Gym, Running or Competitive Sports? When Should Young Adults Get Their Heart Check?

Gym-goers, runners and young athletes may wonder when a heart check is necessary. Learn about warning signs, risk factors and situations where medical evaluation may be important before intense exercise.

When we think about heart disease, we usually think of someone older. A young person running on a football field, lifting weights at the gym or training for a marathon hardly seems like someone who needs to worry about their heart.

However, as a cardiologist, I would say this: being young and physically active does not automatically mean your heart needs no attention.

The good news is that regular exercise is one of the best things we can do for our cardiovascular health. The question is not whether young adults should exercise, but whether there are situations where the heart should be checked before pushing the body harder.

For most healthy young adults without symptoms or significant risk factors, a routine battery of cardiac tests is not necessarily required before starting recreational exercise. What matters first is understanding your personal and family history and paying attention to what your body is telling you.

Certain symptoms should never be ignored. Chest pain or pressure during exercise which is mistaken very often for 'acidity' or heart burn or indigestion or 'gas', unexplained breathlessness that is disproportionate to the level of activity, fainting or near-fainting, unexplained dizziness, or episodes of racing or irregular heartbeat during exercise deserve medical evaluation. A family history of sudden cardiac death, unexplained death at a young age, inherited heart conditions or significant rhythm disorders is another reason to speak to a cardiologist before undertaking intense training.

This becomes particularly important for those involved in competitive sports. High-intensity exercise places greater demands on the heart, and in a small number of individuals, previously undiagnosed cardiac conditions can become apparent during strenuous activity. Current sports-cardiology guidance supports a careful pre-participation assessment, with further tests such as an ECG or echocardiogram considered when the history or examination raises concern.

I also often tell young people not to self-diagnose based on their fitness tracker or smartwatch. A high heart rate during an intense workout can be normal, while symptoms such as fainting or chest discomfort should not simply be dismissed as being “out of shape.”

A heart check does not necessarily mean a long list of expensive investigations. Sometimes a detailed conversation, examination and a simple ECG are enough; in other situations, tests such as an echocardiogram, Holter monitoring or exercise testing may be appropriate depending on the individual's symptoms and risk profile. Athlete evaluation should be tailored rather than based on a one-size-fits-all approach.

The message is simple: exercise is medicine, but listen to your heart. If you are young, active and symptom-free, do not be afraid of exercise. However, if your body is giving you warning signals—or if there is a significant family history—do not ignore them simply because you are young.

In addition, maintaining a healthy lifestyle, avoiding smoking and alcohol, sleeping adequately and eating right are very important. I have 30-35 year olds who somehow falsely believe that workouts will take away the sins of an otherwise unhealthy lifestyle!

A fitness goal is important. Getting there safely is even more important.

-This article is authored by Dr. Jyoti Kusnur, Consultant – Interventional Cardiology, Manipal Hospital, Goa