title: The association between self-reported exercise intensity and acute coronary syndrome in emergency department chest pain patients.
abstract: BACKGROUND
  Regular exercise is thought to be protective against coronary artery disease. As a result, some physicians believe that the likelihood of acute coronary syndrome (ACS) in patients with acute chest pain is reduced in those who exercise regularly. We studied the association between self-reported frequency of exercising and the likelihood of ACS in patients presenting to the Emergency Department (ED) with chest pain.
  
  
  METHODS
  A multi-center prospective, descriptive, cohort study design was used in ED patients to determine whether the risk of ACS was reduced in patients who self-reported regular exercise.
  
  
  RESULTS
  There were 1093 patients enrolled. Median (interquartile range) age was 57 (48-67) years; 506 (45.7%) were female. ACS was diagnosed in 248 (22.7%) patients. Patients who did not exercise at least monthly were more likely to be diagnosed with ACS than those who did (129/466 [27.7%] vs. 119/627 [19.0%]; odds ratio 1.63, 95% CI 1.23-2.17). After adjusting for age, gender, body mass index, smoking, and prior history, limited exercise was still associated with ACS (adjusted odds ratio 1.52, 95% CI 1.10-2.10). There was no apparent association between frequency and intensity of exercise and risk of ACS.
  
  
  CONCLUSIONS
  Although self-reported frequency of exercise was significantly associated with a decrease in ACS in ED patients with chest pain, it should not be used to exclude ACS in symptomatic ED patients.
authors.affiliation: Department of Emergency Medicine, Stony Brook University and Medical Center, Stony Brook, New York 11794-8350, USA.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Singer
authors.forename: Henry C
authors.initials: HC
authors.lastname: Thode
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Judd E
authors.initials: JE
authors.lastname: Hollander
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.forename: Robert
authors.initials: R
authors.lastname: Birkhahn
authors.forename: Nathan
authors.initials: N
authors.lastname: Shapiro
authors.forename: Ted
authors.initials: T
authors.lastname: Glynn
authors.forename: Richard
authors.initials: R
authors.lastname: Nowack
authors.forename: Basmah
authors.initials: B
authors.lastname: Safdar
authors.forename: Chadwick
authors.initials: C
authors.lastname: Miller
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lewandrowski
authors.forename: John
authors.initials: J
authors.lastname: Nagurney
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D002637:Chest Pain / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010809:Physical Fitness; D011446:Prospective Studies; D012307:Risk Factors