The recent death of actor Siddhaanth Vir Surryavanshi has once again raised an alarm among gym-goers and trainers. Siddhaanth, aged 46, collapsed on November 11, right in the middle of a workout session. The incident came as a shock to his fans as Siddhaant was someone who modelled a very active lifestyle and appeared to be extremely fit.

In a similar incident earlier this year, popular comedian Raju Srivastava suffered a cardiac arrest, reportedly while working out in the gym. He was rushed to the hospital where he later passed away. In 2021, Kannada actor Puneet Rajkumar also suffered a cardiac arrest while working out. Abir Goswami and Siddharth Shukla are some other actors who collapsed in gyms this year. The spate of sudden heart-related deaths while working out has left fitness enthusiasts scrambling for answers.

Indians are generally known to be particularly vulnerable to heart ailments, accounting for more than 13 percent of deaths due to heart attacks globally. According to a report, "the number of deaths due to heart attacks has increased by 51 percent in the last six years. In 2015, more than 18,000 people died due to heart attack, in 2016 the death toll increased to about 22,000 and in 2019 it increased to over 28,000. In 2021, more than 28,400 people died of a heart attack."

While there is no doubt that exercise is good, and can greatly reduce the risk of heart-related issues, doctors suggest that it is also important to exercise caution and not push one's body beyond its ability for the sake of quick results. In other words, take it slow.

According to Dr Sunil Chandy, a noted cardiologist and currently Medical Director, ITC Healthcare, "most of these celebrity deaths are because there's a lot of pressure to get into a particular physique, for a particular role. The actors have very little time to drastically lose weight or become muscular. Often, gym goers overshoot their physiological limits. This spurt of activity triggers fast rhythms that acutely drop blood supply to the brain. They collapse. It's not really a heart attack. It's called 'sudden cardiac death'. Fitness freaks and people conscious of their physique overdo this."

A sudden cardiac death is an abrupt loss of heart function, breathing and consciousness, which is usually caused due to a spurt of activity. This usually occurs when there is an irregularity in the electrical system of your heart. This leads to a disruption in the pumping action of the heart, and eventually stops blood flow to the body.

A heart attack and a sudden cardiac arrest are entirely different. In a sudden cardiac arrest, blood flow to a part of the heart is blocked. However, the two conditions can be interrelated.

A heart attack can sometimes trigger electrical disturbance in the heart which leads to sudden cardiac arrest. While a heart attack has symptoms and is easier to treat, a sudden cardiac arrest, like the name suggests happens with no warning. However, according to studies, "cardiopulmonary resuscitation (CPR), using a defibrillator or even just giving compressions to the chest can improve the chances of survival until emergency workers arrive."

Another condition that is caused by intense exercise, according to Dr Chandy, is the athlete's heart. The term athlete's heart refers to a condition which is caused by changes in the heart because of intense athletic training.

Excessive exercise over a period of time can lead to unique electrical, structural, and functional changes in the heart. When you exercise, your body needs more oxygen and in order to meet that demand, the left ventricle of the heart, which pumps oxygen-rich blood to your aorta and sends it out to your body, handles more blood and a higher blood pressure than normal.

After meeting your body's need for more blood and oxygen for a while, your left ventricle starts to get bigger and develop thicker heart muscle. While this phenomenon is common in athletes and is not exactly harmful, there are rare cases when if not monitored, it can lead to death.

"Again, there are certain sports which have a higher risk of leading to adverse physical conditions. For instance, ski divers, people who swim in ice and rugby players are especially prone to this. They are also prone to a type of muscle disorder which slows down the heart," added Dr Chandy.

He added, "When it comes to actors, gym workouts are a significant part of their schedule. If you notice, most male actors are thin when they start off in the film industry. But over time, they become bulky and muscular. That kind of transformation requires routines like the Valsalva manoeuvre, holding your breath, using weights that are more than required, overdoing things."

