Does Andrew Marr’s stroke tell us it’s time to slow down?

The five-a-side pitches of the nation’s parks may have been a bit emptier yesterday. Certainly, there will have been fewer middle-aged men queuing up at the gym, squeezing themselves into cycling gear, or hanging around the squash court, hoping to fit their week’s exercise into an hour’s match.

Instead, many men – having watched Andrew Marr’s return to television yesterday morning, when he declared that his stroke, four months ago, was due to an overenthusiastic session on the rowing machine – may have spent a bit longer over their pint or Sunday roast, wondering whether working out has really been working out for them, either.

So, has the health message been oversold to the squash set? Or is it true that men – of a certain age – can’t quite accept the need to go a bit slower, eat and drink a little less and burn the candle at one end only? In short, to admit that while the spirit feels 25, and wants to go clubbing, the body knows that a country walk, a pair of slippers and an early night are more the thing?

Certainly, Marr seems sure that his stroke had its genesis in a super-aggressive fitness regime. Speaking to Sophie Raworth, the guest host of his BBC One show, he explained – perhaps mischievously – that he had done “the terrible thing of believing what I read in the newspapers, because the newspapers were saying what we must all do is take very intensive exercise, in short bursts, and that’s the way to health”.

He added: “Well, I went on a rowing machine and gave it everything I had, and had a strange feeling afterwards – a blinding headache, and flashes of light. Served out the family meal, went to bed, woke up the next morning lying on the floor unable to move.”

His BBC colleague Nick Robinson clearly agreed, and promptly tweeted: “Great to see Andy Marr back in his studio. Almost watched him from the rowing machine we bought a month ago. Oh well, back to the sofa.”

Fitness instructor Jamie Baird, the head trainer at Sanderson Hotel, London, admits that even he has doubts about high-intensity exercise. “I see a lot of guys trying to go from zero to hero. They spend all day sitting in front of the computer, then sitting on the train, then go to the gym at weekends and do the opposite with extreme exercise. Common sense tells you that you need a basic level of fitness to perform high‑intensity work safely.”

He adds: “It’s quite dangerous for 45‑year-old, stressed, overweight men to go hell for leather on a squash court. It can’t be good for you – you get dehydrated and you get injured.”

Even so, a stroke seems pretty drastic and, at 53, Marr is rather young to have suffered one. Of the 150,000 people who have a stroke each year – in which the blood supply to part of the brain is cut off and brain cells are damaged or die – about 75 per cent are aged over 65. Nor was he at obvious risk: according to the Stroke Association, it is predominantly caused by atherosclerosis, the “furring up” of arteries. Other contributing factors are medical conditions such as high blood pressure, high cholesterol and diabetes, and the impact of lifestyle choices, such as smoking or drinking alcohol excessively and lack of exercise.

Although he is known to enjoy his wine and whisky, neither obesity nor smoking has been a problem for Marr since his twenties, when he started running after being “a very fat, chain-smoking student”.

However, among younger patients (including 400 under-18s), the cause of Marr’s stroke – a right carotid dissection, or tear in the lining of the artery which supplies the head and neck with oxygenated blood – is not so unusual. Tears occur when blood gets between the layers of the blood-vessel wall. This can allow blood to escape into the brain, or to form a clot in the artery, leading to the stroke.

“Often we don’t know the cause of a tear,” explains Dr David Nicholl, a consultant neurologist at Birmingham City Hospital, “but minor trauma can be a precipitant.” That might indeed include a sudden burst of untypical exercise.

Marr is not the only member of the Westminster village to have experienced a stroke at a comparatively young age. Andrew Lansley, the former Health Secretary, suffered a cricket-induced stroke in July 1992. “I went to pick up a ball, stood up again and suddenly I couldn’t stand straight,” he recalled in an interview in The Spectator. “I thought: 'This is very odd.’ I tried to stabilise myself on the pitch, but I had lost my balance. I walked to the pavilion and sat down, but it got progressively worse.”

Although it was initially misdiagnosed as an ear infection, an MRI scan demanded by his then wife, a GP, showed “bits of dead brain, areas coming up as black, because there was no blood passing through… so clearly I must have had a stroke. My vertebrae basilica artery had split – for reasons that I never know to this day.”

He speculated on the cause: “In my case, it could have been turning my head while driving the car or sneezing too hard with too much back pressure.” Other explanations might include a trip to the chiropractor after a fitness injury: research suggests that the manipulations carried out, especially those that involve forceful rotation of the neck to one side, may overstretch the artery that runs along the spine (which could cause a blood vessel to dissect or disintegrate).

A December 2011 paper in the Journal of Neurosurgery concluded that “chiropractic manipulation of the cervical spine can produce dissections involving the cervical and cranial segments of the vertebral and carotid arteries. These injuries can be severe, requiring stenting and surgery.” The study was small, involving 13 patients, but the researchers from the Division of Neurological Surgery, St Joseph’s Hospital and Medical Center, Phoenix, Arizona, noted that 31 per cent were left permanently disabled or died as a result of their arterial injuries.

Whatever the cause of his stroke, there is no doubt, says Dr Nicholl, that Andrew Marr has been “very lucky”. He explains: “Had his other carotid been the source of the tear, it would have affected his speech, causing aphasia. The main concern for Marr is that a right carotid dissection can cause problems with vision and the left side. [On TV yesterday] Marr didn’t seem to have a problem with his sight, although he talked of still being weak on his left and was not using that arm.” He confirms that Marr’s plans to return to work eventually look promising, although he will require intensive rehabilitation.

If so, the presenter has again been fortunate – as well as diligent and well cared for, it seems. More than half of the 1.2 million stroke survivors in the UK are left with disabilities that affect their daily lives. “There is a lot of negative perception around stroke rehabilitation,” says Dr Nicholl, “but you see Marr is going to do all right. Life after stroke can be a long and slow road, but he wants to return to work and he will. Someone of his age, who is otherwise well, will make a good recovery, and he will improve with time.”

So what can the Sunday kickabout crowd learn from Marr? Colin Penning, spokesman for the Men’s Health Forum, a lobbying group for men’s health and welfare, warns that poor basic fitness levels are the real worry – rather than unlucky events such as a stroke.

“There is a big fall-off in fitness at age 35,” he says. “Men go up a trouser size, and give up.” In fact, middle-aged men properly catching the fitness bug – such as politician Ed Balls, about to run his second London Marathon – are a rarity, he adds. “Men need to take action – just start gently.”

Jamie Baird agrees. “Few people have even basic levels of fitness any more. Yet the solution is quite easy: move around more – climb stairs, walk up escalators, walk to meetings, don’t take a bus or Tube if you can avoid it.”

And does Dr Nicholl think we should all now eschew the running track (or rowing machine) for safety’s sake? Not so fast. “This doesn’t mean we should stop exercising,” he says. “All of us live too sedentary a life. A reasonable amount of sensible regular exercise is a good thing. We have to pace ourselves.” Perhaps that one game of squash a week, far from being dangerous, is simply not enough.