Podcast Summary: "How Exercise Changes the Heart"

Health Matters by NewYork-Presbyterian
Host: Courtney Allison
Guest: Dr. Sonia Tilani, Sports Cardiologist
Date: November 5, 2025

Episode Overview

This episode explores how different types of exercise can reshape the heart, particularly in athletes, and reveals the nuances between a healthy, well-trained heart and one that may be at risk. Dr. Sonia Tilani, a sports cardiologist and marathon runner, discusses cardiac adaptations in endurance and strength athletes, the importance of sports cardiology screenings, and life-saving strategies for cardiac emergencies in athletic settings.

Key Discussion Points

1. Dr. Tilani’s Personal Journey with Exercise

• Marathon Training as Middle-Age Fitness Kickoff
  • Dr. Tilani shares her experience training for her first marathon as a "late-in-life, slow runner."
  • Emphasizes the importance of making time for personal fitness and using long-term exercise as preparation for healthy aging.
  • Notably mentions: “No matter what, I’m in the best shape that I’ve ever been in my life. And that feels really good.” (03:00)
• The discussion sets a relatable tone, showing even doctors have setbacks and injuries, but the overall journey is what matters.

2. Understanding "Cardio" and Exercise Types

• What Counts as Cardio?
  • Cardio/aerobic exercise includes walking, jogging, basketball, tennis—activities that raise the heart rate and use many body parts.
  • Three Exercise Intensity Levels:
    • Mild: Easy, conversation and singing possible
    • Moderate: Can converse, but not sing
    • Vigorous: Difficult to talk, but not dizzy or lightheaded
    • Quote: “Moderate effort is what we’re trying to go for for heart health—that’s a level where you could have a conversation but you couldn’t sing a song.” (03:30)
  • Strength training (e.g., weightlifting, yoga, Pilates) is also crucial for health but serves different goals than aerobic exercise.

3. What Makes Sports Cardiology Unique?

• Focuses on distinguishing between normal athletic heart adaptations and potential cardiac disease.
  • Role of Sports Cardiologists:
    • Evaluate whether abnormalities on cardiac tests are normal for athletes or cause for concern.
    • Assess the safety of continued participation in sports at a competitive level.
  • Quote: “Our focus … is helping to sort through issues that may come up in an athlete’s training that would help distinguish whether they’re safe to continue to exercise, or they’re not safe…” (04:40)

4. Cardiac Remodeling: How Different Exercises Change the Heart

• Endurance vs. Strength Athletes:
  • Endurance Athletes (e.g. runners, rowers): Larger heart size, lower resting heart rates.
    • “What happens for an endurance athlete is… their heart can actually grow in size.” (06:22)
  • Strength Athletes (e.g. powerlifters): Thicker heart muscles, adapted to pushing heavy loads in bursts.
    • “Because it’s a load that you’re pushing against all the time, the muscle of the heart can get thicker, just like any other muscle in your body.” (06:23)
• “Athlete’s Heart” vs. Heart Disease:
  • Sometimes changes can look abnormal but are actually normal for athletes—distinguishing these is central to sports cardiology.
  • In some cases, deeper investigation reveals serious inherited conditions.
  • Risk discussions with athletes are based on individualized findings.

5. Screening and Sudden Cardiac Death Risk

• How Screenings Work:
  • Standard physical exams rely on a “12-point questionnaire”—family history, symptoms (e.g., fainting), and physical findings.
  • Abnormalities may prompt further testing (e.g., EKG, cardiac MRI).
  • Screening protocols vary across leagues and schools.
  • Risk of sudden cardiac death (SCD) in athletes is exceedingly low but never zero.
    • “The risk of sudden cardiac death in athletes is actually very low … but obviously nobody wants it to ever happen.” (08:19)
  • Some heart issues may go undetectable on screening, underscoring limitations and need for vigilant emergency preparedness.

6. Emergency Response Planning for Athletes

• Critical Elements:
  • Every institution should have a practiced emergency response plan.
  • Defibrillators (AEDs): Should be available at all athletic events.
  • Hands-Only CPR: All staff, trainers, and even players should be trained. Quote:
    • “What determines whether someone survives a cardiac arrest is how quickly they get resuscitated. So hands only CPR can buy time until a defibrillator comes.” (10:38)
  • Practice, Practice, Practice: Drills are as crucial for emergency plans as for athletic performance.
    • “Sometimes you see these videos and … everybody’s running around in circles … because they haven’t practiced that.” (11:20)
  • Everyday Preparedness: “To be honest, all of us should know CPR … this could happen on a plane, this could happen at a family event … Hands only CPR. And that … just buys time until equipment can come.” (11:45)

Notable Quotes & Memorable Moments

• “Unless you’re an elite athlete, we’re all just out there to get our participation medal, right? … At the end, no matter what, I’m in the best shape that I’ve ever been in my life.” – Dr. Tilani (02:07, 02:36)
• “Moderate effort is what we’re trying to go for for heart health—that’s a level where you could have a conversation, but you couldn’t sing a song.” – Dr. Tilani (03:30)
• “Their heart can actually grow in size… their heart rates are often much lower. And those are all parts of the athletic changes that would be normal.” – Dr. Tilani (06:22)
• “The risk of sudden cardiac death in athletes is actually very low… but obviously nobody wants it to ever happen.” – Dr. Tilani (08:19)
• “What determines whether someone survives a cardiac arrest is how quickly they get resuscitated. So hands only CPR can buy time until a defibrillator comes.” – Dr. Tilani (10:38)
• “All of us should know CPR … this could happen on a plane, this could happen at a family event … Hands only CPR … just buys time until equipment can come.” – Dr. Tilani (11:45)

Timestamps for Key Segments

• Dr. Tilani’s marathon training & exercise philosophy: 01:45–03:00
• Defining cardio and exercise intensity: 03:12–04:21
• Sports cardiology and screening athletes: 04:35–08:19
• Distinguishing athlete’s heart from disease: 06:01–08:08
• Screening protocols and sudden cardiac death: 08:08–09:39
• Cardiac remodeling comparison: 09:39–10:29
• Emergency response and preparedness: 10:29–12:28

Final Thoughts

Dr. Tilani emphasizes that exercise, whether for everyday health or elite performance, brings adaptive changes to the heart—most of which are normal and beneficial. The role of sports cardiology is to ensure these adaptations are safe by using careful screening and, just as importantly, by training athletes and teams to be ready for unlikely but possible cardiac emergencies. The episode encourages everyone—athlete or not—to make physical activity a priority and to get trained in hands-only CPR, as it has the potential to save lives both on and off the field.