The Valsalva manoeuvre is a breathing method that can slow your heart when it's beating too fast. In order to perform it, one must breathe out strongly through the mouth while holding the nose tightly closed. This creates a pressure which can force your heart back to a normal rhythm, but sometimes, because of the raised pressure inside the chest, it can lead to bursting of blood vessels. However, these are rare instances.

Dr Chandy added that even the various types of diets and quick fixes can potentially upset one's body functioning. There are ample varieties of diet solutions these days to lose weight, gain muscle, detox, etc.

While many of these diets can be good for the body, not everything is safe and it is important to research and be well informed before starting any such routine. Another celebrity that died due to heart attack this year was Australian cricketing legend Shane Warne.

Warne was reportedly on a 14-day extreme liquid diet to lose weight. While there is no evidence that his diet was linked to his death, it certainly brought about more discourse around the safety of quick fix and extreme diets.

Dr Chandy also warned about the use of caution while taking pre workout drinks and performance enhancing drinks. These drinks claim to 'help you recover faster' after working out.

While these are over the counter drinks and are taken by almost all gym-goers, it is not entirely risk free. Most pre-workouts contain anywhere from 150 to 300 mg of caffeine per serving and experts recommend making sure one chooses a product with 200mg caffeine or less. Over-caffeination, that is if you take more than the recommended limit can cause high blood pressure, racing heartbeat and nausea.

Dr Chandy adds that when it comes to fitness, there's always two kinds. One is purely for optics, the kind where you try to chisel your body to look a certain way. These are not necessarily fit people. He says that this is the group which uses a lot of steroids and proteins. The other type of fitness is where you focus on your health, not the way you look.

Another major reason for deaths while working out is the fact that a lot of underlying heart conditions go unchecked. People who are genetically predisposed to heart attacks or have a history of diabetes and blood pressure should exercise more caution while working out.

Sudden cardiac death during strenuous physical activity occurs more often in cases when blockages are undiagnosed. Sometimes, it also happens when a known condition is not monitored carefully. Vigorous exercise can therefore lead to plaque rupture or trigger electrical disturbances in the heart leading to cardiac arrest.

Dr Chandy added that after the age of 40, it's always advisable to get a check up done by a doctor before starting on a fitness programme. But some doctors recommend a check up for everyone above 30 due to the current lifestyle patterns.

It is also important to have qualified and highly trained physical trainers. They are trained to monitor progress on the treadmill and warn you about when to stop. But those who want quick results sometimes overdo despite warnings.

Jibin Raj, Director of Team creative fitness with about 15 years in the health and fitness field as a fitness coach said, "I have experienced many clients complain about difficulties they face pre and post workouts. We generally ask for health conditions and exercise background on the first day of commencement. And in selected cases, we do demand blood checkup reports. We seek client feedback on a daily basis and continue to monitor heart rate during the session.

"All our certified trainers are qualified for CPR and first aid, and well capable of handling an emergency situation. If clients push beyond their limit, then they feel dizziness and nausea. Some clients also feel palpitations and shivering often. In such cases, we have to give proper rest to reduce the pulse and heart rate back to normal.

"We strictly prohibit the usage of steroids by any of our clients until and unless doctors prescribe it. If any athletes use steroids without the recommendation of a doctor, it is highly risky and you can collapse any time. There are high chances of getting heart attacks or strokes."

However, steroids are still used widely by many gym-goers, especially those into extreme fitness like bodybuilders and powerlifters. Dr Rajiv Santhosham, a Chennai based body builder and thoracic surgeon says there have been more than 50 deaths in the bodybuilding community in the last one year. One of the reasons he says is because of the unsupervised intake of steroids.

"Bodybuilding and powerlifting are some of the sports that are not tested for drugs across the world. None of the bodybuilding federations in India test anymore. Sports like bodybuilding is a sport which has zero rules. You can intake anything just to look a certain way."

