title: Association of Exercise and Metabolic Equivalent of Task (MET) Score with Survival Outcomes after Out-of-Hospital Cardiac Arrest of Young and Middle Age.
abstract: Regular physical activity is recommended to prevent cardiovascular disease including out-of-hospital cardiac arrest (OHCA). However, it is uncertain whether the intensity during physical activity is associated with better outcomes. We studied the effect of exercise at the time of arrest and the association between metabolic equivalent of task (MET) score and survival of OHCA patients of young and middle age.
  
  
  
  All OHCAs of presumed cardiac etiology who were 18-65 years of age and were witnessed by a layperson between 2013 and 2015 were analyzed. The main exposure of interest was physical activity at the time of, or immediately prior to, the arrest and the MET score groups (0-3 for light, 3-6 for moderate, and ≥6 for vigorous). The endpoint was survival with good neurological recovery. For the sensitivity analysis, we created a matched dataset by matching for age, gender, residential area, and comorbidities (diabetes, hypertension, heart disease, and stroke). Multivariable logistic regression analysis was performed, adjusting for patient and arrest-environmental factors.
  
  
  
  A total of 6,273 patients in the original dataset were included, and 762 (12.1%) patients had a cardiac arrest during exercise. The exercise-related OHCAs were more likely to have a good neurological recovery rate (25.9%) than the non-exercise-related OHCA (12.9%) in the original dataset (AOR (95% CI): 1.36 (1.08-1.70)) but not in the matched dataset (1.37 (0.92-1.97)). Using MET score groups, the moderate-intensity group compared with the non-exercise group was associated with better neurological outcome (1.70 (1.11-2.63)), but neither light-intensity (0.77 (0.40-1.49)) nor vigorous-intensity (1.44 (0.91-2.28)) groups were associated with better outcomes.
  
  
  
  Patients who had an OHCA during exercise were more likely to have neurologically intact survival compared to patients who had an OHCA during periods of non-exercise; however, only the moderate-intensity group was associated with a better neurological outcome.
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: Ro.youngsun@gmail.com.
authors.forename: Young Sun
authors.initials: YS
authors.lastname: Ro
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: shinsangdo@gmail.com.
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University College of Medicine, Republic of Korea. Electronic address: skciva@gmail.com.
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea; Department of Emergency Medicine, Seoul National University Boramae Medical Center, Republic of Korea. Electronic address: emkjhong@gmail.com.
authors.forename: Ki Jeong
authors.initials: KJ
authors.lastname: Hong
authors.affiliation: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Republic of Korea. Electronic address: arendt75@gmail.com.
authors.forename: Ki Ok
authors.initials: KO
authors.lastname: Ahn
mesh_terms: D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D015444:Exercise; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult
keywords: Exercise; Metabolic equivalent of task; Out-of-Hospital Cardiac Arrest