Most of us rightly believe that exercise is good for our health as it helps in building a strong body, mind and heart. However, our beliefs are at times rudely interrupted by some flash news of apparently young athletic celebrities dying suddenly during or after exercise. Listed here are factors that may be responsible for sudden deaths due to exercise.

Exercise is truly a paradox.  It is so essential for good health and yet at times, it may lead to sudden death. It is essential to comprehend the factors responsible for mortality associated with exercise. 

1. People who otherwise live a sedentary lifestyle, have a high risk of death if they take part in unaccustomed vigorous physical activity. If they need to do so, they must gradually and steadily build up their stamina over a prolonged period of time preferably under professional guidance. 
2. Some people have a family history of sudden deaths or they themselves have survived such events. These patients must get themselves thoroughly checked up before taking up an exercise regimen. Hypertrophic cardiomyopathy or coronary artery disease must be ruled out along with a few other ailments in such patients. 
3. Many subjects have mild atherosclerotic plaques. These plaques are non-occlusive and do not cause symptoms unless they rupture. When they do so, they may cause very high mortality events such as acute coronary syndrome. It has been observed that such mildly occlusive coronary plaques require some exacerbating event such as vigorous physical activity to induce coronary thrombosis. This could well be one reason that exercise-induced sudden death has been observed in asymptomatic young individuals.
4. By various surrogate as well direct estimates, it has been observed that a substantial Indian population has been infected with COVID-19 infection. Many such infections had been asymptomatic. However, a German study has shown that even in mildly symptomatic patients, during recovery from COVID-19 infection, active inflammation may be persisting in the heart tissue. Vigorous exercise during active Myocardial inflammation can precipitate fatal arrhythmia. It could be hypothesised that an asymptomatic COVID-19 convalescent patient may have fatal arrhythmias on exercise if healing has not been complete.
5. Health supplements and exercise- Despite repeated warnings by health authorities, health supplements are in vogue for muscle building and exercise performance. Many such supplements contain banned substances and are potentially toxic to the heart and other body organs. Extreme discretion is needed and one must remember that there is no substitute for a good traditional balanced diet.
6. Thirst and overhydration- It is important to keep yourself optimally hydrated during exercise. Dehydration is not good especially in summers, however, overhydration could also lead to dangerous consequences and it needs to be avoided.
7. Winters and exercise- Heart attacks are more in cold winter months, Mondays and early mornings. Winter months see high heart attack admissions and many such attacks are triggered by unaccustomed exercise. Consumptions of rich dense caloric snacks, excessive liquor intake and a reflex increase in normal blood pressure during winters are some of the causes of more heart attacks particularly after exercise. It is prudent to avoid at least morning exercise during these months or to do so with full woollen protection.
8. An excessive unaccustomed burst of physical activity may lead to cardiac fatigue. This may cause abnormal cardiac haemodynamics leading to sudden death. The key to preventing this entity is gradual learning and prolonged intermittent rests in between the exercise regimens. The temptation to quickly get the desired body image may force an individual to overstretch his or her capacity to exercise.

The probability of dying suddenly increases sharply with vigorous exercise, this is true especially in those who do not exercise regularly. The key to prevention is measured and systematic training. In an era where physical looks and eternal youth are the coveted style statements and preferred priorities, one must remember that there is no shortcut and abridged edition to the perfect body.

To summarise, the link between exercise and sudden death is real and respect for nature’s method of body improvement must be adhered to. Gradual and physiological bodybuilding should be the chosen way to achieve the sought after success. It is important to allow healing to be complete especially in infections such as COVID-19. A physician’s clearance is a must before initiating enrollment in an exercise program. 

Disclaimer- The views and opinions expressed in this article are those of the author's and do not necessarily reflect the official policy or position of M3 India.
The author, Dr. Arun Kochar is a Senior Interventional Cardiologist practising in Mohali.