Experts point out that during exercise, blood pressure rises and heart rate accelerates, which can easily lead to the tearing of an aortic dissection. The mortality rate for a ruptured aortic dissection is as high as 80%.
Even if young people have underlying structural or functional abnormalities in the heart, these conditions are often concealed and can easily result in sudden death when subjected to continuous strong stimuli.
On November 18, the news of a 21-year-old university student dying from sudden cardiac arrest during a marathon was heartbreaking. Why would a “sport-loving, physically capable” young person lose their life to exercise? At the same time, a number of universities including Peking University and Beijing Normal University have cancelled long-distance running events... Exercise itself should promote health, so why does it harm those who love it? In the cold winter weather, how can one stay safe while exercising?
Exercise-induced sudden death is a type of sports-related medical condition
“Cases of fatal sudden death like the marathon death of a university student in Guangzhou often occur during competitive situations such as basketball, football, or marathons,” said Professor Cao Jianmin from the Department of Exercise Biochemistry at the Beijing Sport University. “These are especially likely to happen among individuals who usually lack long-term, standardized professional sports training and suddenly participate in competitions. Young people generally have better physical functions, and even if they have potential structural or functional heart abnormalities, these are more easily concealed under normal circumstances, showing no typical symptoms, so neither the patients nor their families are aware. When subjected to continuous strong stimuli, sudden death can occur. Additionally, young people may not be as mentally mature, so they might not properly gauge or actively adjust their physical state during exercise. They could become overly excited or competitive due to encouragement, pushing beyond their limits. Also, if they do not pay attention to regular hydration or maintaining body warmth during exercise, or fail to take appropriate breaks to allow recovery, it can easily lead to body temperature rising to unbearable levels and result in sudden death. Sudden death is often caused by the combination of multiple factors.”
“This is exercise-induced sudden death. It is a type of sports-related medical condition, referring to the onset of symptoms during or immediately after exercise, leading to non-traumatic death. Exercise-induced sudden death is not simply due to overexertion, but rather results from various factors that impair the three vital signs of respiration, heartbeat, and consciousness during exercise. Most cases of exercise-induced sudden death are due to cardiopulmonary issues, with cardiac-related sudden death being the most common manifestation. Examples include myocarditis, congenital coronary artery anomalies, and cardiac hypertrophy,” said Wang Liming, a lecturer in the Physical Training Teaching and Research Section of the Exercise Rehabilitation Department at the Beijing Sport University and a doctor of sports medicine.
Taking your “heart” lightly can also be fatal
In daily life, people use the term “heartbroken” to describe sadness, but exercise can actually “break your heart” too.
“During exercise, by reducing parasympathetic nerve tension and increasing sympathetic nerve tension, exercise hormones rise, stimulating a faster heartbeat, altering atrioventricular conduction, increasing myocardial oxygen consumption, shortening the diastolic phase of the heart, and reducing the time for blood flow into the coronary arteries. If there are potential or obvious heart problems, this can lead to serious consequences such as ischemia or sudden death,” said Cao Jianmin. Without structural heart abnormalities, high-intensity exercise generally only causes benign arrhythmias such as premature beats, rather than fatal arrhythmias leading to sudden death.
For young people, potential heart conditions are mostly structural issues, such as hypertrophic cardiomyopathy, congenital coronary artery anomalies, idiopathic left ventricular hypertrophy, or even aortic rupture, arrhythmogenic right ventricular cardiomyopathy, aortic valve stenosis, and coronary heart disease. Among older athletes and general exercisers over the age of 35, coronary heart disease is the most common cause of SCD (sudden cardiac death).
■ Doctor’s Warning: Sudden Death Is Often Caused by Aortic Dissection
● Hu Tao Hong, Director of the Cardiology Department at the PLA Second Artillery General Hospital
Such acute, sudden deaths during exercise are, in the vast majority of cases, caused by aortic dissection. Because during exercise, blood pressure rises and heart rate accelerates, which can easily lead to the tearing of an aortic dissection — and it is often fatal. Aortic dissection is a dangerous acute condition, and even with timely and aggressive treatment, it can still quickly lead to death. If the aortic dissection completely ruptures, it will cause rapid and massive blood loss, leading to circulatory failure and immediate death. The mortality rate for a ruptured aortic dissection is 80%. As many as 50% of patients die before even reaching the hospital. Therefore, if an aortic dissection reaches 6 cm, the patient must undergo emergency surgery.
Clinically, we also encounter some young and middle-aged individuals who come to see a doctor due to emotional agitation or other reasons, presenting symptoms such as merely elevated blood pressure or localized tearing pain. However, CT scans reveal that they have an aortic dissection. Generally, undergoing routine annual electrocardiograms and echocardiograms is sufficient. The prevalence of aortic dissection is relatively low, and the examination cost is around 1,500 yuan, which is quite expensive, so it is not commonly used as a general screening test.
