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Physical activity plays a crucial role in preventing cardiovascular disease and reducing cardiovascular risk factors, including diabetes and hypertension; it helps maintain a healthy weight and balance blood lipid profiles and supports mental health. According to World Health Organization guidelines, it is important to engage in light-to-moderate-intensity aerobic activity (e.g., brisk walking) for at least 150 minutes per week, or high-intensity aerobic activity (e.g., running) for at least 75 minutes per week, and that any additional activity further reduces morbidity.
However, when physical activity is not adjusted and performed at very high intensity, it may increase the risk of cardiac events, especially among people aged 35 and older who are not regularly active because of having undiagnosed atherosclerotic disease. Atherosclerosis is a systemic disease that can affect arteries throughout the body, including the heart’s arteries (coronary arteries), leading to the gradual narrowing of vessels and reduced blood flow. This condition is often silent, and it is not accompanied by symptoms in its early stages; signs may appear only when the narrowing of the blood vessels becomes very severe, and in some cases, the first presentation can be an acute cardiac event.
Risk factors for atherosclerosis include elevated blood lipid levels, smoking, being overweight, high blood pressure, and diabetes.
During strenuous exercise, there is a significant increase in the heart muscle's demand for oxygenated blood. When the coronary arteries are normal, increased flow can meet demand, but when there is stenosis, a mismatch between oxygen demand and supply occurs. This condition is called ischemia, and it is life-threatening and requires immediate treatment by coronary catheterization to restore the blood supply. If blood flow is not restored, the sequelae is acute myocardial infarction.
Many people in their forties decide to adopt an active, athletic lifestyle, join running or cycling groups, and start participating in recreational high-intensity sports, including popular competitions. Some of these individuals have built up risk factors over years of inactivity due to uncontrolled eating, smoking, and sometimes a family history of heart disease and high blood lipid levels, which they are unaware of. Paradoxically, it is precisely these people who are at high risk of cardiac events during strenuous activity. Importantly, their risk can be significantly lowered through pre-participation cardiac screening.
Dr. Shirit Kazum-Beizer is a cardiologist and sports physician, Head of the Sports Cardiology Service.
According to the European 2020 sports cardiology guidelines and the position paper of the Sports Cardiology Forum of the Israeli Heart Society published in 2022, pre-participation cardiac screening is recommended for people aged 35 and older who are interested in starting high or very high-intensity physical activity and who have one of the following:
In addition, it is recommended that people aged 65 and over who engage in strenuous physical activity undergo annual screening tests.
In such a case, it is necessary to expand the investigation with more advanced tests, such as stress echocardiography, cardiac CT, or cardiac perfusion mapping.
If the advanced test suggests ischemia, treatment is usually necessary with coronary catheterization to restore the blood supply.
After treatment for ischemia, physical activity can be initiated gradually and safely.
In conclusion, physical activity should be an integral part of our daily routine, and not every walk in the park or a jog on the beach requires a medical evaluation. However, for individuals involved in high-intensity sports, it is important to ensure periodic cardiac evaluation to allow safe activity and a peaceful heart.
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