According to a survey by Brain Intelligence and Strategy, 42% of Brazilians have started to include physical activity in their routine in recent years. Among young people, the habit is even more common: 47% choose gyms to exercise. Despite this progress, many people start training, whether in the gym, on the field or on the track, without undergoing a prior medical evaluation. And that is precisely where the risk lies.

“Vigorous exercise associated with hidden heart disease can act as a trigger for serious arrhythmias, conditions that simply do not appear at rest. Many of the conditions that pose a risk during physical exercise it does not generate any symptoms on a daily basis”, says Dr. Carlos Eduardo Suaide, cardiologist at Delboni and Lavoisier, specialist at Dasa.

In this context, the patient may have a condition without knowing it. “The person feels good, lives normally, starts training with enthusiasm, and it is exactly at that moment that the body is placed under a demand that it had never faced before. The pre-participation assessment exists to map this scenario before it becomes a problem”, adds the doctor.

What the pre-participation assessment includes?

The Sports Pre-Participation Assessment (APP) is recommended by the Brazilian Society of Exercise and Sports Medicine (SBMEE), in a joint guideline with the Brazilian Society of Cardiology (SBC), for all individuals before starting to practice physical or sporting activities.

For beginners between 20 and 39 years old without risk factors, basic exams include electrocardiogram at rest, complete blood count, fasting blood glucose, total cholesterol and fractions, triglycerides, renal function and type I urine. For those over 40 years old or with cardiovascular risk factors, an exercise test and echocardiogram are added and, depending on the profile, 24-hour Holter and hormonal tests.

“The exam protocol is not the same for everyone. A 35-year-old adult with no family history and no comorbidities has a different starting point than someone with hypertension or overweight. The doctor is the one who defines this path — and the clinical consultation, with a complete history and physical examination, always comes before the laboratory tests”, warns Dr. Carlos Eduardo Suaide.

The World Health Organization (WHO) recommends that adults accumulate between 150 and 300 minutes of moderate-intensity aerobic physical activity per week, or between 75 and 150 of vigorous intensity. The institution reinforces that the starting point must be small, with gradual progression of frequency, intensity and duration over time.

Safe practice also depends on adequate nutrition, quality sleep and monitoring by a qualified physical education professional to set up and adjust the progression of training. And even those who are far from the initial goal already benefit from the movement.

Below, check out other tips and tests to start exercising safely:

1. The clinical consultation comes before the exams, not the other way around

A common mistake is arriving at the laboratory without having seen a doctor. The anamnesis (clinical history) and physical examination are what define which tests are necessary for each profile. Scheduling exams on your own, without this screening, can leave important gaps and generate unnecessary costs.

2. Heart disease is silent at rest

Hypertrophic cardiomyopathy is responsible for the abnormal thickening of the heart muscle. Those who have this condition usually do not experience symptoms until they put their heart under intense strain. The electrocardiogram at rest is capable of identifying changes that would go unnoticed in everyday life.

3. Above 40, the exercise test is not optional

The stress electrocardiogram evaluates how the heart behaves under real load: frequency, rhythm, pressure and response to exercise, and is a standard part of the pre-participation assessment. The Brazilian Society of Cardiology (SBC) recommends the test as an essential exam in check-up preventive care for men over 40 and women over 50.

4. Blood glucose and cholesterol reveal risks that training can worsen before improving

Anyone who starts training with undiagnosed diabetes or highly altered cholesterol is subject to unpredictable metabolic responses in the first few weeks. Identifying these conditions before starting allows the doctor to adjust the training protocol — intensity, duration, frequency — in a way that is compatible with the actual metabolic state.

5. Gradual progression is not a lack of ambition, it is physiology

The WHO recommends starting small and progressing gradually. The reason is concrete: tendons, ligaments and cartilage adapt at a slower rate than muscles and the cardiovascular system. Those who ignore this in the first few months tend to stop due to injury before completing 90 days.

By Barbara Cheffer