Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology.
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.
Thompson
Paul D
PD
Hartford Hospital, USA.
Franklin
Barry A
BA
Balady
Gary J
GJ
Blair
Steven N
SN
Corrado
Domenico
D
Estes
N A Mark
NA
Fulton
Janet E
JE
Gordon
Neil F
NF
Haskell
William L
WL
Link
Mark S
MS
Maron
Barry J
BJ
Mittleman
Murray A
MA
Pelliccia
Antonio
A
Wenger
Nanette K
NK
Willich
Stefan N
SN
Costa
Fernando
F
D000208:Acute Disease; D000572:American Heart Association; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000378:metabolism / Q000517:prevention & control*; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control*; D004734:Energy Metabolism; D015444:Exercise; D006801:Humans; D015994:Incidence; D009043:Motor Activity; D015596:Nutrition Assessment; D012307:Risk Factors; D014481:United States