I believe that before people engage in any strenuous exercise they need to have a medical check which includes an ECG.
Over the past 30 years, colleges and universities have increasingly screened athletes for health conditions that may pose undue risk to sports participation. Sudden cardiac death is the leading cause of death among college athletes, so a primary function of these screenings is to reveal unknown heart conditions.
Research indicates that screenings that incorporate an ECG are more effective at detecting cardiac conditions that put athletes at risk, and more efficient in terms of cost-per-diagnosis of at-risk players, than screenings involving only a physical exam and patient history.
When my kids played high school sports, not that long ago but before Covid, they were required to have a physical with a doctor’s signature.