unmask] or at: C/O Balance, Richmond Times-
Dispatch, P.O. Box 85333, Richmond, VA 23293

SOURCE: Richmond Times Dispatch, VA
http://tinyurl.com/2vazt

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