One of the more common statements about people who suffer a heart attack or death during athletic competition is, “I thought he was so healthy.” This misconception of “being healthy” simply because one engages in athletic competition, especially high-endurance competition, can often be misleading. The two athletes who suffered heart attacks in the La Jolla Half-Marathon this year once again bring to light the need for athletes to take their heart health seriously. Throughout history, physicians have often debated the benefits and risks of exercise. Interestingly, the mythical story of the Greek soldier who ran the first marathon ended up dying from exhaustion after he completed his mission. Despite this outcome, the ancient philosophers still heralded the benefits of exercise. As the debate grew throughout the years, it was at the turn of the 19th century when physicians began to evaluate high-endurance athletes, discovering dilation and damage to the human heart. This led physicians to often discourage high-endurance exercise, considering it extremely dangerous and deleterious to one’s health. It wasn’t until the mid-19th century when better research began to highlight the benefits of exercise including decrease in mortality, weight loss, cancer prevention, improvement in psychological well-being and reduction in cholesterol, blood sugar and blood pressure. As the benefits of exercise became more prevalent, so did exercise. Eventually high-endurance activities, such as marathons and triathlons, have become very popular — especially in San Diego. As the popularity of high-endurance competitive exercise has grown, so has the number of heart attacks and deaths suffered by amateur and professional athletes. So is exercise safe? In the United States, guidelines and requirements are in place to allow for better screening of high school and college athletes. However, no such guidelines or even recommendations exist for the adult athlete. The leading cause of death in the adult athlete is still coronary disease and a simple history and physical by a physician can assess for this risk. The adult athlete typically believes they are healthy and will often dismiss symptoms as a cramp or a sign of weakness. Furthermore, research has shown the highest risk for athletes are in those who don’t train regularly before engaging in a high-endurance event, the so-called weekend warriors. Physical activity should be a part of everyone’s life, irrespective of their physical abilities or limitations. Exercise safety can be achieved through appropriate screening and guidance. I recommend that all athletes be evaluated by their physician with regular follow-up. If you are not currently exercising, start by walking five minutes per day and get evaluated by your physician. — Dr. Chris Suhar is an integrative cardiologist at Scripps Center for Integrative Medicine. Dr. Suhar will give a free lecture about the benefits and risks of exercise and how to use a mind-body approach to improving athletic performance on Tuesday, June 8 at 7 p.m. For information, call (800) 727-4777.