The pursuit of health is fuelling a massive fitness boom across the world, but many medical experts are warning against the much-touted “no pain, no gain” ethos. While regular physical activity remains a cornerstone of good health, excessive exertion can lead to catastrophic consequences.
These warnings grew louder in Thailand when Bangkok-based South African fitness coach Leroy Saunders, 41, collapsed during the BYD HYROX competition in Bangkok on August 13 and died shortly after.
The event, held at Queen Sirikit National Convention Center (QSNCC) from August 13-16, set a regional record by drawing more than 20,000 athletes from over 60 countries.
7 warning signs
Saunders’ sudden death has raised questions over the fine line between peak performance and dangerous overexertion. While pushing boundaries is a core objective on the track, in the gym or during a marathon, health experts warn that red flags should never be ignored.
According to Thailand’s Department of Disease Control, critical warning signs include: crushing chest discomfort; severe heartburn; shooting pain travelling down one or both arms or spreading to the jaw, neck and back; cold sweats; breathing difficulties; sudden dizziness or light-headedness; and loss of consciousness.
“These symptoms could signal an underlying cardiovascular problem,” the department warns, adding that any of these signs means the body has triggered its alarm system.
Dr Akanis Srisukwattana, a prominent sports cardiologist and founder of the Health Performance Team, which specialises in human performance and metabolic testing, explains that intense workouts become dangerous primarily in two scenarios: when participants ignore underlying heart problems or when they exert their bodies beyond trained capacity.
When workouts can kill
Dr Akanis explained that although sudden cardiac arrest while working out is statistically rare, occurring in about 1 in every 100,000 athletes, the risk rises dramatically to 1 in 5,000 in people over the age of 50 or those with underlying conditions.
There is currently no data showing that HYROX carries greater risks than running or other endurance sports. However, HYROX presents a unique physical challenge, combining long-distance running with resistance exercises – like pushing heavy sleds or performing broad-jump burpees, which drive blood pressure and heart rates to far higher peaks than standard workouts.
While intense exercise does not cause heart disease, heavy physical strain can expose hidden cardiac problems, sometimes with fatal results.
A landmark 2019 review published in the British Medical Journal, titled “Mortality During Marathons: A Narrative Review of the Literature”, analysed decades of global data to evaluate the risk of sudden death during marathons.
The review confirmed that though overall mortality is extremely low, approximately 0.67 deaths per 100,000 finishers, the risk changes sharply when divided by gender. Males face a far higher mortality rate of 0.98 per 100,000 runners compared to 0.41 per 100,000 female runners.
Deaths also overwhelmingly occur in the final quarter of the race, when cardiovascular stress, body temperature and dehydration all peak at the same time.
Precaution, prevention and proper recovery
Dr Akanis says conditions like high cholesterol, hypertension, diabetes, smoking history and pre-existing heart disease exponentially increase the risk of cardiac arrest during high exertion. Hence, he said, athletes should always compete at levels they have trained for.
“Don’t work out at an intensity beyond what your body can handle,” he warned.
Despite the risks, survival rates have improved significantly thanks to the widespread adoption of CPR and defibrillators at competitive events.
A study titled “Cardiac Arrest During Long-Distance Running Races” shows that fatalities caused by cardiac arrest during racing events dropped from 71% between 2000 and 2009 to 34% between 2010 and 2023.
The Disease Control Department, meanwhile, advises bystanders to seek immediate first aid or call the 1669 emergency hotline if a runner displays distress or collapses on the field.
Finding the perfect balance
To maintain cardiovascular health without overtaxing the body, the World Health Organization (WHO) recommends that adults aged 18 to 64 engage in 150-300 minutes of moderate-intensity or 75-150 minutes of vigorous-intensity aerobic exercise per week, along with at least two days of muscle strengthening exercises.
Though there are no hard and fast rules about training limits, sports cardiologists agree that the key lies in listening to the body for early warning signs and allowing enough recovery time between demanding sessions.
They also advise people to tailor their fitness goals based on their age, fitness baseline and medical history.
