In everyday life, we tend to rely on how we feel, and in most situations this approach is sufficient. For this reason, before starting sports activities or increasing physical load, screening is often not performed at all or is limited to questionnaires and questions about well-being, past medical conditions, and family history. Such an approach is based on subjective information and assumes that, in the absence of symptoms, the risk of cardiovascular complications is low. However, many changes in heart function can remain asymptomatic and may not affect well-being – especially in people who are accustomed to regular physical activity. At the same time, modern physical activity increasingly involves a deliberate and sometimes rapid increase in load. People independently begin intensive training, purchase gym memberships, take part in mass running events and amateur marathons, often significantly increasing training volume and intensity over a short period of time. Under these conditions, subjective screening alone may be insufficient. Physical activity becomes potentially risky when the level of load does not correspond to the actual condition of the cardiovascular system.
The problem is not sports or the desire to be physically active. The problem is that in many countries, before starting sports activities or significantly increasing physical load, basic objective screening is usually not performed – neither for adults nor for children who are enrolled in sports programs.
Cases of sudden cardiac death during physical activity remain rare, but they most often occur in people who have no symptoms and are confident in their health. It is precisely this absence of symptoms that creates a sense of safety, which may not reflect the actual condition of the cardiovascular system as physical load increases.
A practical perspective on this issue is presented in the article “Cardiovascular Screening in Physically Active Individuals: Findings from an Ambulatory Cross-Sectional Study”, published in the American Journal of Sports Science and Medicine. The study included 96 physically active individuals, both professional athletes and amateurs. Participants ranged in age from 18 to 74 years, with a mean age of 34 years. All participants considered themselves healthy, reported no cardiac symptoms, and had no previously diagnosed cardiovascular diseases. This sample was intentionally chosen: the focus was not on patients, but on people who already engage in regular physical activity and are confident in their health.
Screening was carried out in two stages. First, participants completed standard questionnaires and answered questions about well-being, training habits, and medical history, thereby undergoing subjective screening, which is most commonly used in practice in many countries. This was followed by digital cardiac auscultation using Stethophone, applied as a form of basic objective screening that allows analysis of heart sounds and detection of cardiac murmurs.
The results were revealing. Twenty of the 96 participants, approximately one in five, were found to have heart murmurs requiring further cardiological evaluation. These findings were detected in both men and women, and among both professional athletes and amateurs. It is important to emphasize that the study was not intended to establish diagnoses or restrict people from participating in sports. All participants with suspicious auscultatory findings were referred for further cardiological assessment. In some cases, the murmurs were found to be functional; in others, they required more detailed evaluation and follow-up by a cardiologist. The authors’ key conclusion was not the identification of disease itself, but the recognition that subjective screening alone is insufficient to detect asymptomatic changes in physically active individuals.
We find it particularly valuable that digital auscultation using Stethophone was applied not in laboratory settings, but in real-world sports medicine practice, as an accessible tool for objective screening. This approach makes it possible to identify potential risks in a timely manner, without turning an active person into a patient or depriving sport of its core purpose.
Ultimately, the issue is not fear of physical activity or the search for problems where none exist, but predictability and safety. Physical activity should support health and well-being regardless of age, fitness level, or type of load. Objective screening methods do not interfere with the training process or limit physical activity, but help identify situations in which the heart may require additional attention. It is this approach that allows us to speak of truly healthy and conscious sport – without unnecessary risks and without losing the essence of movement.
Sources
Totska Y, Padalko I, Tereshchenko T, Kasatka O. Cardiovascular Screening in Physically Active Individuals: Findings from an Ambulatory Cross-Sectional Study. American Journal of Sports Science and Medicine. 2025;13(2):30–34. doi:10.12691/ajssm-13-2-2