Triggering of Sudden Death from Cardiac Causes by Vigorous Exertion
Open accessAbstract
BACKGROUND: Retrospective and cross-sectional data suggest that vigorous exertion can trigger cardiac arrest or sudden death and that habitual exercise may diminish this risk. However, the role of physical activity in precipitating or preventing sudden death has not been assessed prospectively in a large number of subjects. METHODS: We used a prospective, nested case-crossover design within the Physicians' Health Study to compare the risk of sudden death during and up to 30 minutes after an episode of vigorous exertion with that during periods of lighter exertion or none. We then evaluated whether habitual vigorous exercise modified the risk of sudden death that was associated with vigorous exertion. In addition, the relation of vigorous exercise to the overall risk of sudden death and nonsudden death from coronary heart disease was assessed. RESULTS: During 12 years of follow-up, 122 sudden deaths were confirmed among the 21,481 male physicians who were initially free of self-reported cardiovascular disease and who provided information on their habitual level of exercise at base line. The relative risk of-sudden death during and up to 30 minutes after vigorous exertion was 16.9 (95 percent confidence interval, 10.5 to 27.0; P<0.001). However, the absolute risk of sudden death during any particular episode of vigorous exertion was extremely low (1 sudden death per 1.51 million episodes of exertion). Habitual vigorous exercise attenuated the relative risk of sudden death that was associated with an episode of vigorous exertion (P value for trend=0.006). The base-line level of exercise was not associated with the overall risk of subsequent sudden death. CONCLUSIONS: These prospective data from a study of U.S. male physicians suggest that habitual vigorous exercise diminishes the risk of sudden death during vigorous exertion.
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Claims the paper makes
3 of 11 cited sources checked · 3 supported · 0 flagged
- Findingown data
The relative risk of sudden death during and up to 30 minutes after vigorous exertion was 16.9 (95% CI, 10.5 to 27.0; P<0.001).
“The relative risk of sudden death during and up to 30 minutes after vigorous exertion was 16.9 (95 percent confidence interval, 10.5 to 27.0; P<0.001).”
- Also stated in: § RESULTS · plain
“the relative risk of sudden death during the one-hour period associated with vigorous exertion (Fig. 1), as compared with other time points, was significantly elevated at 16.9 (95 percent confidence interval, 10.5 to 27.0; P<0.001).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Also stated in: § RESULTS · plain
- Findingown data
Men who rarely engaged in vigorous exercise (less than once a week) had a relative risk of sudden death of 74.1 during and 30 minutes after exertion.
“Men who rarely engaged in vigorous exercise (less than once a week) had a relative risk of sudden death of 74.1 in the period during and 30 minutes after exertion.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
The relative risk associated with an acute episode of vigorous exertion was not significantly modified by the time of death.
“The relative risk associated with an acute episode of vigorous exertion was not significantly modified by the time of death.”
Quote in the paperSubstantial claim - Findingown data
Among men who exercised at least five times per week, the risk of sudden death during and after vigorous exertion remained significantly higher than during periods of lighter exertion or none.
“In comparison, men who exercised at least five times per week had a much lower risk (relative risk, 10.9); however, this risk was still significantly higher than that during periods of lighter exertion or none.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
The risk of nonsudden death from coronary heart disease was lower among men who participated in vigorous exercise than among those who did not.
“In contrast, the risk of nonsudden death from coronary heart disease was lower among the men who participated in vigorous exercise than among those who did not.”
Quote in the paperNot a substantial claim
- Findingown data
Men who exercised at least five times per week had a relative risk of sudden death of 10.9 during and 30 minutes after exertion.
“In comparison, men who exercised at least five times per week had a much lower risk (relative risk, 10.9); however, this risk was still significantly higher than that during periods of lighter exertion or none.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
Habitual vigorous exercise attenuated the relative risk of sudden death associated with an episode of vigorous exertion (P for trend=0.006).
“Habitual vigorous exercise attenuated the relative risk of sudden death that was associated with an episode of vigorous exertion (P value for trend= 0.006).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
When the usual duration of vigorous exercise was estimated to be 40 minutes, the relative risk of sudden death in the 60-minute hazard period was 14.6 (95% CI, 9.10 to 23.4).
“it was 14.6 (95 percent confidence interval, 9.10 to 23.4) when the duration was estimated to be 40 minutes.”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
The baseline level of exercise was not associated with the overall risk of subsequent sudden death.
“The base-line level of exercise was not associated with the overall risk of subsequent sudden death.”
- Also stated in: § Overall Risk Associated with Vigorous Exercise at Base Line · plain
“The base-line level of vigorous exercise was not significantly associated with the risk of subsequent sudden death, either before or after potential confounders had been controlled for.”
Quote in the paperNot a substantial claim - Also stated in: § Overall Risk Associated with Vigorous Exercise at Base Line · plain
- Findingown data
When the usual duration of vigorous exercise was estimated to be 20 minutes, the relative risk of sudden death in the 60-minute hazard period was 20.4 (95% CI, 12.7 to 32.7).
“When the usual duration of vigorous exercise was estimated to be 20 minutes, the relative risk of sudden death in the 60-minute hazard period was 20.4 (95 percent confidence interval, 12.7 to 32.7)”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
In the sensitivity analysis including unwitnessed deaths and deaths during sleep, the excess risk of sudden death associated with vigorous exertion was still modified by the frequency of vigorous exercise (P for trend=0.003).
“and this excess risk was still modified by the frequency of vigorous exercise (P for trend=0.003)(Table 4).”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
When deaths that occurred during sleep or were unwitnessed were included as sudden deaths, the relative risk of sudden death in the 60-minute hazard period remained elevated at 13.8 (95% CI, 8.9 to 21.2).
