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Whether you’re a soccer pro, training for your first 5k, or serving as a first responder, your heart is your most important piece of athletic equipment.
Regular exercise is one of the most powerful tools for cardiovascular prevention, improving efficiency, metabolic health, and overall longevity. When you push your body to its limits, your heart and blood vessels can change over time. An athlete’s heart is a high-performance machine that requires specialized care to stay healthy.
While a general cardiologist focuses on diagnosing and treating diseases such as heart failure or rhythm issues, sports cardiology manages the heart through a different lens. Sports cardiology focuses on the intersection of cardiovascular performance, physiologic adaptation, and long-term risk assessment in active individuals.
We define athlete broadly to mean anyone whose lifestyle includes significant physical exertion, including:
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Elite and professional athletes: We work with top-level competitors including but not limited to the NFL, WNBA, NBA, NHL, MLB and the Olympics.
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Competitive student-athletes: High school and collegiate-level players and performers.
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Tactical athletes: Military personnel, police officers, firefighters, and others whose jobs require high degrees of physical exertion.
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Recreational athletes: “Weekend warriors” who lift weights, run, play pickup ball, or are looking to safely start a new, intense exercise routine.
In our sports cardiology practice, our goal is to provide all athletes with the data you need to stay safe and perform well in your sport of choice.
Fitness is not heart immunity.
Regular exercise is the best way to improve longevity. Studies have shown keeping active can fortify the heart, support your metabolism and stabilize blood sugar, lower inflammation, and even reduce dementia risk.
But fitness doesn’t give you immunity from heart conditions. In fact, acute cardiac events, while rare, are more likely to occur during or immediately after intense exertion, particularly in individuals with underlying, often unrecognized cardiovascular disease. This concept is known as the exercise paradox.
Even elite athletes can have genetic risks or other health challenges that training can’t fully erase, which may mean they need regular specialized care. Coronary anomalies and hypertrophic cardiomyopathy are examples of inherited conditions that raise your risk of a cardiac event.
Here’s an example: A Ferrari has a high-performance engine, but it still needs proactive maintenance to keep operating at a high level over time. Just like a sports car, the athlete’s heart needs expert assessment and care.
Advanced testing and the fifth vital sign.
In our clinic, we use specialized tools to create a precise exercise prescription for patients of all activity levels. Among our most powerful tools is a cardiopulmonary exercise test (CPET), also known as a maximal effort VO2 study.
The fifth vital sign: VO2 max.
VO2 max is sometimes referred to as the fifth vital sign. It reflects the maximum rate at which your body can take in, deliver and use oxygen during exercise. It is one of the strongest physiologic predictors of longevity and cardiovascular health.
An Apple Watch or a Fitbit can estimate VO2, but these wearable devices provide estimates based on population-based algorithms rather than direct physiologic measurement. A CPET is the only way to objectively measure how your body uses oxygen at peak effort.
Using CPET to plan an exercise prescription.
During this non-invasive test, we monitor your heart rate, blood pressure, and gas exchange, particularly oxygen consumption and CO2 production, while you exercise to your maximum effort on a stationary bike or a treadmill.
With the data from CPET, we can identify each patient’s unique heart rate zones and plan a safe, effective exercise prescription.
Finding hidden risk factors.
We look beyond standard cholesterol tests to build a complete profile of your cardiovascular health, including your genetic blueprint and your anatomy:
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Lipoprotein (a): Unlike standard cholesterol, Lp(a) is inherited in your genes, not influenced by your diet, and is an independent risk factor for premature cardiovascular disease. Knowing this genetic marker in your blood can help us identify risks exercise can’t eliminate.
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Coronary artery calcium (CAC) Scan: This specialized test looks for calcium build up in the coronary arteries, which can be an early sign of coronary artery disease. It helps us better understand heart risk, even when the heart has adapted normally to training.
Pairing these inherited risk signals with direct imaging of your arteries allows us to integrate biology and structure, giving a more precise and complete assessment of your true cardiovascular risk.
Related: Read “When To Trust a Smartwatch for Your Heart (And When Not To!).”
Understanding changes in the athlete’s heart.
High levels of exercise put stress on the heart, causing it to adapt over time. This is called exercise-induced cardiac remodeling. These changes can sometimes look like heart disease, so specialized experience is required to know the difference.
There are three primary ways an active heart can differ:
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Chamber dilation: Symmetrical enlargement helps the heart circulate higher volumes of blood more efficiently.
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Reduced heart rate: Conditioned hearts are more efficient, often beating just 30 or 40 times per minute at rest. A “normal” resting rate for most adults is 60 – 100 beats per minute.
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Muscle thickening: Adaptations to help handle the pressure of heavy strength training.
A sports cardiologist can help you know the difference between healthy remodeling and heart disease. We can work with you to develop a plan so you can continue to get the benefits of exercise long term.
Recognizing heart health red flags as an athlete.
While we encourage activity, it’s important to know and be watchful for symptoms that could occur during or after exercise. Some warning signs are obvious, but others are subtle.
Talk with your doctor if you experience:
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Fainting or passing out (syncope): Losing consciousness during or right after physical activity.
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Shortness of breath (inordinate dyspnea): Difficulty breathing that feels out of proportion to your actual fitness level.
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Performance decline: An unexplained drop in speed or endurance can be a sign of heart failure or coronary disease.
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Reproducible symptoms: Lightheadedness, or discomfort that consistently appears during exercise and goes away with rest.
Even top athletes can develop heart conditions, so it’s important to stay aware of warning signs such as chest discomfort, unusual shortness of breath, palpitations, or excessive fatigue. If you experience these symptoms, they should be evaluated promptly.
Related: Read “Patient-Centered Teamwork: The Power of Multidisciplinary Heart Care.”
Return-to-play evaluations.
Athletes who’ve received a new diagnosis or had a cardiac event are often eager to get back to exercise. Sports cardiologists use “return-to-play” evaluations to find a safe way to help patients stay active. Our goal is not restriction, but safe optimization of performance.
We avoid unnecessary restrictions through:
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Individual risk assessment: We consider each patient’s specific heart condition and how it interacts with the physical demands of their sport.
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Promoting activity: We look for green lights that allow athletes to continue training, even if that means adjusting the intensity level.
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Alternative prescriptions: If high-intensity competition isn’t safe at the moment, we help you find other options so you can keep moving.
Sometimes feeling fine when you’re at rest doesn’t mean it’s safe to push your heart. To get back to competition safely, it’s important to partner honestly with your doctor and follow their recommendations.
Nutrition and exercise for prevention.
Helping patients avoid heart conditions is an important part of our work, and nutrition is among our most powerful tools for prevention. I advise my patients to approach their diet with a predominantly plant-forward, Mediterranean-style eating pattern:
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Build the foundation of your diet around foods that grow from the ground or trees, including vegetables, fruits, and tree nuts.
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Incorporate seafood regularly, particularly flaky fish such as salmon, sardines, tuna, and trout.
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Use poultry, such as chicken and turkey, as your primary meat sources, and limit red meat intake given its high cholesterol content.
To help keep your heart healthy, exercise is also key. The standard guideline is at least 150 minutes of moderate intensity aerobic activity, or 75 minutes of vigorous activity, each week.
At MedStar Health, you’ll have a team of heart specialists working together to care for you. We deliver individualized, data-driven care by integrating advanced diagnostics, performance physiology and preventive cardiology. We partner with patients to understand each person’s exercise goals to build a plan that keeps you moving safely on and off the field.