■ Pre-Exercise Preparation: Medical Checkups and Health Screening Are Required
In the “Registration Notice” for the Guangzhou Marathon, there is such a prompt: “The marathon is a high-load, high-intensity, long-distance competitive sport and a high-risk athletic event. Participants should be in good health and have a foundation of long-term running exercise or training. The Guangzhou Marathon Organizing Committee requires every participant to undergo a medical checkup at a corresponding medical institution before the race.” Similar wording is also found in the “Registration Notices” for the Shanghai Marathon and the Beijing Marathon.
“Abroad, before participating in a marathon, individuals are required to fill out a health status questionnaire and provide a health checkup certificate from within the past six months to prove they do not have any cardiopulmonary function defects. Additionally, foreign marathons and similar sports events have on-site sports injury prevention specialists and team doctors who can respond to emergencies within 30 seconds to 1 minute,” said Wang Liming. Healthy individuals rarely experience sudden death. However, if there are congenital cardiopulmonary function issues, survival may not be possible. Tragedies of sudden death among both professional athletes and amateurs have occurred at various sports events both domestically and internationally.
Wang Liming said that exercise should be reasonable and scientific, and health screening and related questionnaires are necessary before engaging in physical activity. One should not take it lightly just because running seems like a simple sport where giving a final push is enough. Even professional athletes, such as members of China’s national tennis team, undergo medical checkups and specific cardiopulmonary function tests before starting winter training. Ordinary people should have the same awareness before exercising, rather than assuming they are “usually sport-loving and physically capable.”
“Abroad, before participating in a marathon, individuals are required to fill out a health status questionnaire and provide a health checkup certificate from within the past six months to prove they do not have any cardiopulmonary function defects. Additionally, foreign marathons and similar sports events have on-site sports injury prevention specialists and team doctors who can respond to emergencies within 30 seconds to 1 minute,” said Wang Liming. Healthy individuals rarely experience sudden death. However, if there are congenital cardiopulmonary function issues, survival may not be possible. Tragedies of sudden death among both professional athletes and amateurs have occurred at various sports events both domestically and internationally.
Wang Liming said that exercise should be reasonable and scientific, and health screening and related questionnaires are necessary before engaging in physical activity. One should not take it lightly just because running seems like a simple sport where giving a final push is enough. Even professional athletes, such as members of China’s national tennis team, undergo medical checkups and specific cardiopulmonary function tests before starting winter training. Ordinary people should have the same awareness before exercising, rather than assuming they are “usually sport-loving and physically capable.”
Generally speaking, an annual physical examination for white-collar workers that includes cardiopulmonary function checks is sufficient. If you’re still concerned, you can opt for a medically monitored examination.
A resting electrocardiogram cannot reveal potential dangers
“An electrocardiogram taken in a resting state only serves as a preliminary screening and cannot reveal potential risks. Therefore, it is recommended that young and middle-aged individuals also undergo an incremental load test, which involves gradually increasing exercise intensity to monitor changes in metrics such as heart rate, blood pressure, and pulse wave velocity under varying loads, thereby scientifically evaluating cardiovascular function. If abnormalities are detected, the tester will be advised to keep exercise intensity below a certain level.”
Cao Jianmin said that physical exercise is beneficial to health, but only scientific and reasonable fitness activities can improve physical condition. It is not true that the longer or more intense the exercise, the better.
■ Related Injuries: Yoga-Induced Fractures Are Often Due to Improper Movements
Cao Jianmin said that physical exercise is beneficial to health, but only scientific and reasonable fitness activities can improve physical condition. It is not true that the longer or more intense the exercise, the better.
■ Related Injuries: Yoga-Induced Fractures Are Often Due to Improper Movements
In recent years, there have been frequent cases of fractures occurring during yoga practice, and many believe this is due to yoga’s demands for precise, proper, and professional movements. Cao Jianmin believes that yoga is inherently a stretching exercise, and improper or unreasonable movements can lead to ligament injuries. Excessively increasing workout intensity can also cause harm. This is not an issue with yoga itself, but rather with improper movements by practitioners or instructors.
Wang Liming also believes that yoga is a vast training system, and inaccurate execution or non-standard techniques can easily lead to sports injuries due to technical errors. Standardization of training and rationalization of movements are needed. Examples of improper movements include doing them too quickly or trying to learn all movements at once. Yoga emphasizes bodily flexibility, and improper practice can easily lead to strains. Yoga is about control, not brute force — many injuries occur because individuals follow non-professional instructors or learn directly from videos, resulting in incorrect techniques.
Ao Yingfang, Director of the Institute of Sports Medicine at Peking University Third Hospital, also reminds everyone that different people should tailor their exercise methods accordingly. For example, having a child jump on a wooden horse is clearly inappropriate and can damage the child’s knee and ankle joints. Patients with osteoarthritis are not advised to use seesaw training. Elderly individuals with degenerative joint changes, brittle muscles, and ligament attachment points are also not advised to go mountain climbing or participate in yangko dancing. People say that life lies in movement, but in reality, life lies in scientific and reasonable movement. Overdoing it becomes violence.
