title: Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors.
abstract: OBJECTIVE
  To test whether greater exercise is associated with progressively lower mortality after a cardiac event.
  
  
  METHODS
  We used Cox proportional hazard analyses to examine mortality vs estimated energy expended by running or walking measured as metabolic equivalents (3.5 mL O2/kg per min per day or metabolic equivalent of task-h/d [MET-h/d]) in 2377 self-identified heart attack survivors, where 1 MET-h/d is the energy equivalent of running 1 km/d. Mortality surveillance via the National Death Index included January 1991 through December 2008.
  
  
  RESULTS
  A total of 526 deaths occurred during an average prospective follow-up of 10.4 years, 376 (71.5%) of which were related to cardiovascular disease (CVD) (International Statistical Classification of Diseases, 10th Revision codes I00-I99). CVD-related mortality compared with the lowest exercise group decreased by 21% for 1.07 to 1.8 MET-h/d of running or walking (P=.11), 24% for 1.8 to 3.6 MET-h/d (P=.04), 50% for 3.6 to 5.4 MET-h/d (P=.001), and 63% for 5.4 to 7.2 MET-h/d (P<.001) but decreased only 12% for ≥7.2 MET-h/d (P=.68). These data represent a 15% average risk reduction per MET-h/d for CVD-related mortality through 7.2 MET-h/d (P<.001) and a 2.6-fold risk increase above 7.2 MET-h/d (P=.009). Relative to the risk reduction at 7.2 MET-h/d, the risk for ≥7.2 MET-h/d increased 3.2-fold (P=.006) for all ischemic heart disease (IHD)-related mortalities but was not significantly increased for non-IHD-CVD, arrhythmia-related CVD, or non-CVD-related mortalities.
  
  
  CONCLUSIONS
  Running or walking decreases CVD mortality risk progressively at most levels of exercise in patients after a cardiac event, but the benefit of exercise on CVD mortality and IHD deaths is attenuated at the highest levels of exercise (running: above 7.1 km/d or walking briskly: 10.7 km/d).
authors.affiliation: Life Sciences Division, Lawrence Berkeley National Laboratory, Berkeley, CA. Electronic address: ptwilliams@lbl.gov.
authors.forename: Paul T
authors.initials: PT
authors.lastname: Williams
authors.affiliation: Department of Cardiology, Hartford Hospital, Hartford, CT.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Thompson
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000401:mortality*; D004734:Energy Metabolism; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D055686:Metabolic Equivalent; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality*; D016016:Proportional Hazards Models; D012306:Risk; D012420:Running / Q000706:statistics & numerical data; D017741:Survivors / Q000706:statistics & numerical data*; D016138:Walking / Q000706:statistics & numerical data