The death last week of ex-SAS officer and former mercenary Simon Mann of a heart attack at the age of 72, reportedly while exercising on an indoor rowing machine, is not the first to be linked to strenuous exercise and gym machines.
The husband of Facebook‘s then-chief operating officer, Sheryl Sandberg, died while running on a treadmill in 2015 – autopsy results suggested that Dave, just 47, had an undiagnosed heart arrhythmia, which may have caused him to fall while working out, leading to a fatal head injury.
In 2013, the broadcaster and journalist Andrew Marr suffered a major stroke while ‘vigorously’ exercising on a rowing machine. At the time his family was told he might not make it – he has since made a remarkable recovery although his left arm and leg are still affected.
While Simon was in his eighth decade when he died, a long-time friend and business associate of the Old Etonian, Howard White, described his death as ‘shocking’. ‘Simon was super fit. He used to go out in the mornings for a ten-mile run,’ he said.
Yet experts explain that people of all ages, many of whom were apparently fit and healthy, can suddenly collapse during high-intensity workouts.
Last week ex-SAS officer and former jailbird mercenary Simon Mann, left, died of a heart attack at the age of 72, reportedly while exercising on an indoor rowing machine
‘Although death during exercise is rare and all the evidence shows exercise is overwhelmingly good for cardiovascular health and helps to boost longevity, strenuous workouts are linked to increased risk for fatality – particularly among those who have a history of heart problems or risk factors that increase the risk of coronary artery disease such as smoking or obesity,’ explains Michael Hickman, a consultant cardiologist at the Royal Surrey County Hospital.
An obvious cause is a heart attack, when a coronary artery becomes blocked and the heart muscle starts to die. In middle-aged and older adults the most common cause of sudden cardiac death related to exercise is a build-up of plaque in the arteries, a 2020 study by the American Heart Association shows.
Perhaps unsurprisingly, men who weren’t used to exercise were most at risk. It seems vigorous exercise, if you have cardiovascular disease, may cause a heart attack possibly through increasing the ‘sheer stress’ on the plaque, which can break off and block the arteries to the heart, explains Dr Chris Pepper, a consultant cardiologist and electrophysiologist at Leeds Teaching Hospitals NHS Trust.
Strenuous exercise may also trigger cardiac arrest, when a person’s heart stops pumping blood around their body and they stop breathing. Data from the charity Resuscitation Council UK shows that one in 217,000 people a year suffers a sports-related sudden death due to cardiac arrest.
Very fit people who regularly undertake high-intensity endurance exercise such as rowing or running may be at more risk of cardiac arrest, according to a 2024 review in the journal EP Europace, possibly because they have larger, thicker hearts from exercising, which interferes with the heart’s natural pacemaker.
Another possibility, reported researchers in the European Heart Journal in 2015, is that long-standing vigorous exercise may alter the electrical activity of otherwise normal hearts. When the heart is under strain during exercise, these changes can cause the electrical system to misfire.
Yet it’s not just the super-fit – one trigger for problems with the heart’s electrical signals is hypertrophic cardiomyopathy, where the heart muscle becomes thickened so it can’t pump blood as effectively and is prone to problems with the heart beat (ventricular arrhythmia). The risk of this may be increased by strenuous exercise, says Dr Hickman.
Viral infections in the heart are a major cause of cardiomyopathy. But you’re also at risk from an unhealthy lifestyle and stress.
The husband of former Facebook chief operating officer Sheryl Sandberg died while running on a treadmill in 2015
Data from the charity Resuscitation Council UK shows that one in 217,000 people a year suffers a sports-related sudden death due to cardiac arrest (picture posed by model)
Another potential cause is the tearing of arteries that supply the heart or brain. Andrew Marr was found to have suffered a tear in his carotid (neck) artery. ‘Arterial dissection usually reflects an underlying abnormality of the vessel which is sometimes genetic,’ says Dr Pepper. ‘It is also more likely in individuals with high blood pressure.’
So should certain people avoid this kind of intense exercise?
Fortunately overall, sudden cardiac death during exercise is rare – affecting between 0.31 and 2.1 people per 100,000 a year. Dr Hickman points out exercise is recommended for everyone, including those with a history of heart problems.
The key is ‘know your limits and do not overdo it’. Unfortunately, he says, many people with underlying health issues may not know they are at risk because the problems have never been diagnosed: ‘The first time they know there is a problem is when they collapse.’
As we age, our arteries thicken, heart valves become stiff and less elastic and there is wear and tear in your body you can’t see, adds Sammy Margo, a sports physiotherapist based in London.
Dr Hickman, who looks after members of elite sports teams including at McLaren Racing and Harlequins Rugby Football Club, says, ‘those considering taking up exercise of any kind over the age of 50 should consider seeking medical advice prior to doing so, and get their blood pressure checked, as high blood pressure can add to the risk of serious health events.’
Ruth Goss, a senior cardiac nurse for the British Heart Foundation, says it’s also always a good idea to build up slowly if you are new to exercise before doing anything strenuous. ‘And if you do already have a history of heart problems, or are concerned about your heart health, ask your doctor if there’s any particular advice to follow in terms of exercising safely,’ she says.
No one is saying people should stop using rowing machines.
‘Rowing is an excellent workout which, when done correctly, at the right pace for the individual, offers huge benefits,’ says Sammy Margo. Unfortunately some people can set themselves unrealistic goals, pushing themselves for too long. ‘And there’s an element of competition with these machines which give you constant feedback.’
Additionally, older men and women who have always been very fit can suffer from ‘athletic identity’, she adds.
‘This happens when people who are in middle and later age link their former performance levels to who they are, and find it difficult to accept they need to slow down.
‘It can be even worse for those who have been trained to develop psychological toughness and who could ignore warning signs they’re pushing their body too hard.’
She advises older people past their physical peak to think about maintaining a healthy exercise routine, ‘but consider less strenuous alternatives including swimming and cycling’.
Howard White, speaking after his friend Simon Mann’s death, suggested his fatal collapse may have been in part due to the ‘background of his life’.
‘He had been in the SAS – the creme de la creme. But he’d had two hip replacements, and half his body was full of metal. I don’t think five or six years in an African jail, with a hole in the ground for a toilet, did him much good. It would take a toll on anyone’s health.’
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