Heart-Risk Assessment for Runners and Marathon Training in London
Individual cardiovascular assessment for people beginning or increasing endurance training, particularly when symptoms, risk factors, known disease or relevant family history need careful interpretation.
Not every runner needs the same tests.
Regular exercise is beneficial for cardiovascular health, but the appropriate evaluation before or during endurance training depends on the individual. Symptoms, age, blood pressure, cholesterol, diabetes, previous illness, medication and family history all influence the assessment.
Dr Bhuva combines general cardiology, cardiovascular imaging and research in exercise adaptation. Testing is targeted to a clinical question and may include no investigation, an ECG, blood tests, echocardiography, rhythm monitoring, exercise testing or specialist imaging.
Reasons to seek assessment
- Chest discomfort, palpitations, dizziness or unusual breathlessness during exercise
- Collapse or near-collapse during or soon after exertion
- Known heart disease or a previous abnormal cardiac test
- High blood pressure, diabetes or important cholesterol concerns
- A family history of premature cardiovascular disease or sudden cardiac death
- Uncertainty about returning to training after illness or a cardiac diagnosis
Decisions based on risk, symptoms and the training goal.
Symptoms first
The pattern, timing and severity of symptoms help determine whether training should pause and which investigation may be useful.
Risk in context
Blood pressure, cholesterol, diabetes, smoking, family history and prior disease are interpreted together rather than as isolated numbers.
Exercise adaptation
Training can produce normal physiological changes. Clinical interpretation helps distinguish expected adaptation from findings that require further review.
Running and heart-assessment questions.
Do I need heart tests before training for a marathon?
Not every runner needs cardiac testing. Assessment is more relevant if you have symptoms, known cardiovascular disease, important risk factors or a family history of premature heart disease or sudden cardiac death. Tests should be selected after clinical review rather than used as a universal package.
Can hard training temporarily change heart-test results?
Yes. Strenuous endurance exercise can temporarily alter heart rate, blood biomarkers and some imaging findings. Timing, symptoms and training load matter when results are interpreted. Persistent symptoms or abnormal findings should be assessed in their clinical context.
Evidence and review.
Dr Bhuva was first author of the peer-reviewed study Training for a First-Time Marathon Reverses Age-Related Aortic Stiffening. The study does not mean every prospective runner requires cardiac testing.
Written and reviewed by Dr Anish Bhuva, Consultant Cardiologist. Last reviewed 2 September 2026. This page provides general information and does not replace an individual medical assessment.
Plan endurance training around your individual cardiovascular health.
If you are planning a marathon or endurance programme and have symptoms, risk factors or a relevant family history, arrange an individual assessment to decide on the most appropriate evaluation for you.