Who should have a pre-exercise checkup?

Philip J. Goscienski, M.D.

July 2006

Who hasn't heard of someone who keeled over while working out at the gym or dashing to return a serve at the tennis court? Does that mean that exercise is dangerous? On the contrary, not exercising causes thousands of times as many deaths as exercising does. Baby Boomers are beginning to get the word that obesity kills and they are making fitness centers the new gold rush.

When I first wandered into a fitness center as a fifty-something I was usually the oldest guy in the weight room. That should be especially true now, a couple of decades later, but it isn't. Men and women even older than I am are grunting through vigorous routines and pumping serious iron. Are they at risk?

They could be if they have an underlying problem that they are not aware of. That's especially true if they push themselves to lift more or run faster, trying to imitate those young studs at the adjacent weight bench or treadmill.

Cardiologist and respected researcher Dr. Dean Ornish chides that there is no such thing as a sudden heart attack. Surprise maybe, but not sudden. Death-dealing diseases may incubate for a decade or two before emerging to cripple with a stroke or to kill with a heart attack. Sometimes they occur with few or no obvious symptoms but a careful medical evaluation will almost always unmask them.

High blood pressure (hypertension) causes damage to the heart and blood vessels so slowly and painlessly that many persons with this condition are unaware of it. Measuring blood pressure is one of the fastest and simplest procedures in the doctor's office but most people with hypertension are not aware that they have a serious but usually treatable condition.

Don't assume that the annual checkup that you had a year or two ago is adequate. Your physician needs to know that you intend to start a vigorous exercise program. (Note: vigorous includes a daily 30-minute brisk walk.) Your family history and personal history could indicate the need for some further testing, such as a cardiac stress test. The physical examination that includes a careful auscultation (listening with a stethoscope) of the heart could reveal a small but potentially serious congenital abnormality that escaped detection during childhood or some other form of silent heart disease.

Type 2 diabetes or prediabetes occur in more than one third of persons over the age of 60 but half of them are unaware that they have an abnormal blood sugar. At the time of their initial diagnosis about half of diabetics already have one or more complications of the disease. There is no cure for diabetes but a healthy diet, moderate exercise and medication can postpone complications.

You need to have a physician's clearance to exercise if you are over age 40, have a personal or family history of heart disease or diabetes, have had chest pain during exercise or you plan to participate in competitive exercise.

The cost of a medical evaluation is about the same as 2 or 3 months' dues at a fitness center. The payoff? Priceless!

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.