You must have come across multiple news reports about people either dying due to sudden cardiac arrests or developing heart-related complications (including heart attack) during intense workout sessions. Experts are divided over whether there has been a sudden, unexplained increase in such incidents over the past few years, but they suggest it is always advisable for middle-aged individuals to do some mandatory heart-screening tests and medical consultation before hitting the gym.
These tests help identify if there are any underlying heart defects or conditions which could trigger severe cardiac complications during a workout session, they say. Quite often such adverse conditions are inherited but remain undetected for long, before turning into a serious health complication.
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When it comes to high-intensity exercises, people must take extra precautions. “Some basic heart tests to diagnose any existing heart issues or cardiac ailment should be conducted, especially for people in the 30-45 age group. Only then can they start high-intensity exercises,” says Dr Thejaswi N Marla, cardio thoracic vascular surgeon, Fortis Malar Hospital, Chennai.
Sunil Kumar, a Bengaluru-based ACE-certified fitness trainer, says: “If a person is just going to start working out, or if they are already an athlete or training to be one, they should be sure about the issues they have and if they have any pre-existing conditions.”
Basic tests and precautions for your heart
Here are the basic tests middle-aged people must do before they hit the gym:
An electrocardiogram (ECG) is a painless and simple test that reads the electrical activity in the heart at rest. It can help with diagnosing any abnormalities of the heart structure and rhythm.
“In an ECG, even subtle changes can be made out in cases of structural heart diseases,” says Dr Marla.
Stress or treadmill test (TMT)
“In a treadmill test, the person is made to walk on the treadmill machine while their heart rate is monitored through an ECG monitor,” says Dr Pallab Kumar Bose, consultant interventional cardiologist, Fortis Hospital, Kolkata.
The test also reveals if there is any variation in the heart rate when the intensity and pace of the steps are increased on the treadmill. The test, which takes about 20 minutes, monitors the heart’s response to physical exertion.
Dr Marla recommends that people over 45 especially should undergo a treadmill test to see if they are able to tolerate high-intensity exercises.
“During a treadmill test, we stress the heart and set a target heart rate,” says Dr Marla. “We check [the individual’s] blood pressure while trying to reach that target heart rate. Once they have reached that target heart rate, we see if they are able to tolerate it and if the ECG result is devoid of any anomalies. If there is a red flag in any of these aspects, further medical intervention is required and the person should not opt for high-intensity workouts.”
Doing this test helps provide the details about blood flow and the structure and function of the heart.
In some cases, high-intensity workouts could also lead to thickening of the heart muscles. “With echo, we can find out if there is any structural problem like valvular heart disease or any drastic thinning of the heart, which can cause hypertrophic cardiomyopathy,” says Dr Marla.
Check your family history
Genetics plays a significant role in determining your cardiac health and also the intensity of some of the main risk factors like high cholesterol levels.
Experts say it is essential that these factors are taken into consideration before middle-aged people (those inching towards 40) decide to intensify their workout routines. “Before going to the gym, one must check their family history, whether anyone had a cardiac death or a heart attack,” says Dr Bose.
Regular cardiac screening
“Routine check-ups after the age of 35, especially for people with an already existing family history of heart disease or diabetes, are very important,” says Dr Rana Sarabjit Singh, consultant, cardiology, Manipal Hospital, Kolkata.
Dr Sanjay Bhat, senior consultant, interventional cardiology, Aster CMI, Bengaluru, adds that chances of sudden cardiac arrests could be minimised through regular cardiac evaluation, ECG, echo and stress tests, and more advanced tests like Holter, cardiac CT and MRI whenever needed. Periodic hypertension examination and blood glucose tests are also suggested for middle-aged people, especially for those already diagnosed with lifestyle risk factors like cholesterol.
How gym trainers can assist their clients
Walk-the-talk test: This is a practical test often adopted by expert gym trainers to ascertain the cardiac status of their clients. “When the client is running or walking on the treadmill or doing some exercise, we talk to them,” says Kumar. “If they respond without breathing too hard, then their heart condition is okay.” It is a sign that the intensity of the workout can be stepped up to the next level.
Kumar explains that a trainer should ensure that they know the client’s breathing capacity while at rest, so they can measure it against their heart rate and breathing rate while they are working out. This way the trainer can know if the client is overexerting.
Dr Marla suggests that gym trainers undergo cardiopulmonary resuscitation (CPR) training. They should also undergo basic life-support training and be able to give cardiac massages and use a defibrillator.
Gyms should also be equipped with all emergency essentials so, say, small cardiac events can be handled.
It is important to get basic screening tests done before you hit the gym. First, it is important to check if there is any family history of heart attack or cardiac arrest. Second, a full check-up along with tests like echocardiogram and ECG must be done. This can be followed by a treadmill test. Even middle-aged people without a family history of heart conditions should get these tests done before taking up intense workout routines.