While he stresses on the fact that there is indeed a lot of sacrifice, dedication, discipline and hard work involved in body building, the truth is most bodybuilders take performance enhancing drugs, which may have very adverse health impacts in the long run.

He said, "It is not considered cheating in the sport. Even in the 70s, bodybuilders used steroids, but it was from the pharmacies. Top bodybuilders would ask doctors for a prescription for say, dianabol or testosterone and the dosages they used were way way lesser than the guys who compete in competitions now. The reason those guys were still champions because they were genetically gifted. But now you can't even imagine the amounts the guys who compete in bigger events use."

Dr Santhosham, 44, started his fitness journey at 17 and started competing in bodybuilding competitions at the age of 30. He's won Mr Tamil Nadu a few times and is very aware of what happens in the bodybuilding industry. He said, "a lot of bodybuilders take diuretics, peptides, growth hormones and steroids which are not even tested on human beings.

"There are steroids which were not meant for human use, but are now being taken because it's all underground and made by some unrecognised lab. What is written on the label may not even be what's actually inside.

"There are several minor side effects of steroids that are visible, like hair loss, acne, male breasts. These are minor side effects. and can be treated by other drugs. But there are major side effects which include liver damage, high blood pressure, drop in good cholesterol and rise in bad cholesterol.

"In many cases, people also get depressed when you come off steroids. It's highly addictive. Say you start going to the gym to build your body. The first time you take steroids, you put on 6 kgs in a month, then next time, another few kilos. and then you're hooked.

"Your blood pressure goes up. Your skeletal muscles get big, which is ok. But when the blood pressure goes up, and the electric activity in your heart increases, all your arteries can get affected and can even lead to atherosclerosis, which is basically the buildup of fats, cholesterol and other substances in and on the artery walls.

"This buildup is called plaque. The plaque can cause arteries to narrow, blocking blood flow. High blood pressure over a period of time can swell up the aorta. Aneurysms, an abnormal bulge or ballooning in the wall of a blood vessel can be developed. Growth hormones used over a certain limit can lead to insulin resistance and thereby diabetes.

"There is a huge black market for these drugs. There are peptides which can be bought online. All you have to do is go online and click a button which says this is not for human use, this is for research purposes, you click on agree and then you can buy and use it.

"These are peptides which are not even tested. You have drugs to increase your appetite, you have drugs to increase a weaker muscle group, there are drugs for everything. There is also a particular oil which can be injected into the muscle to build it up. It's not available in India now, but a lot of bodybuilders use it. These things have never been tested.

"The amount of drugs that bodybuilders these days take is also unbelievable. I know the magnitude because I'm a doctor as well as body builder. I know people here who take more than thrice the amount of steroids than Mr Olympia would. They don't care if they die. In my prediction, in the next few years, there will be many young bodybuilders who could die due to kidney issues and other body failures.

"There are people who die on the spot because they take a shot of potassium. Potassium is used for capital punishment in some countries because that's how fast it can kill you. We also used it during heart surgeries.

"But certain diuretics have potassium and certain other diuretics increase your potassium levels. When you put it in your vein, it will kill you instantly. I know someone who took it just because he was told he would look better and he died right in front of his wife."

Reuben, a gym regular said, "The recent reports of deaths has got many of us worried. One of my gym buddies has been complaining of a tight feeling in the chest after his workouts. I think we should get our health checkups done as soon as possible, since many of us in the gym go workout after long stressful work days and don't get enough rest. So it's important to ensure we're not doing any damage to our bodies.

"I also wish there was more clarity about the safety of the pre-workout drinks. Advised by my trainer, I've been taking a pre-workout drink which has caffeine and creatinine. Almost all gym-goers take this drink. But I'm skeptical now if it is safe for the body in the long run."

Dr Santhosham added that it is not just professional bodybuilders who use these steroids, but most people who are into extreme fitness to achieve a particular look. Speaking about celebrities, he said, "How can a 50-year-old actor have muscles like that without taking drugs. It's not physically possible because your testosterone levels will naturally drop.