“Finally, if deaths that occurred during sleep or were unwitnessed were included as sudden deaths, the relative risk of sudden death in the 60-minute hazard period remained elevated (relative risk, 13.8; 95 percent confidence interval, 8.9 to 21.2)”
Quote in the paperNot a substantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Findingown data
In a sensitivity analysis using only the period during vigorous exertion (a 30-minute hazard period), the estimated relative risk of sudden death was 44.9 (95% CI, 26.7 to 75.4).
“Using the case-crossover method, we found the estimated relative risk of sudden death during exertion (a 30-minute hazard period) to be higher (relative risk, 44.9; 95 percent confidence interval, 26.7 to 75.4) than that during the 60-minute hazard period”
Quote in the paperNot a substantial claim - Findingown data
During 12 years of follow-up, 122 sudden deaths from cardiac causes occurred among the 21,481 male physicians initially free of self-reported cardiovascular disease who provided baseline information on habitual exercise.
“During 12 years of follow-up, 122 sudden deaths were confirmed among the 21,481 male physicians who were initially free of self-reported cardiovascular disease and who provided information on their habitual level of exercise at base line.”
- Also stated in: § RESULTS · plain
“During 12 years of follow-up, 122 sudden deaths from cardiac causes occurred among the 21,481 participants.”
Quote in the paperSubstantial claim - Also stated in: § RESULTS · plain
- Findingown data
No further reduction in the risk of nonsudden death from coronary heart disease was observed for a frequency of vigorous exercise of more than once a week.
“However, no further reduction in risk was observed for a frequency of exercise of more than once a week (Table 5).”
Quote in the paperSubstantial claim - Findingreasoning
The absolute excess risk of sudden death associated with an episode of vigorous exertion was 1 excess sudden death per 1.51 million episodes of exertion.
“However, the absolute risk of sudden death during any particular episode of vigorous exertion was extremely low (1 sudden death per 1.51 million episodes of exertion).”
- Also stated in: § RESULTS · hedged
“From these data, the unadjusted difference in risk associated with exposure to vigorous exertion can be estimated at 1 excess sudden death per 1.51 million episodes of vigorous exertion.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Also stated in: § RESULTS · hedged
- Interpretationown data
Because the study and the earlier retrospective study included only men, these data may not apply to women.
“Finally, our study and the earlier retrospective study 11 included only men, and therefore these data may not apply to women.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] source
- Interpretationown data
The risk of sudden death was transiently elevated in association with an episode of vigorous exertion by a factor of 14 to 45, as compared with the risk during periods of lighter or no exertion.
“the risk of sudden death was transiently elevated in association with an episode of vigorous exertion by a factor of 14 to 45, as compared with the risk during periods of lighter or no exertion.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Premisecitation
Acute bouts of exercise activate the sympathetic nervous system and decrease vagal activity, leading to an acute increase in susceptibility to ventricular fibrillation.
“Acute bouts of exercise activate the sympathetic nervous system and decrease vagal activity, leading to an acute increase in susceptibility to ventricular fibrillation.26”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [26] Peronnet F, 1981, J Appl Physiol source
- Study design and conductnone given
The baseline data on the frequency of vigorous exertion were not updated during the study.
“Second, the base-line data on the frequency of vigorous exertion were not updated during the study.”
Quote in the paperSubstantial claim - Interpretationown data
The most active men's risk of sudden death remained significantly elevated during and after vigorous exertion in all analyses.
“however, the most active men's risk remained significantly elevated during and after vigorous exertion in all analyses.”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Interpretationown data
Habitually active men had a much lower risk of sudden death in association with an episode of vigorous exertion than men who exercised less than once a week.
“Habitually active men had a much lower risk of sudden death in association with an episode of vigorous exertion than men who exercised less than once a week”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Study design and conductown data
The study had no information about moderate levels of activity, in which men in the sedentary category could have been participating regularly.
“First, we had no information about moderate levels of activity, in which the men in our sedentary category could have been participating regularly.”
Quote in the paperSubstantial claim - Study design and conductown data
The study lacked information on the duration of vigorous exertion.
“In addition, we lacked information on the duration of vigorous exertion.”
Quote in the paperNot a substantial claim - Interpretationown data
The absolute magnitude of the increase in risk associated with vigorous exertion is extremely small.
“The absolute magnitude of the increase in risk associated with vigorous exertion is extremely small”
Quote in the paperSubstantial claim- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Interpretationreasoning
The magnitude of the relative risk associated with an acute episode of vigorous exertion should be viewed as an estimate.
“For both of these reasons, the magnitude of the relative risk associated with an acute episode of vigorous exertion should be viewed as an estimate.”
Quote in the paperSubstantial claim
- May combine two claims. 5
- Classified as probably not a substantial claim. 6
May combine two claims.
InterpretationcitationThese results are similar to those reported for nonfatal myocardial infarction and corroborate those previously reported in a population-based, retrospective case-control study of victims of cardiac arrest.
“These results are similar to those reported for nonfatal myocardial infarction 17,25 and corroborate those previously reported in a population-based, retrospective casecontrol study of victims of cardiac arrest.11”
Quote in the paperNot a substantial claim2 of 3 sources checked- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
Classified as probably not a substantial claim. May combine two claims.
PremisecitationModerate physical activity is associated with a markedly reduced risk of coronary events and cardiac arrest.
“Moderate physical activity is associated with a markedly reduced risk of coronary events 32,36 and cardiac arrest, 37 and therefore it might also protect against sudden death.”
Quote in the paperSubstantial claim1 of 3 sources checkedMay combine two claims.
Findingown dataThe relative risk associated with vigorous exertion remained significantly elevated at times other than the circadian peak in sudden death, except for the period from midnight to 6 a.m., when exposure to exertion was low.
