Guidelines for Heart-Healthy Running
Running is good for your heart. It can reduce risk factors for heart disease through lowering blood pressure, body mass index (weight), and triglycerides, reducing systemic inflammation, and helping boost good cholesterol and insulin sensitivity.
At the same time, running can pose a risk to heart health in some people. In a very few cases—fortunately, quite rare—this risk can be life threatening.
Brett Toresdahl, MD, a sports medicine physician with a research focus on running medicine and sports cardiology, and a member of New York Road Runners'
Medical Advisory Council, spoke at the
2025 HSS NYRR Runner Health Symposium about how runners can take care of their heart.
New York Road Runners works closely with professional medical partners and dedicated volunteers to ensure trained staff are positioned at our events—at the start, along the course, and at the finish area—to respond to the medical needs of runners, spectators, volunteers, and staff.
We also work with medical experts to help runners understand and safeguard their own heart health. And with our medical partner, CrowdRx, we’re teaching runners and others how to respond to cardiac events.
Running’s Benefits to Heart Health
According to Dr. Toresdahl, runners have a 30–45% lower risk of cardiovascular disease and mortality because of all the good ways running helps the heart.
There's probably a diminishing return on investment for running—that is, running very high mileage may not confer added benefits. In fact, at the extremes there may even be a slight increase in the risk of cardiac problems.
Running and Cardiac Risks
Atrial fibrillation (arrhythmia of the heart) is the most common long-term risk associated with running or other endurance exercises. “Symptoms are an irregular heartbeat,” said Dr. Toresdahl. “You might feel palpitations, fatigue, dizziness, or passing out.”
Beta blockers are often used to control irregular heartbeat in the general population, he said, but these are often not well tolerated in runners, so the treatment of choice may be ablation, a minimally invasive surgical procedure.
Changes to the heart rhythm during a race or other strenuous activity can predispose a runner to developing sudden cardiac arrest. “This is where the heart actually stops,” said Dr. Toresdahl, adding that it can happen during running or up to an hour later.
“The overall rate of sudden cardiac arrest among runners is quite low,” he said—just one in 100,000 marathon participants in a study published in 2025. The rate is higher in full marathoners than in those running a half, and it’s six times higher in men than in women.
A viral illnesses or other systemic illness can put a runner at risk for developing an arrhythmia. During COVID, myocarditis was considered a potential issue for runners and others participating in strenuous exercise.
An underlying heart condition can put a runner at risk for cardiac arrest. Under age 35, more often the underlying condition is a congenital electrical or structural abnormality. Those 35 and over are more likely to have coronary artery disease that puts them at risk.
How to Protect Your Heart While Running
Every runner should know their own and their family’s heart health history. “Some underlying heart conditions have a genetic basis,” said Dr. Toresdahl. “Discuss your heart health with your primary care provider or cardiologist.”
If you have an underlying condition, determine with your doctor how to manage it, including how you exercise and participate in races. And whether you have a condition or not, recognize and take seriously symptoms such as palpitations, fatigue, dizziness, or fainting.
Follow these guidelines when racing:
- Don’t race or run hard if you’re sick, especially if you have a fever.
- Know the medications you’re taking and how they might put you at risk. Certain medications, including stimulants for ADHD, diuretics, and Sudafed (pseudoephredrine), as well as caffeine and caffeinated beverages, have been associated with arrhythmias.
- Adjust your race plan to the weather, especially if it’s different from what you’re used to. “If you're coming from a cool or dry condition and going to a hot, humid day, you may not want to try to PR,” said Dr. Toresdahl. The extra stress on your heart could put you at risk.
- Listen to your body and monitor your heart rate throughout the race and particularly with the final push to the finish line when your energy reserves will be depleted the stress on your body will be at its peak. “If you've been running for hours, trying to sprint to the finish line may not be a wise decision," says Dr. Toresdahl. "That's why the final mile of a race can be where some cardiac arrests are most likely to occur.”
Treating Cardiac Arrest in Runners
Dr. Toresdahl noted that the most effective way to treat a cardiac event is to activate an emergency response. “In a race setting, the faster you can get chest compression started, get an AED on a runner, the more likely they are to survive,” he said.
Medical professionals at races are trained to do this, but runners and spectators also play a vital role. The video below includes a demonstration of chest compressions and guidelines from Matt Freidman, medical director of NYRR’s medical partner, CrowdRx, on how to recognize and respond to a cardiac emergency.
“We’ve seen the survival of cardiac arrest increase from 29% to 66% through improved emergency response,” said Dr. Toresdahl. “It’s still a very serious medical event, but thankfully the numbers are trending in the right direction.”
New York Road Runners half marathon and marathon expos have stations to train runners and others in chest compression–only CPR and activating an emergency response, and information on how to quickly call for help if there's a collapsed runner in a race. Learn more here.
“We’re working to continually optimize the race medical support so people can recognize cardiac arrest quickly and get the runner the treatment they need,” said Dr. Toresdahl.