Many of us would like to get back into shape by taking on an endurance challenge, such as a 5k run. But should we get our hearts checked first? One of our world-leading cardiologists provides advice.

Benefits and risks of running

There are many health benefits to regular physical activity and running endurance events (even as long as a marathon) are overwhelmingly safe for the vast majority that take part each year.

However, with an increasing number of research studies suggesting that some heart problems may arise during training for an endurance event and after completing it, you might feel a little worried about taking part in one yourself.

Sudden cardiac arrest which can occur during long-distance running and be fatal, is a condition where the heart suddenly and unexpectantly stops beating. It is a well characterised problem for young athletes, as for them, the main cause is a condition called hypertrophic cardiomyopathy.

This condition occurs when the heart muscle thickens over time, making it harder for the heart to pump blood around the body. It is normally inherited (occurs in families), so it can be captured whilst young, but athletes who don’t have the disorder in their families can get their hearts screened just in case.

Atrial fibrillation, a type of heart rhythm disorder, has also recently been found to be more common in athletes. This condition causes the heart to beat too fast or too slow and can result in heart failure and strokes if not controlled.

The study by the British Journal of Sports Medicine found that athletes are 2.5 times more likely to have atrial fibrillation than non-athletes and this risk is higher in younger athletes under 55 years of age.

In Italy, the only country in the world where it is mandatory to screen all young athletes between 12 and 35 for silent heart conditions, they have managed to reduce deaths by 89%.

For non-athletes, sudden cardiac arrest can still occur during a marathon, but it is mostly in those who have underlying coronary heart disease, which usually occurs in men over 40. However, it can be caused by other heart conditions and occur in women too.

Does training help protect my heart?

Anyone wishing to take part in an endurance event is advised to train well to protect themselves from injury. However, research has shown that training may not necessarily protect you from a sudden cardiac arrest during a marathon.

This is most likely because training programmes don’t put your body under the same sort of stress as you would experience on the race itself, where you would typically run for longer. The stress on the body during running a marathon can increase the risk of blood clots in the heart and longer races are generally associated with a higher risk of sudden cardiac arrest, but it can occur even in shorter races.

Should I get my heart checked before a race?

“The answer depends on the age and level of activity of the person. For anyone over 35, a clinical history, physical examination and an ECG would be appropriate. Although an ECG has its limitations, it may help capture some silent heart conditions. It also provides an opportunity for a doctor to assess their physical condition and give advice on training before embarking on an endurance challenge,” explains Professor Mark Mason, consultant cardiologist and medical director for Royal Brompton and Harefield hospitals.

“For anyone under 35, screening would not be appropriate unless they are at risk of a heart condition, such as if they have a family history, or are experiencing signs and symptoms of one. However, if they are under 35 and an athlete regularly taking part in vigorous sporting activities, they may benefit from an intensive heart screening to rule out a silent heart condition.

“Overall, regular exercise is beneficial and should be encouraged. As doctors, we can help advise our patients on the most appropriate level of exercise that is safe for them and participation in any endurance event, whatever its distance, should be considered with care.”

If you would like to get your heart checked before training for a race, take a look at our sports cardiology service to see how we can help you, or contact our customer services team.