“In addition, the relative risk associated with vigorous exertion remained significantly elevated at times other than the circadian peak in sudden death, except for the period from midnight to 6 a.m., when exposure to exertion was low.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Findingnone givenThe 23 sudden deaths associated with vigorous exertion in this study make up one of the largest series to date.
“although the number is still quite small, the 23 sudden deaths that were associated with vigorous exertion in this study make up one of the largest series to date.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenTwo cardiologists reviewed medical records and next-of-kin reports for all subjects who died from cardiac causes and reached agreement on whether the death was sudden.
“To identify sudden deaths, medical records and reports from the next of kin for all subjects who had died from cardiac causes were reviewed again by two cardiologists, and agreement was reached on whether the death was sudden.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationThe case-crossover study design permits the assessment of change in the risk of an event during a brief hazard period during and after exposure to a transient risk factor.
“The casecrossover study design permits the assessment of change in the risk of an event during a brief”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [13] Maclure M, 1991, Am J Epidemiol source
May combine two claims.
Study design and conductown dataThe rarity of exertion-related sudden death limits the statistical power of the study and tends to produce unstable estimates of risk.
“Third, the rarity of exertion-related sudden death limits the statistical power of the study and tends to produce unstable estimates of risk.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductown dataThe relative risks of sudden death and nonsudden death from coronary heart disease for the base population were computed with Cox proportional-hazards models with simultaneous control for potential confounders.
“the relative risks of sudden death and nonsudden death from coronary heart disease for the base population of 21,481 men were computed with use of Cox proportional-hazards models 23 with simultaneous control for potential confounders.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23] Cox DR, 1972, J R Stat Soc [B] source
Classified as probably not a substantial claim.
Study design and conductnone givenAn end-points committee of physicians confirmed all events by review of medical records.
“An end-points committee of physicians confirmed all events by review of medical records.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationHabitual vigorous exertion increases basal vagal tone, resulting in increased cardiac electrical stability and in protection against ventricular fibrillation.
“However, habitual vigorous exertion increases basal vagal tone, resulting in increased cardiac electrical stability and in protection against ventricular fibrillation.27”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27] Hull SS, 1994, Circulation source
The authors state this as an assumption.
Each episode of exertion was associated with 60 minutes of exposure time.
“We therefore assumed that each episode of exertion was associated with 60 minutes of exposure time.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
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 [1]
The Results table reports that the relative risk of sudden death during or shortly after vigorous exertion was lower among men who exercised vigorously more often. This supports the claim's direction, but the study measured habitual exercise rather than fitness and examined sudden death in male physicians, not exercise-related cardiovascular risks generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredVigorous-intensity physical activity transiently increases the risk of nonfatal acute myocardial infarction and sudden cardiac death approximately sixfold to 17-fold as compared with resting behavior.
“Retrospective and prospective data suggest that vigorous-intensity physical activity transiently increases the risk of nonfatal AMI and SCD approximately sixfold (31) to 17-fold (1) as compared with resting behavior.”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [1]
The Results report a 16.9-fold increase in sudden cardiac death risk during or shortly after vigorous exertion, supporting the approximately 17-fold figure attributed to this paper. The comparator was periods of lighter exertion or none, not resting behavior alone. The sixfold nonfatal-AMI figure is attached to a different citation. (LLM, conf=0.86)
Experimental — accuracy not yet measuredSome evidence suggests that diabetes mellitus and renal disease may be associated with exercise-related sudden cardiac death and acute myocardial infarction.
“Nonetheless, some evidence suggests that diabetes mellitus and renal disease may be associated with exercise-related SCD and AMI (1,31), and specific recommendations for individuals with these comorbid conditions are incorporated into the new procedures.”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [1]
Table 1 reports that diabetes was more common among men who died suddenly than among those who did not, supporting an association with sudden cardiac death in this cohort. It does not establish that diabetes was associated specifically with exercise-related deaths. The indexed copy does not report a renal-disease association or link either condition to exercise-related acute myocardial infarction. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIn the Physician's Health Study, exercise substantially increased the relative risk of sudden cardiac death.
“In the Physician's Health Study, exercise substantially increased the relative risk of sudden cardiac death, 91”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [91]
The Abstract reports a 16.9-fold relative risk of sudden cardiac death during and up to 30 minutes after vigorous exertion, compared with lighter or no exertion. The claim omits this short-term, vigorous-exertion condition: the Abstract also says habitual exercise was not associated with an increased overall risk of subsequent sudden death. (LLM, conf=0.87)
Experimental — accuracy not yet measuredIn 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 [1]
The transient risks of sudden cardiac death and acute myocardial infarction are substantially higher during acute vigorous physical exertion as compared with rest.
“It is well established that the transient risks of SCD and AMI are substantially higher during acute vigorous physical exertion as compared with those during rest (1,31).”
From Updating ACSM's Recommendations for Exercise Preparticipation Health Screening (2015) · cites this paper as [1]
In the Physician's Health Study, although sudden cardiac death increased during exercise, habitual vigorous exercise reduced the risk of sudden cardiac death during exercise 7-fold.
“In the Physician's Health Study, although sudden cardiac death increased during exercise, habitual vigorous exercise reduced the risk of sudden cardiac death during exercise 7-fold.91”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [91]
Habitual exercise is a factor known to decrease exercise-related sudden cardiac death.
“One factor known to decrease exercise-related sudden cardiac death is habitual exercise.”
From Managing with pacemakers and implantable cardioverter defibrillators (2013) · cites this paper as [91]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Absolute risk is confused with excess risk
MinorThe abstract reports 1 sudden death per 1.51 million episodes as the absolute risk. The results instead give the absolute risk as 1 per 1.42 million episodes and identify 1 per 1.51 million as the excess risk compared with lighter activity or none.
