The heart is most likely to malfunction when placed under more stress acutely than it is used to. An 80 year old who does the stair stepper is much less likely to have a heart attack walking up stairs at home because his heart is working at a lower percentage of its maximum at that point compared to someone who does not work out.
Another important note is that the idea that a heart has a certain number of beats before it gives out is old and pretty silly nowadays. Obviously some beats are different than others, and heart structure/function/energy requirements can alter throughout life.
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