Ready to hoop it up? Net some benefits on the court, but be wary of risks

It's the most wonderful time of the year to be a basketball fan. And whether you're enjoying the memory of your alma mater's winning buzzer-beater in the NCAA Tournament or hoping to see your favorite pro posterize an opponent in the NBA playoffs, all those high-flying jams and nothing-but-net 3-pointers might have you wondering, "Can I do that?"

Unless your name is LeBron James or Stephen Curry – probably not. But if you're looking for a fun way to get some heart-healthy exercise, basketball is a slam dunk for most people, experts say.

"Basketball is such a physically and emotionally healthy sport," said Dr. Sara Gould, a professor of orthopedic surgery at the University of Alabama at Birmingham. For most people, basketball provides a fun workout and an opportunity to build healthy social ties, said Gould, who has served as team physician for the UAB women's basketball team and as medical director for NBA events worldwide, including the All-Star Game.

And it doesn't take much to get started, she said. "All you basically need is a ball and a flat surface and a hoop."

Health benefits of playing hoops

"Basketball is a great workout," said Dr. Dermot Phelan, director of the Gragg Center for Cardiovascular Performance at Atrium Health Sanger Heart and Vascular Institute in Charlotte, North Carolina. He is also team cardiologist for the NFL's Carolina Panthers and Major League Soccer's Charlotte FC and part of the NBA's Cardiac Screening Advisory Committee.

Like any regular form of exercise, Phelan said, basketball provides benefits such as "lowering blood pressure, keeping weight under control, lowering cholesterol, reducing stress – all of those other factors that we think about when we think about modifiable risk factors for coronary disease or cardiac disease."

Federal physical activity guidelines recommend adults engage in at least 150 minutes of moderate-intensity physical activity or 75 minutes of vigorous-intensity physical activity each week, or a combination of both. The guidelines also suggest moderate- to high-intensity activities to strengthen muscles at least two days per week.

Basketball is a form of high-intensity interval training – short bursts of intense activity followed by periods of rest, said Gould, who is also a co-director of UAB's Sports Medicine Cardiology Clinic for Young Athletes. "That has been shown to be one of the most successful forms of exercise and enhancing conditioning."

During a 40-minute game, a basketball player may run 3 miles or more, studies have shown. Soccer and field hockey players cover more distance, a 2017 review of research published in Sports Medicine found, but basketball had a higher ratio of high-intensity running to sprinting.

A study published in the journal Biology of Sport in 2023 involving 12 recreational players found that playing basketball actually produced a higher heart rate and levels of exertion than a high-intensity workout involving exercises such as pushups and jumping jacks, but the players also considered it more enjoyable.

Advice for heart patients

While great for many people, Phelan said, a high-intensity workout from basketball might not be good for those who have a known cardiac condition – or related symptoms such as chest pain, heart palpitations, a sensation of heart racing, fainting episodes or dizziness from exertion.

That would include people with some rare congenital conditions, he said, such as arrhythmogenic right ventricular cardiomyopathy, or ARVC, which can lead to irregular heartbeats and sudden death.

It also would be a concern for people with hypertrophic cardiomyopathy, or HCM, a thickening of part of the heart muscle that can disrupt the electrical impulses that stimulate heartbeats, Gould said.

Obviously, anybody whose doctor has said they shouldn't play basketball should not play, Gould said. But she and Phelan said that advice about such restrictions has been evolving.

"We used to say if you had those conditions, all you could do was bowl, basically," Gould said. But a recent scientific statement from the American Heart Association and American College of Cardiology, co-written by Phelan, shifts away from blanket bans on competitive sports for people with such conditions.

"We moved away from that because we've recognized the fact that they probably get a long-term benefit from participating," Phelan said. "But we do recognize that there may be a slightly higher risk during that intense play."

The case of basketball player Bronny James, who survived a cardiac arrest caused by a congenital heart defect while in college in 2023, drew attention to links between basketball and heart health. Cardiac arrest, where the heart stops beating, is fatal unless someone quickly intervenes by calling 911, performing CPR and using a defibrillator.

NCAA basketball players have a higher risk of sudden cardiac death as compared with other college athletes, Phelan said, and the higher the level of play, the higher the risk. A study published in the American Heart Association journal Circulation in 2023 found the incidence of sudden cardiac death was greater than 1 in 2,000 over a four-year Division I career for Black and white men's basketball players. That compares with about 1 in 16,000 for all types of athletes.

"We don't know why," Gould said. "There are so many different theories about why that could be," ranging from the nature of data collection to something about the genetics or physiology of athletes. "This underscores the need for more research," she said.

It also underscores the importance of having automated external defibrillators, or AEDs, widely available wherever basketball and other sports are played, Gould said.

But while the reasons remain a mystery, Phelan said, for the average person, "the likelihood of anything bad happening to you playing basketball is extremely low, and yet the benefits are very high."

What to know before hitting the court

Phelan said there's a paradox involving high-intensity training. The odds of a heart rhythm disturbance are highest during such exercise, but if you do it regularly, your overall long-term risk is better than if you don't exercise.

But if you're headed straight from the couch to the court, don't try to be Michael Jordan, Dr. J or Caitlin Clark right away.

"The advice we always give is start slow and work up, and don't begin with playing competitive games," Phelan said. Ease into things to make sure your body can tolerate it.

A little cross-training can help prevent the knee injuries often associated with the game, Gould said. A lot of those injuries are related to jumping, she said, and weak muscles are often the cause.

Watch somebody who isn't conditioned jump, Gould said. When they land, their legs will bend in at the knees and form an inverted "V" shape. That can be an invitation to a ligament injury.

Cross-training and resistance training can help prevent that, Gould said. Here's a test: Practice jumping in front of a mirror. "When you land, you want your knees to come straight out over your toes." If that's not how you look, "you need to work on those hip abductors," muscles that are important for stability. Try exercises such as wall sits or clamshells (lying on the floor and opening and closing your knees).

Take time to warm up, Gould said. "Don't go play for three hours if you haven't been doing any other physical activity. Maybe bring some extra friends and rotate so that you get rest breaks." Make sure to stay hydrated.

And enjoy being out and about with people, she said. Like any exercise, basketball is "great for stress-reducing, anxiety, all of those things. It's just a really great sport for people to be able to engage in for their overall health."