“the absolute risk of sudden death during any particular episode of vigorous exertion was extremely low (1 sudden death per 1.51 million episodes of exertion).”
“The risk of sudden death associated with an episode of vigorous exertion was 1 per 1.42 million episodes or person-hours at risk.Alternatively, the risk of sudden death during periods of lighter exertion or none was 1 death per 23 million person-hours.From these data, the unadjusted difference in risk associated with exposure to vigorous exertion can be estimated at 1 excess sudden death per 1.51 million episodes of vigorous exertion.”
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Self-citationExercise: A risk for sudden death in patients with coronary heart disease
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Self-citationPhysical Activity, Physical Fitness, and Sudden Cardiac Death
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Self-citationThe validity of self-reported exercise-induced sweating as a measure of physical activity
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2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
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“among young individuals and adults with both occult and diagnosed heart disease (5,7,25,29).”
BackgroundSelf-citationEvidence-Based Guidelines for Cardiovascular Disease Prevention in Women
Mosca, L. J., Appel, L. J., Benjamin, E. J., Berra, K. A., Chandra‐Strobos, N., Fabunmi, R. P., Grady, D. G., Haan, C. K., Hayes, S. N., Judelson, D. R., et al. (2004) · Circulation · doi:10.1161/01.cir.0000114834.85476.81 · Cited by 917 · see citing works
European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances
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“Habitual vigorous exercise attenuates risk (76,77).”
BackgroundEpidemiology of Sudden Cardiac Death: Clinical and Research Implications
Chugh, S. S., Reinier, K., Teodorescu, C., Evanado, A., Kehr, E. L., Samara, M. A., Mariani, R., Gunson, K., & Jui, J. (2008) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2008.06.003 · Cited by 732 · see citing works
“An analysis from the Physicians Health Study reported no significant differences in total cholesterol or LDL using a case-control analysis.”
BackgroundThe Spectrum of Epidemiology Underlying Sudden Cardiac Death
Hayashi, M., Shimizu, W., & Albert, C. M. (2015) · Circulation Research · doi:10.1161/circresaha.116.304521 · Cited by 719 · see citing works
“Case–control and case-crossover analyses have demonstrated that vigorous exertion can trigger cardiac arrest(116) and SCD,(119,121) and this risk seems to be greater in men versus women.(119,121) Habitual exercise lowers this transient excess risk of SCD; however for men, the risk remains significantly elevated even a…”
Self-citationUpdating ACSM's Recommendations for Exercise Preparticipation Health Screening
RIEBE, D., FRANKLIN, B. A., THOMPSON, P. D., GARBER, C. E., WHITFIELD, G. P., MAGAL, M., & PESCATELLO, L. S. (2015) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0000000000000664 · Cited by 688 · see citing works
“Less is known about the risks of SCD and AMI during light- to moderate-intensity exercise, but they are assumed to be substantially lower (44).”
BackgroundInfluentialPhysical Activity for Health: What Kind? How Much? How Intense? On Top of What?
Powell, K. E., Paluch, A. E., & Blair, S. N. (2011) · Annual Review of Public Health · doi:10.1146/annurev-publhealth-031210-101151 · Cited by 685 · see citing works
Epidemiology and Genetics of Sudden Cardiac Death
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Self-citationMaron, B. J., Chaitman, B. R., Ackerman, M. J., Bayés de Luna, A., Corrado, D., Crosson, J. E., Deal, B. J., Driscoll, D. J., Estes, N. A. M., Araújo, C. G. S., et al. (2004) · Circulation · doi:10.1161/01.cir.0000128363.85581.e1 · Cited by 591 · see citing works
Cardiac arrest during long-distance running races
Kim, J. H., Malhotra, R., Chiampas, G., d'Hemecourt, P., Troyanos, C., Cianca, J., Smith, R. N., Wang, T. J., Roberts, W. O., Thompson, P. D., et al. (2012) · New England Journal of Medicine · doi:10.1056/nejmoa1106468 · Cited by 597 · see citing works
“Ventricular fibrillation or ventricular tachycardia 6 (26) 7 (88) 0.”
Assessment of Autonomic Function in Cardiovascular Disease
Lahiri, M. K., Kannankeril, P. J., & Goldberger, J. J. (2008) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2008.01.038 · Cited by 562 · see citing works
“The risk of cardiac arrest and sudden death is substantially increased during and immediately after vigorous activity (99,100).”
