Exercise and the Heart
Exercise has numerous positive effects on the heart. With regular physical activity, the heart’s resting stroke volume increases significantly. As a result, the heart can pump more blood with each beat while working more slowly. Regular exercise improves blood circulation to the heart, lungs, brain, and muscles. Consequently, high blood pressure normalizes, and the risk of heart disease, heart attack, and stroke decreases. Metabolically, insulin resistance is reduced, and the risk of diabetes, overweight, and obesity declines. Levels of “bad” cholesterol (LDL) decrease, while “good” cholesterol (HDL) increases. In parallel, the amount of endorphins rises, allowing individuals to feel more energetic and refreshed, look healthier, and experience better sleep.
The type of exercise determines the type of load placed on the heart. Endurance sports such as running, cycling, and swimming result in a volume load on the heart by reducing or not changing peripheral vascular resistance. Strength sports such as weightlifting, shot put, and discus throwing increase peripheral vascular resistance and thus cause a pressure load on the heart. These are normal physiological responses to exercise. In an unhealthy heart, however, the heart wall may thicken, the internal chamber size may shrink, or sudden cardiac death may occur due to other underlying causes.
During sports activities, increased stress, sympathetic stimulation, elevated blood pressure, inadequate coronary perfusion relative to heightened cardiac demand, and the development of exercise-triggered arrhythmias can lead to sudden cardiac death. In young athletes, the annual risk of sudden death is approximately 1–3 per 100,000. Hypertrophic cardiomyopathy, coronary artery disease, myocarditis, various arrhythmias, and aortic stenosis further increase this risk.
Hypertrophic cardiomyopathy, a pathological form of heart enlargement, is the most common cause of cardiac sudden death in athletes under the age of 35. It is a genetic disorder with a prevalence of 0.2%. All first-degree relatives (parents and siblings) of an affected individual should be screened for the presence and severity of the disease. In individuals over 35, the most common cause of sudden cardiac death is coronary artery disease (blockage in the heart vessels).
In Turkey, considering local conditions, young adults—especially those engaging in competitive sports—should undergo detailed history-taking and physical examination as part of cardiac assessment. Electrocardiography (ECG) should be evaluated by a cardiologist. Exercise testing is recommended for athletes over the age of 35. Echocardiography is highly valuable for diagnosing and monitoring structural heart conditions such as hypertrophic cardiomyopathy and aortic stenosis. When serious cardiovascular disease is still suspected, patients should be referred to specialized centers for further investigations such as coronary angiography or cardiac electrophysiological study.
Precautions During Exercise
Individuals with a sedentary lifestyle who wish to begin intense exercise should consult a physician, undergo evaluation, and have risk factors managed beforehand. Those who smoke should avoid heavy exercise entirely. Physical activity should not begin until at least 2–3 hours after eating; early morning hours, extreme heat, cold, or humidity should be avoided. Monitoring heart rate during exercise is very important.
Target Heart Rate: 50% of the number obtained by subtracting age from 220.
Exercise should be performed at least three times per week, preferably daily. For heart health, a minimum of 30 minutes of brisk walking on flat terrain outdoors is ideal. If symptoms such as chest discomfort, unusual shortness of breath, palpitations, or dizziness occur during exercise, activity should be stopped immediately and medical evaluation sought.
Hydration and electrolyte balance must be maintained with adequate water and, if necessary, mineral-containing beverages. Cold-water exposure—such as swimming in cold water or taking a cold shower—should be avoided. Excessively hot or cold showers and saunas should also be avoided after exercise.
Exercises that activate skeletal muscles and involve rhythmic movement are beneficial for heart health. The key is consistent, regular, and appropriately paced activity suited to one’s age and physical condition.
If you are unable to monitor your heart rate during exercise, being able to comfortably carry out a conversation with a companion is another indicator that the exercise intensity is appropriate. If you cannot speak comfortably, you should slow down.
Cardiac patients should also engage in exercise. In individuals with heart failure, prior myocardial infarction, or those who have undergone bypass surgery, regular exercise has been shown to improve long-term cardiac performance, provide additional benefits beyond medication, and accelerate clinical recovery.
