On November 6, the 2022 Beijing Marathon will start in Tiananmen Square.

It can be said that marathon has become one of the most popular strenuous endurance sports in the world, and more and more sports enthusiasts are joining the ranks of "horse racing".

However, running seems to be very simple. Long-distance running, especially "horse racing", is not as simple as running. Due to the lack of professional training and guidance, many people often run 5 kilometers or 10 kilometers, which is very easy to "running injury".

　　Therefore, cardiologists recommend that you test your blood vessels before running a long distance.

Should high-intensity exercise be blamed for sudden death?

　　Just in early October, the news of a famous person's sudden death after a 28-kilometer long-distance run caused a heated discussion among the public. Should high-intensity exercise be responsible for sudden cardiac death?

Answer first: Although a large number of studies have confirmed that physical exercise is beneficial to cardiovascular and even health, exercise may also cause cardiovascular disease and even sudden cardiac death.

　　The patient's 28-kilometer long-distance run was longer than a half-marathon. It was a strenuous endurance exercise. Since the details of the onset were not disclosed, it is unknown whether he had chronic diseases or even structural heart diseases.

　　There are many causes of sudden cardiac death.

Hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy are the most common causes of exercise-related sudden cardiac death in people under the age of 35, and coronary artery disease is the most common cause in the elderly.

　　We often promote the benefits of exercise, and the "Guidelines for Physical Activity for the Chinese Population (2021)" also recommend that adults should do at least 150 to 300 minutes of moderate-intensity aerobic exercise or 75 to 150 minutes of vigorous-intensity aerobic exercise per week. , or an equivalent combination of two intensities of exercise.

　　However, regardless of whether the patient died suddenly due to high-intensity exercise, it should be noted that not everyone is suitable for vigorous endurance exercise, such as running a marathon.

　　It can be said that physical activity is a double-edged sword. On the one hand, moderate physical activity can prevent cardiovascular disease.

On the other hand, exercise may also increase the incidence of cardiovascular disease or sudden cardiac death in potential patients.

Check vascular status before strenuous exercise

　　It is very important to establish a healthy view of sports without fighting unprepared battles. This is the key to long-term adherence to sports and avoiding sports injuries, including pre-exercise assessment and preparation, exercise planning and execution, and post-exercise feedback.

　　Before you start exercising regularly, you should assess your exercise-related cardiovascular risks, including age, medical history, and exercise habits.

The evaluation items are divided into the following two major items:

　　Core variables included age (>50 years in men and >60 years in women); concomitant family history of established cardiovascular disease, type 2 diabetes, or other congenital or inherited heart disease; participation in or planning to participate in high-risk extreme sports.

　　Non-core variables included lack of regular exercise habits; presence of clinical symptoms such as chest tightness, chest pain, and dyspnea suggesting possible cardiovascular disease; men > 40 years old and postmenopausal women; smoking; hypertension; high cholesterol; and obesity.

　　According to the above options, if there is no core variable and at most one non-core variable, the tester is in a low-risk state; if there is at least one core variable or two or more non-core variables, the tester is in a high-risk state.

Continue screening to do these two physical assessments

　　If you are in a low-risk state, you generally do not need to continue the evaluation, and you can choose exercise according to your personal situation.

If you specifically want further evaluation, you can also do a primary evaluation like a high-risk group.

　　The primary evaluation requires going to the hospital. The doctor will ask you whether you have symptoms, what medical history you have, and give you laboratory tests such as blood sugar, blood lipids, and renal function.

If cardiac disease is suspected, an electrocardiogram and echocardiogram should also be performed.

Generally speaking, if you are going to perform intense endurance sports competitions, such as marathons, extreme mountaineering, triathlons, etc., it is also recommended to carry out the above inspections before the competition, which can screen out some people with potential hidden dangers.

　　If the assessment is ok, you can choose your favorite exercise and start moving.

　　Cardiopulmonary exercise testing If the initial assessment is abnormal, a cardiopulmonary exercise test (CPET) should also be performed to assess performance status.

If there is no problem with the cardiopulmonary function test and there are no other important diseases or risk factors, you can start with low-intensity exercise and gradually increase the amount.

If the cardiopulmonary function test is abnormal, or combined with other diseases or risk factors, further examinations are required according to the situation, and exercise should be guided by a doctor.

Preparing before and after the gradual exercise

　　Exercise is a life-long thing, must not be rash, it is best to go with the flow, step by step, in moderation.

　　Before starting regular exercise, you should also develop an exercise plan and learn more about the sport, such as exercise skills, exercise risks, etc.

Sports safety is very important. You must fully understand the sport and prepare all kinds of equipment, including clothes, shoes, socks and protective equipment, before you can start exercising.

Warm up before exercise, exercise gradually, and also pay attention to stretching after exercise.

　　During exercise and after exercise, you should be sensitive to your own symptoms, such as chest pain, suffocation and other uncomfortable symptoms. If you stop exercising and rest still not relieved, you should go to the hospital as soon as possible.

In addition, the above assessments should be performed regularly so that you can understand your exercise status.

　　Text/Liu Jian (Peking University People's Hospital)

　　Beijing Youth Daily