Sports-Related Sudden Death in the General Population
Marijon, É., Tafflet, M., Celermajer, D. S., Dumas, F., Perier, M., Mustafić, H., Toussaint, J., Desnos, M., Rieu, M., Bénameur, N., et al. (2011) · Circulation · doi:10.1161/circulationaha.110.008979 · Cited by 540 · see citing works
“lthough regular physical activity benefits cardiovascular health,(1) sport, particularly when practiced vigorously, has been shown to increase the risk of dying suddenly during or shortly after exercise.(2,3) The devastating consequences of unexpected sports-related sudden death (SD) and the recent availability of pub…”
BackgroundRognmo, Ø., Moholdt, T., Bakken, H., Hole, T., Mølstad, P., Myhr, N. E., Grimsmo, J., & Wisløff, U. (2012) · Circulation · doi:10.1161/circulationaha.112.123117 · Cited by 511 · see citing works
Mohlenkamp, S., Lehmann, N., Breuckmann, F., Brocker-Preuss, M., Nassenstein, K., Halle, M., Budde, T., Mann, K., Barkhausen, J., Heusch, G., et al. (2008) · European Heart Journal · doi:10.1093/eurheartj/ehn163 · Cited by 487 · see citing works
Autonomic Tone as a Cardiovascular Risk Factor: The Dangers of Chronic Fight or Flight
Curtis, B. M., & O’Keefe, J. H. (2002) · Mayo Clinic Proceedings · doi:10.4065/77.1.45 · Cited by 446 · see citing works
Exercise acts as a drug; the pharmacological benefits of exercise
Vina, J., Sanchis‐Gomar, F., Martinez‐Bello, V, & Gomez‐Cabrera, M. (2012) · British Journal of Pharmacology · doi:10.1111/j.1476-5381.2012.01970.x · Cited by 443 · see citing works
Updated Cardiovascular Prevention Guideline of the Brazilian Society of Cardiology - 2019
Précoma, D. B., de Oliveira, G. M. M., Simão, A. F. L., Dutra, Ó. P., Coelho-Filho, O. R., Izar, M. C. D. O., Póvoa, R., Giuliano, I. D. C. B., Filho, A. C. D. A., Machado, C. A., et al. (2019) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.20190204 · Cited by 469 · see citing works
Prospective Study of Sudden Cardiac Death Among Women in the United States
Albert, C. M., Chae, C. U., Grodstein, F., Rose, L. M., Rexrode, K. M., Ruskin, J. N., Stampfer, M. J., & Manson, J. E. (2003) · Circulation · doi:10.1161/01.cir.0000065223.21530.11 · Cited by 421 · see citing works
Self-citationDose of Jogging and Long-Term Mortality
Schnohr, P., O’Keefe, J. H., Marott, J. L., Lange, P., & Jensen, G. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.11.023 · Cited by 416 · see citing works
Gelsolin superfamily proteins: key regulators of cellular functions
Silacci, P., Mazzolai, L., Gauci, C. G., Stergiopulos, N., Yin, H. L., & Hayoz, D. (2004) · Cellular and Molecular Life Sciences · doi:10.1007/s00018-004-4225-6 · Cited by 418 · see citing works
Franklin, B. A., Thompson, P. D., Al-Zaiti, S. S., Albert, C. M., Hivert, M.-F., Levine, B. D., Lobelo, F., Madan, K., Sharrief, A. Z., Eijsvogels, T. M. H., et al. (2020) · Circulation · doi:10.1161/cir.0000000000000749 · Cited by 410 · see citing works
Self-citationRelationship of Walking to Mortality Among US Adults With Diabetes
Gregg, E. W., Gerzoff, R. B., Caspersen, C. J., Williamson, D. F., & Narayan, K. M. V. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.12.1440 · Cited by 400 · see citing works
Panteleimon Ekkekakis, A., Hall, E. E., & Petruzzello, S. J. (2005) · Journal of Sports Sciences · doi:10.1080/02640410400021492 · Cited by 375 · see citing works
“On the other hand, physical activity of excessive intensity entails risk, leading to an increased incidence of sudden cardiac death (e.g. Albert et al., 2000; Cadroy et al., 2002), musculoskeletal injuries (e.g. Hootman et al., 2001) and suppression of immune function (e.g. Nieman, 1997).”
BackgroundMethodGebel, K., Ding, D., Chey, T., Stamatakis, E., Brown, W. J., & Bauman, A. E. (2015) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2015.0541 · Cited by 344 · see citing works
Emotional and physical precipitants of ventricular arrhythmia
Lampert, R., Joska, T., Burg, M. M., Batsford, W. P., McPherson, C. A., & Jain, D. (2002) · Circulation · doi:10.1161/01.cir.0000031733.51374.c1 · Cited by 347 · see citing works
Evidence-Based Guidelines for Cardiovascular Disease Prevention in Women
Mosca, L., Appel, L., Benjamin, E., Berra, K., Chandra‐Strobos, N., Fabunmi, R., Grady, D., Haan, C., Hayes, S., Judelson, D., et al. (2004) · Circulation · doi:10.1161/01.atv.0000114834.85476.81 · Cited by 783 · see citing works
Autonomic Nervous System Dysfunction
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“The role of exercise and other conditions associated with sympathoexcitation as a major precipitant for MI (169,170) and ventricular arrhythmias and/or sudden cardiac death (171,172), and the proven usefulness of beta-adrenergic blockers to improve survival after MI and in heart failure with reduced ejection fraction…”
BackgroundClinical neurocardiology defining the value of neuroscience-based cardiovascular therapeutics
Shivkumar, K., Ajijola, O. A., Anand, I., Armour, J. A., Chen, P., Esler, M., De Ferrari, G. M., Fishbein, M. C., Goldberger, J. J., Harper, R. M., et al. (2016) · The Journal of Physiology · doi:10.1113/jp271870 · Cited by 308 · see citing works
“While the roles for sympathetic activation as a trigger for life-threatening ventricular arrhythmias (Albert et al. 2000, 2003; Lampert et al. 2002), and for parasympathetic activation’s protective effect (Vanoli et al. 1991; Ng, 2014) are well established, none of the heart rate-based parameters…”
BackgroundMarijon, É., Narayanan, K., Smith, K. L., Barra, S., Basso, C., Blom, M. T., Crotti, L., d’Ávila, A., Deo, R., Dumas, F., et al. (2023) · The Lancet · doi:10.1016/s0140-6736(23)00875-9 · Cited by 329 · see citing works
Self-citationExercise at the Extremes: The Amount of Exercise to Reduce Cardiovascular Events.
Eijsvogels, T., Molossi, S., Lee, D.-C., Emery, M., & Thompson, P. (2016) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2015.11.034 · Cited by 297 · see citing works
“9%) of which were exercise related, occurred in a study of 21,481 male physicians (45).”
