Exercise and Acute Cardiovascular Events

Abstract

Abstract-Habitual physical activity reduces coronary heart disease events, but vigorous activity can also acutely and transiently increase the risk of sudden cardiac death and acute myocardial infarction in susceptible persons. This scientific statement discusses the potential cardiovascular complications of exercise, their pathological substrate, and their incidence and suggests strategies to reduce these complications. Exercise-associated acute cardiac events generally occur in individuals with structural cardiac disease. Hereditary or congenital cardiovascular abnormalities are predominantly responsible for cardiac events among young individuals, whereas atherosclerotic disease is primarily responsible for these events in adults. The absolute rate of exercise-related sudden cardiac death varies with the prevalence of disease in the study population. The incidence of both acute myocardial infarction and sudden death is greatest in the habitually least physically active individuals. No strategies have been adequately studied to evaluate their ability to reduce exercise-related acute cardiovascular events. Maintaining physical fitness through regular physical activity may help to reduce events because a disproportionate number of events occur in least physically active subjects performing unaccustomed physical activity. Other strategies, such as screening patients before participation in exercise, excluding high-risk patients from certain activities, promptly evaluating possible prodromal symptoms, training fitness personnel for emergencies, and encouraging patients to avoid high-risk activities, appear prudent but have not been systematically evaluated. (Circulation. 2007;115:2358-2368.)Key Words: AHA Scientific Statements Ⅲ death, sudden Ⅲ exercise Ⅲ myocardial infarction Ⅲ coronary disease R egular physical activity is widely advocated by the medical community in part because substantial epidemiological, clinical, and basic science evidence suggests that physical activity and exercise training delay the development of atherosclerosis and reduce the incidence of coronary heart disease (CHD) events. [1][2][3][4] Nevertheless, vigorous physical activity can also acutely and transiently increase the risk of acute myocardial infarction (AMI) and sudden cardiac death (SCD) in susceptible individuals. [5][6][7] This scientific statement presents the cardiovascular complications of vigorous exercise, their pathophysiological substrate, and their incidence in specific patient groups and evaluates strategies directed at reducing these complications. The goal is to provide healthcare professionals with the information they need to adviseThe American Heart Association makes every effort to avoid any actual or potential conflicts of interest that may arise as a result of an outside relationship or a personal, professional, or business interest of a member of the writing panel. Specifically, all members of the writing group are required to complete and submit a Disclosure Questionnaire showing all such relationships that m...

Exercise‐Related Out‐of‐Hospital Cardiac Arrest Among the General Population in the Era of Public‐Access Defibrillation: A Population‐Based Observation in Japan

“…The reasons for these differences between the sexes could not be determined from our data and may result from variations between men and women in exercise participation rates and duration or level of exertion during each exercise session. Sex‐related differences in the prevalence of underlying causes and later onset of coronary heart disease in women may also explain this finding,32, 33 as male sex may be an independent risk factor for cardiac arrest.…”

Exercise Training and Cardiac Rehabilitation in Primary and Secondary Prevention of Coronary Heart Disease

“…112 Survey data from the 1980s and 1990s enable analysis of the incidence of major CV events in patients with CHD enrolled in CRSP programs. 113 Although these events are very serious when they occur, the rate per 1,000,000 patient-hours of ET for cardiac arrest, acute MI, and cardiac death were only 8.6, 4.5, and 1.3, respectively. In all likelihood, better medical management with revascularization, statin therapy, and more potent antiplatelet agents has probably further reduced these rates during the past 2 decades.…”

Impact of cardiac rehabilitation and exercise training programs in coronary heart disease

“…The 2007 American Heart Association scientific statement on exercise and acute CVD events estimated that the risk of any major CV complication (sudden cardiac death, total mortality or MI) is one event in 60,000-80,000 patient-hours. 107 In a study of >25,000 patients participating in 65 CR centers, there was one CVD event for every 8484 exercise tests performed, one CVD event for every 50,000 patient hours of ET, and 1.3 cardiac arrests for every million patient hours of ET. 108 In a review of 4846 CHD patients enrolled in interval and continuous CR regimens in Norway, the difference in event rates were 1 in 129,456 hours of moderate ET and 1 in 23,182 hours of high intensity ET.…”