Is your heart working the way it should?

By Dr. Emma SUN  of Jiahui Health


The age of internet fitness gurus and easy access to online workout plans means that a healthy lifestyle is an increasingly popular option for many people. Maybe you are one of them, or maybe you’re preparing to take the dive and start exercising more.
But is there anything we should know before we jump on the treadmill? We often overestimate the ease of exercise,Or underestimated the importance of cardiorespiratory endurance.


Most people think that the physical threshold for exercises like jogging are low, but if you don’t know how to adjust and monitor your heart rate, breathing, pace, etc., abnormal cardiovascular circulation will not only lead to physical and mental fatigue, but in severe cases, exercise-related sudden cardiac death may occur.

What is exercise related sudden cardiac death?

Exercise-related sudden cardiac death (SCD) events are mostly caused by malignant arrhythmias, such as ventricular tachycardia (VT) or ventricular fibrillation (VF). Therefore, if you already know that you have a heart disease (such as hypertrophic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, etc.), don’t take the risk of high-intensity competitive sports, because it may increase your risk of VT/VF.
SCD is not just something that elderly people need to worry about, young and middle-aged people who seem to be healthy may also experience exercise-related SCD. Certain cardiovascular issues may not affect your daily life, but high-intensity exercise can trigger serious consequences.


Traditionally, the four major signs of life include respiration, body temperature, pulse, and blood pressure. At the end of 2016, however, the American Heart Association identified cardiorespiratory fitness as the “fifth” vital sign. Carrying out a cardiopulmonary exercise risk assessment, and designing preventive measures and exercise training programs under the advice of doctors can help reduce the risk of exercise-related SCD.

Who needs a cardiopulmonary exercise risk assessment?


1. People with potential heart complications, athletes

To evaluate the degree of aging and health of the heart and lungs, screen for hidden cardiopulmonary diseases, and evaluate functions of the heart, lungs and muscles, in order to provide a tailored health and exercise plan. 

2. “Three highs”, obese people

Early diagnosis of high blood pressure, high cholesterol and high blood sugars (diabetes), as well as cardiopulmonary dysfunction, assessment of cardiovascular disease risk, and other abnormal indicators. 

3. Family history of cardiovascular disease

These patients should monitor for high-risk clinical phenomena that may occur during exercise, and then formulate preventive measures. They should also determine whether there are early signs of myocardial ischemia, hypertension, functional arrhythmia, etc., treat chronic heart failure caused by genetic diseases, and evaluate the long-term prognosis of diseases such as chronic obstructive pulmonary disease (COPD). 

4. Patients who underwent cardiac stent surgery

These patients should focus on the rehabilitation of their cardiopulmonary function, determine the degree of impairment of their ability to do cardiopulmonary exercise, formulate a personalized postoperative rehabilitation exercise program, and plan safe exercise intervals.
*Although the application range of cardiopulmonary exercise test is very wide, it should be noted that patients with serious diseases such as acute myocardial infarction, acute myocarditis, unstable angina, etc. should not undergo a cardiopulmonary exercise test.

What can you screen for cardiopulmonary exercise risk?


The main purpose of screening is to identify those with high risk of exercise-related SCD, and improve their prognosis through the restriction/adjustment of exercise or other specific treatment.
Screening methods depend on age and expected activity level, and generally include initial risk assessment, standard 12-lead electrocardiogram examination and exercise stress test.

Initial risk assessment

The doctor will make an initial risk assessment based on the patient’s medical history (personal history and family history) through consultation and analysis of existing data, and formulate a plan for further examination.

Inspection plan

Includes the following two inspection methods:

① Standard 12-lead ECG:
One of the most widely used clinical examinations, an electrocardiogram (ECG) is a medical test that detects heart abnormalities by measuring the electrical activity generated by the heart as it contracts.
② Exercise stress test:
Including “treadmill test” and “exercise cardiopulmonary test”.
The principle of this test is to increase the cardiopulmonary load on your body through exercise (on a treadmill or stationary bike). During the test, the doctor will observe any resulting changes in your ECG and the overall function indicators of the heart, lungs and other organ systems.

Safety assessment

Your doctor will then be able to make suggestions for appropriate exercise based on their analysis of the test results. They may also propose further examination/treatment plans based on any abnormal examination results.
Dr. Emma SUN currently serves as a cardiologist in Jiahui Health. Dr. Sun obtained her bachelor’s degree in clinical medicine from Shanghai Jiao Tong University in 2013. Then during 2013-2018, she continued to study for doctor degree in cardiology in Shanghai Jiao Tong University. She was once a visiting scholar at Newark Beth Israel Medical Center for advanced studies in cardiac imaging and clinical arrangement of transcatheter aortic valve replacement (TAVR). After graduation, Dr. Sun finished her standardized residency training in internal medicine at Shanghai First People’s Hospital during 2018-2019. She passed the national residency examination in 2019 and obtained the certificate. Prior to joining Jiahui Health, Dr. Sun worked as a resident physician and fellowship in the Department of Cardiology at Shanghai Chest Hospital affiliated to Shanghai Jiao Tong University. Dr. Sun is proficient in diagnosis and treatment of cardiac conditions and diseases, such as hypertension, hyperlipidemia, coronary heart disease (CHD), acute/chronic heart failure, pulmonary hypertension, cardiomyopathy and so on.