Should You See a Doctor Before Exercising?

Diet and exercise are both part of a healthy lifestyle, but how safe is it to start an exercise program?  Most programs encourage people to see their doctor first.  Is there really a reason to do this?

The short answer is yes, but the more important question is why.  Exercise pushes the body to work at a harried pace.  The extra stress on the heart and lungs is both good and potentially bad.  Exertion encourages the heart to grow new blood vessels, causes deep breathing which is essential for healthy lung function and promotes good circulation in the extremities.

Patients with underlying medical problems can find those same invigorating effects to be detrimental – if heart or lung disease is present exercise can lead to heart attack, worsening of asthma or even sudden death.  Having said that, exercise is a major part of a healthy lifestyle, and without it the risks for diabetes, obesity and heart disease skyrocket.

So, who should go to the doctor before hopping onto the Stairmaster?  In general, younger patients who have no medical problems, have had a recent checkup and who have safely exercised in the past are usually safe.  Patients seeking a very low impact program, like simple walking are usually safe as well.  (Although patients with underlying medical problems should consider discussing their intended program with the doctor first).

Patients who have never exercised before may have a congenital heart disease called Hypertrophic Obstructive Cardiomyopathy (HOCM) which can predispose to sudden cardiac death with vigorous exercise.  HOCM is usually found in childhood as a heart murmur, but in some cases it can be diagnosed later in life.  Patients with HOCM may have palpitations and shortness of breath, or may have no symptoms whatsoever.

Patients with asthma may have or develop exercise induced asthma.  Some patients will only have the exercise induced form.  Treatment of this usually requires the use of an inhaler prior to the workout.

Patients with diabetes, high blood pressure or cholesterol may be at increased risk of ischemic heart disease.  This can lead to heart attacks or sudden cardiac death as well. Prior to exercising these patients usually undergo a stress test where the activity and health of the heart under stress (either exercise or medication induced) can be measured and observed.

Men over the age of forty or women over the age of fifty should consider a stress test with there doctor for the same reasons as patients with other risk factors.  Heart disease can present with a first heart attack (and often does).

Finally, some medications can affect your workout.  Medicines can make your heart beat more slowly, diminishing your ability to exercise as easily.  Other medicines can predispose the heart to rapid heart rates.

In summary, most patients considering a new exercise program should consider a discussion with their doctor as an important prerequisite to beginning.  Many patients will need testing and counseling to ensure their workout is both safe and productive.

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