BackgroundVanhees, L., Geladas, N. D., Hansen, D., Kouidi, E. J., Niebauer, J., Reiner, Ž., Cornelissen, V., Adamopoulos, S., Prescott, E., & Börjesson, M. (2011) · European Journal of Preventive Cardiology · doi:10.1177/1741826711430926 · Cited by 309 · see citing works
Assessment of parasympathetic reactivation after exercise
Goldberger, J. J., Le, F. K., Lahiri, M., Kannankeril, P. J., Ng, J., & Kadish, A. H. (2006) · American Journal of Physiology-Heart and Circulatory Physiology · doi:10.1152/ajpheart.01118.2005 · Cited by 296 · see citing works
Physical Activity and Mortality in Patients With Stable Coronary Heart Disease
Stewart, R., Held, C., Hadziosmanovic, N., Armstrong, P. W., Cannon, C. P., Granger, C. B., Hagström, E., Hochman, J. S., Köenig, W., Lonn, E., et al. (2017) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2017.08.017 · Cited by 296 · see citing works
“Vigorous exercise may increase CV risk by triggering MI (28) or sudden death (29), and this risk could be greater in patients with stable CHD.”
BackgroundThe short-term mortality consequences of income receipt
Evans, W. N., & Moore, T. (2011) · Journal of Public Economics · doi:10.1016/j.jpubeco.2011.05.010 · Cited by 292 · see citing works
“…1 Triggers for heart attacks include getting out of bed (Elliott, 2001), returning to work on Mondays (Witte et al., 2005), shoveling snow (Heppell et al. 1991), the Christmas season (Phillips et al., 2004) and physical exertion (Albert et al. 2000).”
BackgroundInfluentialBreuckmann, F., Möhlenkamp, S., Naßenstein, K., Lehmann, N., Ladd, S. C., Schmermund, A., Sievers, B., Schlosser, T. W., Jöckel, K., Heusch, G., et al. (2009) · Radiology · doi:10.1148/radiol.2511081118 · Cited by 291 · see citing works
Lampert, R., Olshansky, B., Heidbuchel, H., Lawless, C., Saarel, E., Ackerman, M., Calkins, H., Estes, N. A. M., Link, M. S., Maron, B. J., et al. (2013) · Circulation · doi:10.1161/circulationaha.112.000447 · Cited by 286 · see citing works
Physical Activity, Health Benefits, and Mortality Risk
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“5 to 30 times higher when compared to those who engage even moderate levels of physical activity (twice weekly) [152–154].”
BackgroundExercise Dose in Clinical Practice
Wasfy, M., & Baggish, A. (2016) · Circulation · doi:10.1161/circulationaha.116.018093 · Cited by 222 · see citing works
Triggering of Acute Cardiovascular Disease and Potential Preventive Strategies
Tofler, G. H., & Muller, J. E. (2006) · Circulation · doi:10.1161/circulationaha.105.596189 · Cited by 264 · see citing works
Mont, L., Pelliccia, A., Sharma, S., Biffi, A., Börjesson, M., Brugada, J., Carré, F., Guasch, E., Heidbüchel, H., Gerche, A. L., et al. (2016) · European Journal of Preventive Cardiology · doi:10.1177/2047487316676042 · Cited by 262 · see citing works
Sudden cardiac death in athletes: the Lausanne Recommendations
Bille, K., Figueiras, D., Schamasch, P., KAPPENBERGER, L. J., Brenner, J. I., Meijboom, F. J., & Meijboom, E. J. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000238397.50341.4a · Cited by 252 · see citing works
Lin, J. S., O’Connor, E., Whitlock, E. P., & Beil, T. L. (2010) · Annals of Internal Medicine · doi:10.7326/0003-4819-153-11-201012070-00007 · Cited by 252 · see citing works
“42 million person-hours of exercise (126).”
Chugh, S. S., Reinier, K., Singh, T., Uy‐Evanado, A., Socoteanu, C., Peters, D., Mariani, R., Gunson, K., & Jui, J. (2009) · Circulation · doi:10.1161/circulationaha.108.797035 · Cited by 236 · see citing works
Billman, G. (2009) · American Journal of Physiology. Heart and Circulatory Physiology · doi:10.1152/ajpheart.00534.2009 · Cited by 219 · see citing works
Association of Short-term Ambient Air Pollution Concentrations and Ventricular Arrhythmias
Rich, D. Q., Schwartz, J. D., Mittleman, M. A., Link, M. S., Luttmann‐Gibson, H., Catalano, P. J., Speizer, F. E., & Dockery, D. W. (2005) · American Journal of Epidemiology · doi:10.1093/aje/kwi143 · Cited by 232 · see citing works
Self-citationHigh Intensity Interval Training for Maximizing Health Outcomes.
Karlsen, T., Aamot, I., Haykowsky, M., & Rognmo, Ø. (2017) · Progress in cardiovascular diseases · doi:10.1016/j.pcad.2017.03.006 · Cited by 212 · see citing works
Risk of sports: do we need a pre-participation screening for competitive and leisure athletes?
Corrado, D., Schmied, C. M., Basso, C., Börjesson, M., Schiavon, M., Pelliccia, A., Vanhees, L., & Thiene, G. (2011) · European Heart Journal · doi:10.1093/eurheartj/ehq482 · Cited by 232 · see citing works
Maron, B. J., de Araújo, C. G. S., Thompson, P. D., Fletcher, G. F., de Luna, A. B., Fleg, J. L., Pelliccia, A., Balady, G. J., Furlanello, F., Camp, S. P. V., et al. (2001) · Circulation · doi:10.1161/01.cir.103.2.327 · Cited by 227 · see citing works
Börjesson, M., Urhausen, A. P., Kouidi, E. J., Dugmore, D., Sharma, S., Halle, M., Heidbüchel, H., Björnstad, H. H., Gielen, S., Mezzani, A., et al. (2011) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/hjr.0b013e32833bo969 · Cited by 228 · see citing works
“This step incorporating further risk stratification/evaluation should be performed by a qualified physician, thereby concentrating the physician’s efforts towards the group of individuals with a higher risk of events during PA.”
