February is American Heart Month, and it’s a good time to revisit an important question: How can you take care of your heart while exercising or playing sports?

UAB Sports & Exercise Medicine – a partnership between the Departments of Family and Community Medicine, Orthopaedics and Physical Medicine and Rehabilitation – operates a Sports Medicine Cardiology Clinic for Young Athletes at UAB Hospital-Highlands and helps athletes of all ages maximize their performance and stay safe and healthy while competing.

Irfan Asif, M.D., professor, chair of the Department of Family and Community Medicine, associate dean for primary care and rural health and director of UAB’s primary care service line, offered tips for maintaining cardiac health while exercising and playing sports. Asif specializes in sports and exercise medicine and particularly in sports cardiology.

Q. First, how can regular exercise help your heart?

A. Regular exercise has many benefits, including building muscle endurance and strength. Your heart is a muscle, so regular exercise strengthens that muscle. There is also an inverse relationship between regular exercise and heart disease. This includes a beneficial effect of lowering bad cholesterol (LDL) and raising good cholesterol (HDL). Regular exercise also lowers inflammation in your body and reduces blood pressure, both of which have protective benefits for the heart.

Q. What are some of the most common cardiac concerns that athletes of all levels can face?

A. If you are younger than 35, your chance of having heart problems is much lower than those over 35 or over 50. However, there are some conditions that can affect younger individuals. About one in 300 individuals might have an underlying condition and not realize it. Some of those conditions include hypertrophic cardiomyopathy, which is an enlarged heart, Wolff-Parkinson White Syndrome, which is an electrical problem, and arrhythmogenic right ventricular cardiomyopathy, where fat might infiltrate your heart. Those are all conditions that you can be born with and would typically show up before age 35. We don’t yet know the exact mechanism that triggers problems with those conditions – if exercising at high intensity causes a little problem to become a big problem, or if there is another factor, such as not getting enough oxygen. We are still learning about that.Irfan Asif, M.D.

Individuals over 35, and especially over age 50, are at higher risk of coronary artery disease. Blockages in your heart often occur due to buildup in the arteries that occurs over time. That buildup might get worse with diabetes, high blood pressure or smoking.

Q. What are some simple best practices to keep in mind for exercise?

A. Regular exercise is important. Getting 150 minutes per week is a good goal, balancing between endurance training, such as running, biking or walking, and strength training to build muscle.

One study, in the Journal of the American Medical Association, showed that increasing moderate-to-vigorous physical activity by 10, 20 or 30 minutes per day was associated with a 6.9%, 13.0% and 16.9% decrease in the number of deaths per year, respectively, in the adult U.S. population. Adding 10 minutes per day of physical activity resulted in an estimated 111, 174 fewer preventable deaths per year, with greater benefits associated with the addition of more physical activity.

Q. Are there any warning signs that people should look for before, during or after exercise?

A. If you are exercising and you feel light-headed, short of breath or you get chest pain more than what you might experience normally, that is a cause for concern. Shortness of breath can be tough to quantify, but if you are getting unexpectedly short of breath, are in more pain than usual or if you pass out, you should go straight to a medical provider to be checked out.

Q. If you already know that you have a heart condition, are there certain types of exercise you should pursue or avoid?

A. It depends on the condition, so you would want to work with your doctor to figure out which forms of exercise are best for you. Your health care provider might do certain tests to determine which exercises are safe for you or which heart rate zones you might need to stay within, but the specifics are dependent on the type of disease.

Q. We have heard a lot about heart conditions associated with COVID-19. What should athletes keep in mind if they have had COVID?

A. We are seeing that most people who had COVID but had no symptoms or mild symptoms tend to do OK afterwards and not face cardiac issues. Those with more moderate or severe symptoms should have their heart checked out by a doctor, particularly before athletic activity. I would consider an EKG (electrocardiography) test at minimum, and additional testing depending on the case, to make sure the heart is functioning well.

Most often with COVID, we have seen myocarditis, or inflammation of the heart, after infection. In addition to COVID, myocarditis can occur after other viral infections, such as influenza, and can lead to heart trouble. The risk is highest in the short-term aftermath of an infection and diminishes over time.

I was part of the team that developed cardiopulmonary guidelines for high school student-athletes during the pandemic, published by the National Federation of State High School Associations. Among other things, we recommended that athletes with moderate symptoms, including a fever greater than 100.4 degrees, chills, flu-like symptoms for two or more days, or initial cardiopulmonary symptoms such as chest pain of palpitations, should be evaluated by a clinician. Cardiac testing is recommended for any athletes with cardiopulmonary symptoms during the acute phase of infection. Carefully screening for those symptoms and conducting tests as needed can help get athletes back into competition safely.