Anyone with heart disease or
risk factors for developing heart disease or stroke should seek medical
advice before beginning a workout program. Patients with heart disease
can nearly always exercise safely as long as they are evaluated
beforehand. Some will need to begin their workout under medical
supervision. Still, it is often difficult for a doctor to predict health
problems that might arise as the result of an exercise program. At-risk
individuals should be very aware of any symptoms warning of harmful
complications while they exercise.
Some
believe that anyone over 40 years old, whether or not they are at risk
for heart disease, should have a complete physical examination before
starting or intensifying an exercise program. Some doctors use a
questionnaire for people over 40 to help determine whether they require
such an examination. The questions they use are as follows:
- Has any doctor previously recommended medically supervised activity because of a heart condition?
- Does physical activity bring on chest pain?
- Has chest pain occurred during the previous month?
- Does the person faint or fall over from dizziness?
- Does bone or joint pain intensify during or after exercise?
- Has medication been prescribed for hypertension (high blood pressure) or heart problems?
- Is the person aware of, or has a doctor suggested, any physical reason for not exercising without medical supervision?
Those
who answer "yes" to any of the above questions should have a complete
medical examination before developing an exercise program.
Some people should get a full evaluation and a stress test.
Stress Test.
A stress test helps determine the risk for a heart problem resulting
from exercise. Anyone with a heart condition or history of heart disease
should have a stress test before starting an exercise program. Some
health care professionals also recommend this test before a vigorous
exercise program for older persons who are sedentary, even in the
absence of known or suspected heart disease. The test is expensive,
however. Many physicians believe that it may not be necessary for older
people who start low intensity exercise such as walking, and have no
evident health problems or risk factors.
Heart Attack and Sudden Death from Strenuous Exercise
A small percentage of heart attacks occur after heavy physical work.
High-Risk Individuals. In general, the following people should avoid intense exercise or start it only with careful monitoring:
- People who have certain medical conditions: These conditions include uncontrolled diabetes, uncontrolled seizures, uncontrolled high blood pressure, a heart attack within the previous 6 months, heart failure, unstable angina, significant aortic valve disease, or aortic aneurysm.
- People with moderate-to-severe hypertension: Moderate or severe high blood pressure (systolic blood pressure over 160 mm Hg or diastolic (lower number) pressure over 100 mm Hg) should be brought to lower levels before a person starts a vigorous exercise program.
- Sedentary people should be cautious.
- Episodes of exercise-related sudden death in young people are rare but of great concern. Some are preceded by fainting, which is due to a sudden and severe drop in blood pressure. It should be noted that fainting is relatively common in athletes, and is dangerous only in people with existing heart conditions. Young people with genetic or congenital (present at birth) heart disorders should avoid intensive competitive sports.
- Anabolic steroids or products containing ephedra have been associated with cases of stroke, heart attack, and even death.
The
risk for heart attack from exercise should be kept in perspective,
however. Some form of exercise, carefully personalized, has benefits for
most of the individuals mentioned above. In many cases, particularly
when the only risk factors are a sedentary lifestyle and older age,
exercise can often be increased over time until it is intense.
Hazardous Activities for High-Risk Individuals. The following activities may pose particular dangers for high-risk individuals:
- Intense workouts may be particularly hazardous for people with risk factors for heart disease, especially older people. Examples of intense workouts include snow shoveling, running, race walking, tennis, heavy lifting, heavy gardening. These workouts tend to stress the heart, raise blood pressure for a brief period, and may cause spasms in the arteries leading to the heart. (See image: Coronary Artery Spasm)
- Some studies suggest that competitive sports, which couple intense activity with aggressive emotions, are more likely to trigger a heart attack than other forms of exercise.
Listening for Warning Signs.
It should be noted that according to one study, at least 40% of young
men who die suddenly during a workout have previously experienced, and
ignored, warning signs of heart disease. In addition to avoiding risky
activities, the best preventive tactic is simply to listen to the body
and seek medical help at the first sign of symptoms during or following
exercise. These symptoms include the following:
- Irregular heartbeat
- Shortness of breath
- Chest pain
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