A Bengaluru-based corporate executive in his mid-40s thought he was making a healthy lifestyle change. After years of a demanding desk job, he decided to take up long-distance running and set his sights on completing a 100-km ultramarathon in the United States. He trained diligently, looked fit and had none of the warning signs commonly associated with heart disease.What happened next came as a shock to him. He collapsed on the track during his practice runs. That’s when his friends got him to the emergency room. A medical evaluation revealed severe blockages in all three major coronary arteries supplying blood to his heart. Further investigation showed underlying risk factors that had gone unnoticed for years, including elevated cholesterol levels and a family history of heart disease.The executive was fortunate. His condition was detected before a catastrophic event occurred. The case is a reminder that while running is among the best forms of exercise for cardiovascular health, suddenly taking up intense endurance training in middle age without preparation can sometimes expose underlying disease that has remained silent for years.The problem is not runningRunning does not cause heart disease. In fact, regular aerobic exercise lowers blood pressure, improves cholesterol levels, helps control weight and reduces the risk of diabetes. The concern arises when individuals who have been largely sedentary for years decide to train aggressively for marathons, half-marathons or ultramarathons. Many of my patients in their 40s decide they want to get fit quickly and take care of their heart health. The intention is excellent, but the body and the heart need time to adapt. Done hurriedly without priming the heart, running may damage it.Intense exercise dramatically increases the heart’s workload. Heart rate rises, blood pressure climbs and the demand for oxygen-rich blood surges. If a person already has significant but undiagnosed coronary artery disease or plaques, strenuous exertion can trigger symptoms or, in rare cases, dislodge the plaque, triggering a heart attack.Why middle age deserves special attentionThe 40s are often the decade when long-standing risk factors begin to catch up. High cholesterol, diabetes, hypertension, smoking, obesity and family history can quietly contribute to plaque build-up inside the arteries over many years. Because the process is gradual, many individuals remain completely symptom-free.This is particularly true for busy professionals who may feel healthy enough to exercise but have never undergone a detailed cardiovascular assessment.Story continues below this adWhy cardiac screening mattersAnyone over 40 planning to begin a vigorous running programme — especially if training for endurance events — should understand their cardiovascular risk profile. The first step is a thorough clinical assessment that includes family history, cholesterol levels, blood pressure and blood sugar evaluation.Depending on individual risk factors, doctors may recommend tests such as an electrocardiogram (ECG), echocardiogram and treadmill stress test (TMT).For those with multiple risk factors or suspicious findings, a coronary CT angiography may be considered. The test can identify significant blockages before they cause symptoms and help determine whether a person can safely undertake intensive endurance training. The objective is not to discourage exercise but to ensure that individuals exercise safely.Build fitness graduallyOne of the biggest mistakes new runners make is trying to compress years of conditioning into a few months. Start with walking, progressing to brisk walking and then gradually incorporating jogging and running. The emphasis should be on consistency rather than intensity. Tendons, ligaments, joints and muscles need progressive loading to avoid injury. For someone who has not run in years, the goal should be sustainable fitness rather than a race medal.Story continues below this adStrength training is essentialRunning alone is not enough, particularly after the age of 40. Muscle mass naturally declines with age, increasing the risk of injury and reducing overall physical resilience. So incorporate strength training at least twice a week. Building muscular strength improves posture, supports joints, enhances running efficiency and reduces the risk of common overuse injuries affecting the knees, hips and lower back.A balanced programme combines cardiovascular fitness with muscular strength and flexibility.Pay attention to meal timingExperts also advise avoiding intense runs immediately after heavy meals. Exercise is generally best undertaken at least two hours after eating or before the day’s final large meal. This helps reduce gastrointestinal discomfort and allows the body to perform more efficiently during exercise.Taking up running in your 40s can be one of the smartest investments in long-term health. The Bengaluru executive’s story is not an argument against running. It is a reminder that middle age is the right time to understand your heart, assess your risks and train intelligently.Story continues below this ad(Dr Shetty is lead cardiologist and medical director, Sparsh Hospital, Bengaluru)