This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 115/17/2358    most recent CIRCULATIONAHA.107.181485v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Costa, F. Search for Related Content PubMed PubMed Citation Articles by Costa, F. Related Collections Acute coronary syndromes Acute myocardial infarction Chronic ischemic heart disease Exercise/exercise testing/rehabilitation Exercise testing Pediatric and congenital heart disease, including cardiovascular surgery

(Circulation. 2007;115:2358-2368.)
© 2007 American Heart Association, Inc.

AHA Scientific Statement

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

In Collaboration With the American College of Sports Medicine; Paul D. Thompson, MD, FAHA, Co-Chair; Barry A. Franklin, PhD, FAHA, Co-Chair; Gary J. Balady, MD, FAHA; Steven N. Blair, PED, FAHA; Domenico Corrado, MD, PhD; N.A. Mark Estes, III, MD, FAHA; Janet E. Fulton, PhD; Neil F. Gordon, MD, PhD, MPH; William L. Haskell, PhD, FAHA; Mark S. Link, MD; Barry J. Maron, MD; Murray A. Mittleman, MD, FAHA; Antonio Pelliccia, MD; Nanette K. Wenger, MD, FAHA; Stefan N. Willich, MD, FAHA; Fernando Costa, MD, FAHA

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.

Key Words: AHA Scientific Statements • death, sudden • exercise • myocardial infarction • coronary disease

This article has been cited by other articles:

				C. Foster, J. P. Porcari, R. A. Battista, B. Udermann, G. Wright, and A. Lucia The Risk in Exercise Training American Journal of Lifestyle Medicine, July 1, 2008; 2(4): 279 - 284. [Abstract] [PDF]

				S. von Klot, M. A. Mittleman, D. W. Dockery, M. Heier, C. Meisinger, A. Hormann, H.- E. Wichmann, and A. Peters Intensity of physical exertion and triggering of myocardial infarction: a case-crossover study Eur. Heart J., June 5, 2008; (2008) ehn235v1. [Abstract] [Full Text] [PDF]

				C. Pitsavos, S. A. Kavouras, D. B. Panagiotakos, S. Arapi, C. A. Anastasiou, S. Zombolos, P. Stravopodis, Y. Mantas, Y. Kogias, A. Antonoulas, et al. Physical Activity Status and Acute Coronary Syndromes Survival: The GREECS (Greek Study of Acute Coronary Syndromes) Study J. Am. Coll. Cardiol., May 27, 2008; 51(21): 2034 - 2039. [Abstract] [Full Text] [PDF]

				N. K. Wenger Current Status of Cardiac Rehabilitation J. Am. Coll. Cardiol., April 29, 2008; 51(17): 1619 - 1631. [Abstract] [Full Text] [PDF]

				S. Mohlenkamp, N. Lehmann, F. Breuckmann, M. Brocker-Preuss, K. Nassenstein, M. Halle, T. Budde, K. Mann, J. Barkhausen, G. Heusch, et al. Running: the risk of coronary events : Prevalence and prognostic relevance of coronary atherosclerosis in marathon runners Eur. Heart J., April 21, 2008; (2008) ehn163v1. [Abstract] [Full Text] [PDF]

				B. R. Chaitman An Electrocardiogram Should Not Be Included in Routine Preparticipation Screening of Young Athletes Circulation, November 27, 2007; 116(22): 2610 - 2615. [Full Text] [PDF]

				M. A. Mittleman Air Pollution, Exercise, and Cardiovascular Risk N. Engl. J. Med., September 13, 2007; 357(11): 1147 - 1149. [Full Text] [PDF]

				J. Hendry Guidelines Advise Exercise Management for At-Risk Patients DOC News, August 1, 2007; 4(8): 5 - 5. [Full Text]