BackgroundInfluential72-h Kinetics of High-Sensitive Troponin T and Inflammatory Markers after Marathon
Scherr, J., Braun, S., Schuster, T., HARTMANN, C., MOEHLENKAMP, S., Wolfarth, B., Preßler, A., & Halle, M. (2011) · Medicine & Science in Sports & Exercise · doi:10.1249/mss.0b013e31821b12eb · Cited by 228 · see citing works
Are There Deleterious Cardiac Effects of Acute and Chronic Endurance Exercise?
Eijsvogels, T. M. H., Fernández, A. B., & Thompson, P. D. (2015) · Physiological Reviews · doi:10.1152/physrev.00029.2014 · Cited by 229 · see citing works
Exercise and cardiovascular risk in patients with hypertension
Sharman, J. E., La Gerche, A., & Coombes, J. S. (2015) · American Journal of Hypertension · doi:10.1093/ajh/hpu191 · Cited by 224 · see citing works
Mont, L., Pelliccia, A., Sharma, S., Biffi, A., Börjesson, M., Brugada, J., Carré, F., Guasch, E., Heidbüchel, H., Gerche, A. L., et al. (2016) · EP Europace · doi:10.1093/europace/euw243 · Cited by 223 · see citing works
“Whilst intense exercise is an established trigger of coronary events, regular exercise training attenuates this risk.(159)”
BackgroundPaffenbarger, R., Blair, S., & Lee, I. (2001) · International Journal of Epidemiology · doi:10.1093/ije/30.5.1184 · Cited by 246 · see citing works
Self-citationSudden Cardiac Arrest During Sports Activity in Middle Age
Marijon, É., Uy‐Evanado, A., Reinier, K., Teodorescu, C., Narayanan, K., Jouven, X., Gunson, K., Jui, J., & Chugh, S. S. (2015) · Circulation · doi:10.1161/circulationaha.114.011988 · Cited by 214 · see citing works
“4) during vigorous activity among men enrolled in the Physicians’ Health Study.(20,21) Similar sex differences have also been reported in smaller retrospective studies in Finland and in the United States.”
BackgroundMethodResultInfluentialPhysical inactivity: associated diseases and disorders.
Knight, J. A. (2012) · PubMed · Cited by 208 · see citing works
Effects of acute exercise on flow-mediated dilatation in healthy humans
Dawson, E. A., GREEN, D. J., Cable, N. T., & Thijssen, D. H. J. (2013) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00450.2013 · Cited by 207 · see citing works
Dahabreh, I. J. (2011) · JAMA · doi:10.1001/jama.2011.336 · Cited by 199 · see citing works
“One study was nested within the Physicians’ Health Study and enrolled 122 male patients.(37) The other study was nested within the Nurses’ Health Study and enrolled 288 female patients.”
Physical, Psychological and Chemical Triggers of Acute Cardiovascular Events
Mittleman, M. A., & Mostofsky, E. (2011) · Circulation · doi:10.1161/circulationaha.110.968776 · Cited by 199 · see citing works
Self-citationPhysical exertion, exercise, and sudden cardiac death in women.
Whang, W., Manson, J., Hu, F., Chae, C., Rexrode, K., Willett, W., Stampfer, M., & Albert, C. (2006) · Journal of the American Medical Association (JAMA) · doi:10.1001/jama.295.12.1399 · Cited by 190 · see citing works
“Despite all of the known benefits of exercise, there are also well-documented associations between acute episodes of exertion and sudden cardiac death.(9-15) Although exertion-related sudden cardiac deaths are relatively rare compared with other health outcomes, these deaths commonly occur in an unexpected fashion amo…”
BackgroundMethodSelf-citationEXERCISE AND AUTONOMIC FUNCTION IN HEALTH AND CARDIOVASCULAR DISEASE
Rosenwinkel, E. T., Bloomfield, D. M., Arwady, M. A., & Goldsmith, R. L. (2001) · Cardiology Clinics · doi:10.1016/s0733-8651(05)70223-x · Cited by 189 · see citing works
Aerobic exercise conditioning: a nonpharmacological antiarrhythmic intervention
Billman, G. E. (2002) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00874.2001 · Cited by 185 · see citing works
“In a similar manner, a large prospective study of male physicians (2) found that, although the incidence of sudden death significantly increased during or shortly after exercise, the “absolute risk of sudden death during any particular episode of rigorous exertion was extremely low (1 sudden death per 1.”
ResultExercise Prescription and Proscription for Patients With Coronary Artery Disease
Thompson, P. D. (2005) · Circulation · doi:10.1161/circulationaha.104.502591 · Cited by 178 · see citing works
Behavioral and Emotional Triggers of Acute Coronary Syndromes: A Systematic Review and Critique
Strike, P. C., & Steptoe, A. (2005) · Psychosomatic Medicine · doi:10.1097/01.psy.0000155663.93160.d2 · Cited by 179 · see citing works
“An analysis was carried out of deaths in the Physician’s Health Study using case–crossover comparisons with habitual exercise levels measured previously by questionnaire (28).”
