The death of a 38-year-old Uttarakhand Special Operations Group (SOG) officer during a gym workout has once again revived an unsettling question: Why do apparently healthy, fit people collapse while exercising?
“Incidents like these are reminders that fitness and heart health are not always the same thing. The question is not whether Indians should exercise — they absolutely should. The question is whether they know how to exercise safely and wisely. It is about whether they know how to prepare their bodies for exercise, recognise warning signs and understand that fitness is built gradually, not forced suddenly. Most importantly, do they know about their underlying heart condition which a bout of exercise might just exacerbate,” says Dr Ranjan Shetty, lead cardiologist and medical director at Sparsh Hospital, Bengaluru, who has seen many gym-related cardiac arrests and heart attacks among stressed professionals. He speaks to The Indian Express about what we most overlook.
Why we must identify hidden heart problems
Exercise itself rarely creates the disease. Rather, it exposes a condition that has remained hidden. A sudden cardiac arrest is an abrupt failure of the heart’s electrical system. The heart stops pumping blood effectively and, unless help arrives within minutes, death can follow. A heart attack, by contrast, occurs when blood supply to a part of the heart muscle is blocked. One can lead to the other, but they are not the same event.
Sudden cardiac arrests are often linked to inherited disorders of the heart muscle or abnormalities in the heart’s electrical circuitry. These conditions can remain silent for years, producing no symptoms until they are triggered by intense exertion. Among those over 35 or 40 years, the more common culprit is coronary artery disease — narrowing of the blood vessels supplying the heart.
High blood pressure, diabetes, obesity, smoking and chronic stress have become common companions of urban life, all of which are risk factors in people who otherwise appear healthy. Severe dehydration can interfere with heart rhythms, leading to irregularities and stoppage of heartbeats. Dehydration depletes vital minerals like potassium and magnesium, electrolytes which govern the heart’s electrical system. A deficiency can trigger severe rhythm disorder and a cardiac arrest.
Why we should not go from zero to 100
If there is one mistake Indians make while embracing fitness culture, it is confusing enthusiasm with preparedness. A person who has been sedentary for years walks into a gym and immediately signs up for high-intensity interval training, heavy weightlifting or marathon preparation. Trainers promise transformations in 90 days. Social media celebrates extremes. The body, however, operates on a slower timetable.
The heart is a muscle that adapts gradually. It responds to regular training, not sudden torture. Research consistently shows that the risk of sudden cardiac events is highest among people who are habitually inactive and then subject themselves to vigorous, unaccustomed exercise.
The paradox is that regular exercise lowers the risk of sudden cardiac death dramatically over the long term. But sporadic bouts of intense exercise in an untrained individual can increase the risk. Start slowly. Increase duration before increasing intensity.
Why you must do a full body check-up and endurance test before joining a gym
A family history of sudden death, especially before the age of 50, deserves attention. So do episodes of unexplained fainting, chest discomfort, breathlessness out of proportion to effort or palpitations associated with dizziness. Hypertension, diabetes, obesity and smoking are risk factors that should shape how one begins exercising.
People above 40 years, or younger individuals with significant risk factors, may benefit from a medical assessment that includes blood pressure measurement, cholesterol and blood sugar tests and, where indicated, an electrocardiogram or exercise stress test. The purpose is not to frighten people away from exercise. Quite the opposite. It is to ensure that exercise becomes safer and more sustainable.
What are warning signs nobody should ignore
Chest pain or pressure during exercise should never be dismissed as muscular soreness. Breathlessness that seems disproportionate to the effort, palpitations accompanied by dizziness, episodes of blacking out or severe unexplained fatigue after exercise are warning signs that demand medical attention.
Young age offers no immunity. Nor does a muscular physique.
We increasingly encounter patients in their thirties with advanced coronary artery disease, uncontrolled hypertension or structural heart abnormalities that had gone undiagnosed for years.
Why you must seek clinical advice on supplements
No discussion of gym safety is complete without acknowledging the growing culture of performance enhancement. Many commercially available supplements contain large quantities of caffeine and other stimulants that can elevate heart rate and blood pressure. More worrying is the covert use of anabolic steroids. They may produce dramatic gains in muscle mass, but they come at a cost. They can enlarge the heart, worsen cholesterol levels, elevate blood pressure and increase the risk of dangerous arrhythmias. Some studies have linked long-term anabolic steroid use with scarring of the heart muscle and premature cardiovascular disease.
What’s a checklist before choosing a gym?
Few people inquire whether their gym has staff trained in cardiopulmonary resuscitation (CPR); it’s a life saver. Fewer still ask whether there is an automated external defibrillator (AED) on the premises. Immediate CPR and rapid defibrillation can double or even triple survival rates in case of a sudden cardiac event. While fitness centres market transformation, they must also be prepared for emergencies. For most Indians, the greatest threat to the heart is not the workout. It is the belief that health can be postponed until tomorrow.
The paradox is that regular exercise lowers the risk of sudden cardiac death dramatically over the long term. (Source: Pexels/ Representational) 
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