Heart attacks in the gym: what the Indian cases and the research actually show

What has been reported

This year has brought a steady run of reports of people collapsing during a workout. In September, The Week reported a 47-year-old doctor collapsing mid-workout on CCTV and a 37-year-old dying in a Pune gym. In April, ETV Bharat covered a young man collapsing in a Kashmir gym, alongside the deaths of the actor Puneeth Rajkumar and the comedian Raju Srivastava, both of which followed exercise.

Every one of these is a tragedy, and none of them has been published as a medical case with a confirmed cause. So this page does not guess why any particular person died. What it does is set out what the research says about exercise and the heart, because the reporting has left a lot of people unsure whether going to a gym is safe at all.

It is. But not the way some people do it.

Exercise raises the risk for an hour and lowers it for life

The best evidence comes from a twelve-year study of 21,481 American male doctors, published in the New England Journal of Medicine. During vigorous exercise and for half an hour afterwards, the risk of sudden cardiac death was about seventeen times the risk at rest. That sounds alarming until you see the absolute number: one sudden death per 1.51 million episodes of vigorous exercise.

The more important finding was the second one. The men who exercised vigorously and regularly had a much smaller spike than the men who rarely did. Exercise trains the heart to tolerate exercise. The person most at risk is not the regular lifter but the one who has done nothing for years and then tries to keep up with a twenty-two-year-old on day one.

That is the pattern I would warn any new member about before anything else. The first month is for learning the movements with light weight, and it is not a test of how much you can suffer.

Who is actually at risk

The cardiologists quoted in this year's coverage describe much the same causes: a heart muscle that has thickened abnormally, a coronary artery that is already partly blocked, an inherited rhythm problem, or a family history nobody mentioned. Most of these give no sign at rest, which is why someone can look entirely healthy until the moment they are not.

Three groups deserve a doctor's opinion before they train hard: anyone with diabetes, high blood pressure or kidney disease; anyone with a close relative who died suddenly and young; and anyone who has noticed symptoms during exertion. If that is you, training with diabetes and starting after forty are written for your situation, and both begin with the doctor rather than the gym.

The bodybuilding numbers

One group stands apart. A 2025 study in the European Heart Journal followed 20,286 male bodybuilding competitors. It found 46 sudden cardiac deaths, a rate of about 33 per 100,000 a year among those still competing, with professionals at roughly five times the risk of amateurs. The autopsies that were available consistently showed enlarged hearts.

The study did not set out to establish what caused those enlarged hearts, and I will not claim it did. But as somebody who judges this sport and teaches steroid awareness on a trainers' course, I know what the room talks about. The evidence on what anabolic steroids do to the heart is set out in the steroids guide. Nobody on our floor is coached on them.

The warning signs that come first

The American College of Sports Medicine notes that exercise-related cardiac events are often preceded by symptoms. Stop and get checked if you notice any of these during or after exercise:

• Pain, pressure or tightness in the chest, jaw, arm or upper back
• Breathlessness far out of proportion to the effort
• Feeling faint, dizzy, or actually fainting
• A racing, pounding or irregular heartbeat
• Unusual exhaustion that does not match the session

None of these is something to train through, and a coach who tells you to push past chest pain is not a coach.

What to do before your first heavy session

The ACSM's own screening guidance is deliberately simple. It asks three questions: how active are you now, do you have symptoms or a known heart, kidney or metabolic condition, and how hard do you intend to train. An inactive person with no symptoms and no known disease can start light and build up. Anyone with symptoms or a known condition should get medical clearance first.

In practice that means telling whoever coaches you about your medical history before the first session, building intensity over weeks rather than in one evening, skipping anything that promises to make you train harder than you would naturally, and seeing a doctor about any symptom on the list above. If you have trained at S R Gym and something felt wrong, tell me. That is what I am on the floor for.