Q&A: A cardiologist's tips for tennis

June 16, 2021

Eli Friedman, M.D., FACC, the Medical Director of Sports Cardiology for the Miami Cardiac & Vascular Institute, part of Baptist Health South Florida, has made the care of athletes and highly-competitive individuals the focus of his practice.


With vast experience in the sports industry, Friedman is the team cardiologist for Inter Miami CF of Major League Soccer, numerous local universities and colleges and he sits on the health and wellness committee for both the Miami-Dade and Broward County school districts.


His non-clinical interests focus on the recognition and response to sudden cardiac arrest in a sports setting, which led him to create "The Heart of a Champion" CPR program, which focuses on training athletes, parents, coaches, officials and others in sports in hands-only CPR and automatic external defibrillator (AED) use. The program that has been utilized by both the Miami Dolphins and Florida Panthers, in addition to local athletic groups.


Friedman earned his medical degree from The Chicago Medical School at Rosalind Franklin University and completed his internal medicine residency and cardiovascular disease fellowship at the University of Pittsburgh Medical Center. His research has been published in peer-reviewed journals and he has authored educational content for the sports and exercise section of the American College of Cardiology. 


In the below Q&A, Friedman highlights the many ways in which tennis can improve and maintain cardiovascular health.


What prompted you to work with the USTA and add tennis to your professional expertise? 

First and foremost, tennis has always been very present in my family. The sport has provided the basis for lots of really good memories, both in the distant past and in the present. Second, as a sports cardiologist, I spend much of my time with individual athletes and their families working through issues unique to each person. Working with the USTA allows me to leverage the skills of working with athletes more toward the larger vision that is often overlooked in sports cardiology—the health and wellness of athletes in the realm of public health. The USTA has a vested interest in the holistic well-being of those to whom tennis is important, and I am really fortunate to be a part of a really strong, multi-disciplinary team.


Which of the many health benefits of tennis resonate the most to you?

The most obvious one is the exercise and movement that one gets from playing the game. We encourage everyone to try to be as active as possible and do so in a fun, sustainable way. Tennis is really a lifelong game. You can pick up a racquet at ages 4 and 5, like my children, and play it for the rest of your life, no matter how recreational or elite you are. This sets you up for a lifetime full of high-quality exercise, which helps to control cardiometabolic risk factors like blood pressure, cholesterol and blood sugars.


One which may not be so obvious is the social benefit of playing tennis. We know positive social interactions and connections lead to better health outcomes. Meeting friends, teammates and others at the local courts has really positive impacts on our health and well-being. It gives us something to look forward to each week, which only reinforces the benefits that we get from moving our bodies in a really productive way.


How does tennis improve your cardiovascular health? What are the long-term benefits?

We encourage everyone to try to hit 150 minutes of moderate-intensity exercise or 75 minutes of high-intensity exercise per week. By doing so, we maximize our ability to lower our risk of cardiovascular disease. Moderate-intensity tennis is akin to rallying in singles or doubles with friends. High-intensity is a competitive match. Exercise is the best medicine out there for cardiovascular health. If done habitually and with commitment, tennis can lower and help control blood pressure, blood sugar and cholesterol. It also builds social relationships, which reinforces our health and overall well-being.


 How many days a week do you suggest someone play tennis to improve their heart health?

As often as possible! Sessions for exercise are best done in 30-to-60-minute intervals. So, three to four dates per week with tennis on the calendar should provide a really good foundation for overall health.


How can good cardiovascular health important improve a tennis player's game?

Cardiovascular health provides the foundation to build on. As it relates specifically to performance, especially in tennis, the more aerobically fit one is, the better their endurance and the more ready to meet the challenges the invariably arise during a match. In the same light, it is really important to not ignore any symptoms that may be experienced like chest pain or discomfort, abnormal shortness of breath, abnormal fatigue, skipping heart beats or fainting or near-fainting episodes. These could be signs of cardiovascular disease and should be evaluated prior to ensure you are safe to continue to play. Similarly, for those who have chronic medical conditions and who are taking medications, it is always important to speak to your physician to understand how the medical conditions and medications can impact performance and whether it is safe to push the limits on performance.


In addition to tennis, what other activities do you suggest to players to fight heart disease?

As with anything, being well-rounded is always best. Tennis is a really good aerobic sport (e.g., endurance sport), but it does not provide a lot of isometric or resistance training. Thus, adding in weight lifting could improve one’s game. This has also been shown to be beneficial to the cardiovascular system.


It is also important to think about how we recover. Taking time to eat a healthy diet and get a good night’s rest will improve one’s tennis game and cardiovascular health. This means choosing heart-healthy foods and getting 7-to-9 hours of sleep per night.


What can a player do on court to help slow down their heart rate between points?

Focus on breathing between points. Take slow, deep breaths, in and out, and prepare for the point ahead. Mentally, move on from the previous point and be ready for the next serve. Between games, stay well hydrated and take in nutrition or electrolytes if you can. This will keep your system ready for what is to come.


Do you have any final recommendations to players?

Tennis is a life-long game, which is really unique in the world of sport. People can enjoy playing from childhood well into their seventh and eighth decades of life and beyond. It is important to enjoy it in a healthy and safe way. Invariably, though, symptoms may arise which could be worrisome. Whether they are musculoskeletal issues or potentially cardiac, it is important to have them evaluated. Cardiac arrest can happen on a tennis court just as it can in a grocery store or at home. Lean how to perform CPR, use an automated external defibrillator (AED) and work with your local tennis organization to have plans in place should a medical emergency arise on a court. By taking an active role in your local community’s health and wellness, you may have the opportunity to help save a life!

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