■ Hot Topic Q&A: People with Normal Cardiopulmonary Function Are Suitable for Long-Distance Running
Q: What preparations and warm-up exercises are needed before a long run? What first aid measures should be taken if discomfort occurs during exercise? Which groups of people are not suitable for long-distance running?
Wang Liming: Anyone without heart or lung issues is suitable for long-distance running. There is no specific warm-up exercise required before a long run. For ordinary people exercising on their own, if running on a 400-meter track, maintaining a pace of about 2 to 3 minutes per lap with a heart rate between 130-150, and continuing for over half an hour is sufficient. It’s generally best not to exercise for more than 50 minutes. Those who are already well-trained can decide their exercise duration themselves.
When long-distance running, you should carry a mobile phone with emergency numbers saved. If you feel short of breath, lack of blood flow, chest pain, or experience blackouts, you should stop immediately to rest and adjust. Call emergency services if necessary.
The ideal place for jogging is on a rubberized track. But many people don’t have access to such conditions. If you’re running on roads or concrete surfaces in residential areas, we recommend substituting a treadmill for a stationary bike or bicycle, using a treadmill instead of concrete, brisk walking instead of jogging, and wearing professional running shoes with air cushions in the heels. This helps cushion the impact on your knees and prevents knee joint injuries.
Running puts twice the stress on joints compared to walking, and maintaining a heart rate between 130-150 during brisk walking is more suitable. The American Sports Association, considering that many Americans are overweight, particularly recommends brisk walking over jogging for those with excess body weight.
Q: The sudden death of young university students during marathon races has led many netizens to lament and comment, “Nowadays, young people are less physically fit than the elderly.” Do you think this is true?
Wang Liming: University students and young people often face the pressures of life and study, and schools do not emphasize physical exercise, resulting in less activity among the youth compared to the past. In contrast, the elderly have plenty of time for physical activity after retirement, and their health awareness is also stronger than that of young people. Therefore, there is indeed a phenomenon where “young people’s physical fitness is not as good as that of the elderly.”
The afternoon around 3 or 4 PM is the ideal time for exercise in winter.
Q: In winter, cities in northern China such as Beijing experience very low temperatures. How can one ensure the safety of physical exercise in such cold conditions?
Cao Jianmin: Mornings in winter are colder with higher carbon dioxide levels, so we do not recommend exercising in the morning during winter. Instead, we encourage people to exercise when it’s warmer, such as in the afternoon. During exercise, it’s important to stay warm, stay hydrated, and take breaks.
Wang Liming: In northern cities, temperatures are lower in the early morning and evening. When it’s cold, blood vessels constrict, increasing the burden on the heart and making heart problems more likely. Therefore, in winter, the ideal time for exercise is around 3 or 4 PM, when temperatures are higher and air quality is better. If the weather is good, outdoor sports can be chosen. Indoor activities such as basketball, volleyball, badminton, swimming, or using a stationary bike are also good options, as is jumping rope indoors. Avoid exercising outdoors in hazy or poor air quality conditions.
Q: Some traditional Chinese medicine beliefs suggest that there is a certain threshold for the number of heartbeats in a person’s lifetime. If one exercises frequently and their heart rate increases regularly, it’s actually a form of strain on the heart, which could reduce the “usable number of heartbeats” and thereby accelerate death. What do you think about this?
Cao Jianmin: People who exercise regularly have only 40% of the risk of sudden cardiac arrest compared to those who are mostly sedentary. Indeed, the total number of heartbeats in a lifetime is limited, and exercise does increase heart rate. However, those who hold this view overlook the fact that people who engage in long-term physical exercise tend to have a lower resting heart rate than the average person, which allows them to maintain normal vital signs. Research has shown that people who exercise regularly have a sinus rhythm cycle of 20-30 beats per minute.
Therefore, physical exercise does increase the heart’s workload, and athletes who undergo intense training do have a limited athletic lifespan. However, these athletes have lower resting heart rates, and their hearts are not overly burdened. People will not die earlier because of physical exercise. Long-term, reasonable, and scientific physical training—especially endurance training with lower intensity but greater load—can improve the overall internal environment, including the heart, and help prevent sudden death. Short-duration, high-intensity physical exercise does not produce the same effect.
Therefore, physical exercise does increase the heart’s workload, and athletes who undergo intense training do have a limited athletic lifespan. However, these athletes have lower resting heart rates, and their hearts are not overly burdened. People will not die earlier because of physical exercise. Long-term, reasonable, and scientific physical training—especially endurance training with lower intensity but greater load—can improve the overall internal environment, including the heart, and help prevent sudden death. Short-duration, high-intensity physical exercise does not produce the same effect.