Sports
Cardiac Assessment for Endurance Athletes: Dr. Rodrigo Bodanese
Discover the importance of medical evaluation for endurance athletes and how to avoid risks in long-distance events.
Dr. Rodrigo Bodanese, a cardiologist and Ironman athlete, shares essential insights into the heart health of runners. He discusses the necessity of pre-participation medical evaluations and the dangers of competing while sick. A must-read for anyone seeking safe performance.
In an insightful conversation live from the Stemma studio, during the coverage of the NB 42k Porto Alegre 2026 Marathon, renowned cardiologist and athlete Dr. Rodrigo Bodanese was the special guest of Fabio Bessa and Thiago Kawamura. As coordinator of the human physiology and metabolism center at PUC-RS and an experienced triathlete with participations in Ironman, Kona, and Boston, Dr. Bodanese shared his expertise on the heart health of endurance athletes and the necessary precautions for safely tackling long-distance events.
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Pre-Participation Medical Evaluation: An Essential Step for Runners
The discussion focused on the importance of pre-participation sports medical evaluation, especially for events that demand significant physical exertion, such as marathons. Dr. Bodanese emphasized that longer duration events, like a marathon, pose higher risks than half marathons and 10 km races, mainly due to the extended period of exertion. However, any competitive event, regardless of distance, requires a preliminary evaluation.
The protocol recommended by the Brazilian cardiology guidelines and international entities includes a fundamental "tripod":
- Comprehensive Anamnesis: Detailed investigation of exercise-related symptoms, past medical history, and, crucially, family history (unexplained sudden deaths, premature heart attacks). Genetics play a significant role in individual risk.
- Physical Examination: Evaluation for possible alterations such as heart murmurs or hypertension diagnosis, which can influence long-term risk.
- Resting Electrocardiogram (ECG): A simple examination that, combined with the others, can identify about 65% to 70% of the most common risk conditions.
For athletes over 35 or 40, or those engaging in more intense events, additional exams such as stress tests (treadmill) or ergospirometry are valuable. These help identify arrhythmias or signs of cardiac ischemia that might emerge under exertion, guiding the need for more complex investigations. The recommended frequency for these evaluations is annual, ensuring longitudinal monitoring of the athlete's health.
Flu and Competition: When Exertion Becomes a Risk
One of the most frequent questions among athletes is whether to compete or train while having a cold or flu. Dr. Bodanese explained that there isn't a single answer, but there are situations that are a clear "no." If an athlete presents with fever, severe systemic inflammation, persistent cough, or extreme fatigue, the recommendation is not to participate in the event.
The risk lies in the possibility of developing myocarditis, an inflammation of the heart muscle. Even a mild condition, often caused by viral infections (like the flu), can leave lasting effects on the heart, such as areas of fibrosis. These areas, in turn, can trigger arrhythmias under exertion, significantly increasing the risk of sudden cardiac death. Therefore, the decision to compete while ill should be made with extreme caution, always prioritizing long-term health.
The Pursuit of Safe Performance: The Athlete-Cardiologist's Perspective
As an experienced athlete, Dr. Rodrigo Bodanese understands the passion for performance. In his practice, he combines risk prevention with performance optimization. Many athletes seek him out to validate their training zones or for pre-competition evaluations, utilizing tools such as ergospirometry and lactate tests to map each individual's limits and capacity.
Sharing his own experience, Bodanese revealed his goal for the NB 42k Porto Alegre half marathon: to achieve a personal best in the distance, aiming for a time between 1h16 and 1h17. He also mentioned having faced a partial rupture of the plantar plate before the Boston Marathon, where, despite the pain, he managed a personal best. The triathlete's resilience, with the ability to compensate for running rest with swimming and cycling, was crucial in his recovery.
Conclusion
The conversation with Dr. Rodrigo Bodanese underscores a crucial message for all endurance athletes: the pursuit of records and personal bests must always go hand in hand with attention to health. Undergoing periodic medical evaluations and knowing how to listen to one's own body are attitudes that not only ensure safety but also allow for a longer and more fulfilling athletic journey.
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