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Do You Need a Heart Check-Up Before Starting An Exercise Program?

three people running together

New year, new you. Maybe that first step toward your ideal self is to start exercising. If so, you should see your doctor before you hit the gym, right?

Maybe, says Neel Chokshi, MD, MBA, medical director of Penn Sports Cardiology and Fitness Program and assistant professor of clinical medicine.

Most people are familiar with the warning to talk to your doctor about your heart health before starting any exercise regimen. But this guideline might be replaced soon with a clearer explanation—one that doesn’t delay your starting an exercise program if you’re healthy.

This doesn’t mean that these heart check-ups aren’t important for some people, though. 

Questions and answers

To make things clearer, here are a few questions and answers with Dr. Chokshi about who needs a heart check-up before starting an exercise program.

Q: Why should people have a heart check-up before beginning an exercise program?

Dr. Chokshi: The traditional recommendation was that everyone should consult with their doctor before they started to exercise.

The reason behind this is that, in theory, when you start to participate in a moderate or intense activity, there is a slightly increased risk of a heart attack or cardiac complications.

So the heart check-up would be to make sure a person doesn’t have an underlying heart condition that they may not be aware of—or that they don’t undertake a regimen that’s too intense, if they are normally pretty sedentary.

But these guidelines are changing. As a medical community, we’ve realized that recommending everybody see a doctor first before starting to exercise can actually create an obstacle that keeps people from exercising.

So the American College of Sports Medicine has revised its guidelines. The goal is to balance ensuring patient safety with overcoming any obstacle to exercise. So they’ve changed the guidelines to reflect that.

Q: What are the new guidelines as far as who should have a heart check-up before starting an exercise program?

Dr. Chokshi: The new guidelines are that you ask yourself three basic questions before you start to exercise.

Question number one is: are you normally not very active? If your baseline activity level is pretty sedentary, you might want to see a doctor before you start a regular exercise program.

The next question is: do you have signs of heart problems? Or do you have other health conditions that might predispose you to having heart problems? For instance, diabetes, kidney disease and lung disease are all conditions that can predispose you to heart issues.

The final question is: what’s the activity you want to participate in? Is it high intensity, like running? If you’re looking at a high-intensity exercise program, you might want to see a physician first. That’s especially true if you’re not normally very active.

If you answer “yes” to any of these questions, you should definitely consider having a heart check-up first. You might be at a slightly higher risk of having a cardiac event during exercise.

Protect your heart during exercise

Q: What should patients know about the risk of a heart attack or other cardiac issues during exercise?

Dr. Chokshi: The overall rate of having a heart attack or cardiac event during exercise is really very low.

That being said, you should always start slowly. Don’t build up too fast on your intensity, distance, length of time, et cetera. You might want to consider doing a supervised exercise program with certified trainer who can help you build up your activity level correctly.

If you don’t have signs or symptoms of any problems, but you’re still wondering about your heart, have a conversation with your doctor. She can help you figure out if you can benefit from any heart-related testing before you start your exercise program.

About this Blog

The Penn Heart and Vascular blog provides the latest information on heart disease prevention, nutrition and breakthroughs in cardiovascular care.

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