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Cited by 199Physical Activity and HealthAcute Myocardial Infarction ResearchCardiac Health and Mental Health

Association of Episodic Physical and Sexual Activity With Triggering of Acute Cardiac Events: Systematic Review and Meta-analysis

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Dahabreh, Issa J.·2011·JAMA
DOI 10.1001/jama.2011.336PMC PMC5479331
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Abstract

CONTEXT: Evidence has suggested that physical and sexual activity might be triggers of acute cardiac events. OBJECTIVE: To assess the effect of episodic physical and sexual activity on acute cardiac events using data from case-crossover studies. DATA SOURCES: MEDLINE and EMBASE (through February 2, 2011) and Web of Science (through October 6, 2010). STUDY SELECTION: Case-crossover studies investigating the association between episodic physical or sexual activity and myocardial infarction (MI) or sudden cardiac death (SCD). DATA EXTRACTION: Two reviewers extracted descriptive and quantitative information from each study. We calculated summary relative risks (RRs) using random-effects meta-analysis and absolute event rates based on US data for the incidence of MI and SCD. We used the Fisher P value synthesis method to test whether habitual physical activity levels modify the triggering effect and meta-regression to quantify the interaction between habitual levels of physical activity and the triggering effect. RESULTS: We identified 10 studies investigating episodic physical activity, 3 studies investigating sexual activity, and 1 study investigating both exposures. The outcomes of interest were MI (10 studies), acute coronary syndrome (1 study), and SCD (3 studies). Episodic physical and sexual activity were associated with an increase in the risk of MI (RR = 3.45; 95% confidence interval [CI], 2.33-5.13, and RR = 2.70; 95% CI, 1.48-4.91, respectively). Episodic physical activity was associated with SCD (RR = 4.98; 95% CI, 1.47-16.91). The effect of triggers on the absolute rate of events was limited because exposure to physical and sexual activity is infrequent and their effect is transient; the absolute risk increase associated with 1 hour of additional physical or sexual activity per week was estimated as 2 to 3 per 10,000 person-years for MI and 1 per 10,000 person-years for SCD. Habitual activity levels significantly affected the association of episodic physical activity and MI (P < .001), episodic physical activity and SCD (P < .001), and sexual activity and MI (P = .04); in all cases, individuals with lower habitual activity levels had an increased RR for the triggering effect. For every additional time per week an individual was habitually exposed to physical activity, the RR for MI decreased by approximately 45%, and the RR for SCD decreased by 30%. CONCLUSION: Acute cardiac events were significantly associated with episodic physical and sexual activity; this association was attenuated among persons with high levels of habitual physical activity.

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  • In virtually all studies, habitual physical activity was inversely related to the likelihood of sudden cardiac death and/or acute myocardial infarction occurring during or immediately after vigorous-intensity exercise.

    “Moreover, in virtually all studies, habitual physical activity was inversely related to the likelihood of SCD and/or AMI occurring during or immediately after vigorous-intensity exercise (1,12,31,39).”

    From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [12]

    The Results section (‘Effect Modification by Habitual Activity Levels’; page unavailable) reports that higher habitual activity generally reduced the risk of MI or SCD triggered during or following episodic exertion. However, the Results describe the studies’ exertion threshold as moderate activity of at least 5–6 METs, so the claim’s restriction to vigorous-intensity exercise is not fully supported. (LLM, conf=0.84)

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  • A recent meta-analysis reported a fivefold increased risk of sudden cardiac death and 3.5-fold increased risk of acute myocardial infarction during vigorous-intensity physical activity (at least 6 METs).

    “A recent meta-analysis reported a fivefold increased risk of SCD and 3.5-fold increased risk of AMI during vigorousintensity physical activity ( Q 6 METs) (12).”

    From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [12]

    The Results sections on episodic physical activity report relative risks of 4.98 for sudden cardiac death and 3.45 for acute myocardial infarction, matching the approximate fivefold and 3.5-fold figures. However, the Results describe the studies’ activity thresholds as varying around 5–6 METs and do not establish that both estimates specifically apply to vigorous activity of at least 6 METs. No page numbers are available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • For every additional exercise bout per week, there was a 30% reduction in the risk of sudden cardiac death and a 45% reduction in the risk of acute myocardial infarction during physical activity.

    “Furthermore, these authors found that for every additional exercise bout per week, there was 30% reduction in the risk of SCD and 45% reduction in the risk of AMI during physical activity (12).”

    From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [12]

  • The cardiovascular risks associated with exercise lessen as individuals become more physically active/fit.

    “In addition, there is considerable evidence that exercise is safe for most people and has many associated health and fitness benefits; exercise-related cardiovascular events are often preceded by warning signs/symptoms; and the cardiovascular risks associated with exercise lessen as individuals become more physically active/fit.”

    From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [12]

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Research works printed but not linked: 1

  1. [1]Lloyd-Jones D Adams RJ Brown TM Writing Group Members; American Heart Association Statistics Committee and Stroke Statistics Subcommittee Heart disease and stroke statistics: 2010 update: a report from the American Heart Association published correction in Circulation. 2010;121(12):e260 Circulation 2010 121 7 e46 e215 20019324

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Authors
Dahabreh, I. J.
Affiliations
Tufts Medical Center (US)
Corresponding author
Dahabreh, Issa J.
ORCID
Dahabreh, Issa J.
Venue
JAMA
Publisher
American Medical Association (AMA)
Published
2011-03-23
Volume
305
Issue
12
Pages
1225
ISSN
  • 0002-9955 (ISSN-L)
  • 0098-7484
DOI
10.1001/jama.2011.336
PMC
PMC5479331
OpenAlex
W2148436434
Cited by
199
References
57
Citations by year
2026: 1 · 2025: 10 · 2024: 4 · 2023: 29 · 2022: 6 · 2021: 7 · 2020: 10 · 2019: 13 · 2018: 14 · 2017: 10 · 2016: 14 · 2015: 13 · 2014: 20 · 2013: 20 · 2012: 22
FWCI
14.62
Type
journal article
Language
en
Open access
Locations
  • JAMA (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • National Center for Research Resources (UL1RR025752)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
sexual activity, acute cardiac events, myocardial infarction, sudden cardiac death, acute coronary syndrome, sex differences
MeSH terms
Coitus, Female, Humans, Male, Middle Aged, Motor Activity, Myocardial Infarction, Risk, Exercise, Case-Control Studies, Death, Sudden, Cardiac, Cross-Over Studies, Acute Coronary Syndrome

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