Doctor Tells Me to Exercise: But Is It Safe?

By Dr. Rajiv Agarwal in Cardiac Sciences

Dec 13 , 2023 | 4 min read

Whenever a celebrity suffers a heart attack or dies during exercise, there is a wave of panic among young people. It is well known that heart disease is the number one killer in India today. Heart attack rates are steadily increasing along with increasing numbers of overweight and obese people, high blood pressure and diabetes, and smoking.

Sudden deaths are also not uncommon. They often happen to older people who are already sick, but they do occur in young or middle-aged people with no known health issues and sometimes even during or after exercise. These cases get huge publicity and lead to a fear factor.

Yet doctors say that Indians don’t exercise enough, leading to more and more heart disease and should immediately get moving. Is it safe for a physically inactive office executive to start going to the gym or taking up tennis? What about the weekend warriors with 14-hour work days who want to make up for intense jogging or squash on the weekend? Or simply the businessman who wants to do garba night all through Navratri but is stuck to his chair.

The benefits of exercise for preventing high BP, diabetes and heart disease and prolonging health and lifespan are well documented in medical literature. On average, those who do regular exercise and also those who are physically fit (similar but not the same thing) have longer lifespans and health spans. In two large studies, this led to a 7-8 year extension of the lifespan. The benefits of exercise on blood pressure, blood sugar, serum cholesterol and weight are also well documented and may contribute to the protective effect on the heart.

How Much Exercise?

Any exercise is good, but 30-45 minutes of moderate exercise at least five days a week is optimum. For those pressed for time, even 15 minutes of high-intensity workout 3 times a week may be sufficient. So, workaholics can be weekend warriors but do start slow and build up gradually to avoid injuring yourself.

What Exercise?

Any exercise is good; just get moving. A brisk walk, jogging, cycling, playing a sport or formal gym exercise are all good. Maximum benefit is provided by movement type of exercise, what we call isotonic medically and “cardio” in the gym. There should also be some focus on weights and resistance training, but getting an Instagram-worthy muscular body with lots of protein supplements and weights is not the goal for heart health.

Is There Any Harm with Exercise?

New advice suggests that people with heart conditions and those who do not exercise regularly may be at risk of cardiovascular events when participating in intense exercise, especially when quickly starting it. This means that those who are known to have heart disease or multiple risk factors like diabetes, hypertension and smoking should start exercising slowly and cautiously; a medical checkup may be done before starting exercise in those with known heart disease. It is important not to create a fear psychosis which will prevent people from starting to exercise because middle-aged inactive people with risk factors are precisely the

Ones Who Will Get the Maximum Benefit from Exercise

Start slow and build it up gradually, exercise properly with warm-up and cool-down phases, and above all, exercise regularly and listen to your body. The definition of moderate exercise depends on age and fitness levels. A mild walk may be enough for the grandfather, but the youngster may need to jog. Your breathing will tell you surely enough, but for the data-minded with a smartwatch, you may go up to 60-70% of your target heart rate, which usually means about 120-130 beats per minute on the pulse monitor.

Are Professional/Competitive Athletes at Risk of Heart Attack?

Athletes are some of the fittest people on the planet. They even have lower rates of heart attack than the general public. But this benefit can be lost soon if they stop exercising. Also, it is a fact that they are at higher risk of heart attack and sudden death soon after vigorous exercise like a marathon or a steeple chase. This may explain why the Greek runner who ran from Marathon to Athens collapsed soon after delivering his news but gave the name to the most famous race of our times. In modern times, there are examples of sudden death in runners and athletes after a race. This is not as common as you might think, but it does get wide adverse publicity.

While some sudden deaths on the playing field may be heart attacks, most are not. They may be instead due to abnormal heartbeat, also known as arrhythmia. This may be due to abnormal heart structure, including thick heart muscles, also known as hypertrophic cardiomyopathy. Such abnormalities may be detected by echocardiography. In fact, hypertrophic cardiomyopathy is often cited as the most common cause of sudden death in young athletes; in many cases, even the echo is entirely normal in teenagers but may show abnormal heart muscle later in life. Many other issues may be simply due to arrhythmia with a normal heart structure. Athletes and cyclists also have a higher incidence of calcium deposits in the coronary arteries supplying the heart, especially in older age.

What to Do for Athletes?

These events of sudden death and heart attack in athletes are fortunately very rare. Be alert to a history of sudden death in the family. Ensure adequate rest, hydration, and comfortable environmental conditions before and during the race. Medical resuscitation equipment has become mandatory in competitive sports events.

For the average person, the more exercise you do, the better for you. It will make you fitter, healthier, and live longer. You will lose weight and even look and feel smarter and younger. Even those with heart disease need fewer medicines and respond better to heart treatment and even operations if they have been exercising.

I hope this clears up some doubts.