MethodDrezner, J. A., Toresdahl, B. G., Rao, A. L., Huszti, E., & Harmon, K. G. (2013) · British Journal of Sports Medicine · doi:10.1136/bjsports-2013-092786 · Cited by 181 · see citing works
Maron, B. J. (2000) · New England Journal of Medicine · doi:10.1056/nejm200011093431911 · Cited by 191 · see citing works
I Diretriz Brasileira de Prevenção Cardiovascular
Simão, A., Précoma, D., Andrade, J., Filho, H. C., Saraiva, J., Oliveira, G., Murro, A., Campos, A., Alessi, A., Avezum, Á., et al. (2013) · Arquivos Brasileiros de Cardiologia · doi:10.5935/abc.2013s012 · Cited by 182 · see citing works
Zipes, D. P., Link, M. S., Ackerman, M. J., Kovacs, R. J., Myerburg, R. J., & Estes, N. A. M. (2015) · Circulation · doi:10.1161/cir.0000000000000245 · Cited by 172 · see citing works
“There may be as yet unrecognized implications for higher risk of SCD associated with intense exercise in subjects in the general population who do not exercise regularly.(21) This observation should be considered in deconditioned athletes who immediately begin a very intense conditioning program.”
BackgroundRich, D. Q., Mittleman, M. A., Link, M. S., Schwartz, J. D., Luttmann‐Gibson, H., Catalano, P. J., Speizer, F. E., Gold, D. R., & Dockery, D. W. (2005) · Environmental Health Perspectives · doi:10.1289/ehp.8371 · Cited by 167 · see citing works
“These methods have been used previously to study triggers of acute cardiovascular events (Albert et al. 2000; D’Ippoliti et al. 2003; Hallqvist et al. 2000; Mittleman et al. 1995; Peters et al. 2000a; Rich et al. 2005).”
MethodSelf-citationRisk Stratification for Arrhythmic Sudden Cardiac Death
Goldberger, J. J., Buxton, A. E., CAIN, M. E., Costantini, O., Exner, D. V., Knight, B. P., Lloyd‐Jones, D. M., Kadish, A. H., Lee, B. K., Moss, A. J., et al. (2011) · Circulation · doi:10.1161/circulationaha.110.959734 · Cited by 167 · see citing works
Lampert, R., Chung, E. H., Ackerman, M. J., Arroyo, A. R., Darden, D., Deo, R., Dolan, J., Etheridge, S. P., Gray, B. R., Harmon, K. G., et al. (2024) · Heart Rhythm · doi:10.1016/j.hrthm.2024.05.018 · Cited by 167 · see citing works
Mourot, L., Bouhaddi, M., Tordi, N., Rouillon, J. D., & Regnard, J. (2004) · European Journal of Applied Physiology · doi:10.1007/s00421-004-1119-0 · Cited by 164 · see citing works
“However, the risk of sudden death is increased during and immediately after exercise (Albert et al. 2000), possibly related to acute changes in autonomic tone (Curtis and O’Keefe 2002).”
BackgroundCardiac Arrest and Sudden Cardiac Death
Myerburg, R. J., & Castellanos, A. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-0398-6.00041-x · Cited by 165 · see citing works
Extreme sacrifice: sudden cardiac death in the US Fire Service
Smith, D. L., Barr, D. A., & Kales, S. N. (2013) · Extreme Physiology & Medicine · doi:10.1186/2046-7648-2-6 · Cited by 162 · see citing works
“Heavy physical exertion [52-54] or strenuous work [55] can trigger the onset of acute CVD events, particularly in sedentary individuals.”
BackgroundCardiovascular Strain of Firefighting and the Risk of Sudden Cardiac Events
Smith, D. L., DeBlois, J. P., Kales, S. N., & Horn, G. P. (2016) · Exercise and Sport Sciences Reviews · doi:10.1249/jes.0000000000000081 · Cited by 159 · see citing works
“Classic studies have temporally linked heavy physical exertion/ strenuous work (such as running or snow shoveling) to the onset of acute cardiovascular events, with the risk being concentrated among individuals who are unaccustomed to such levels of exertion (1,12).”
BackgroundBaggish, A. L., Battle, R. W., Beaver, T. A., Border, W. L., Douglas, P. S., Kramer, C. M., Martinez, M. W., Mercandetti, J., Phelan, D. M. J., Singh, T. K., et al. (2020) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2020.02.009 · Cited by 156 · see citing works
“However, vigorous physical activity, particularly in CAwith underlying cardiovascular disease (CVD), transiently increases the risk of adverse events, including sudden cardiac death (SCD).(5,6) The true incidence of SCD in CA 35 years or younger is unknown, with estimates ranging from 0.”
BackgroundSafety of Sports for Athletes With Implantable Cardioverter-Defibrillators
Lampert, R. J., Olshansky, B., Heidbüchel, H., Lawless, C. E., Saarel, E. V., Ackerman, M. J., Calkins, H. G., Estes, N. A. M., Link, M. S., Maron, B. J., et al. (2017) · Circulation · doi:10.1161/circulationaha.117.027828 · Cited by 156 · see citing works
Kuriachan, V. P., Sumner, G., & Mitchell, L. B. (2015) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2015.01.002 · Cited by 158 · see citing works
“51 million sessions in the Physicians Health Study of 21,481 men followed for 12 years(4).”
BackgroundHair cortisol and the risk for acute myocardial infarction in adult men
Pereg, D., Gow, R. V., Mosseri, M., Lishner, M., Rieder, M. J., Uum, S. H. M. V., & Koren, G. (2010) · Stress · doi:10.3109/10253890.2010.511352 · Cited by 154 · see citing works
“The association between acute stress and cardiovascular morbidity and mortality is well established (Mittleman et al. 1993, 1995; Leor et al. 1996; Albert et al. 2000; Strike et al. 2006; Brotman et al. 2007; Chida and Steptoe 2010).”
BackgroundKop, W. J., Krantz, D. S., Nearing, B. D., Gottdiener, J. S., Quigley, J. F., O’Callahan, M., DelNegro, A. A., Friehling, T. D., Karasik, P., Suchday, S., et al. (2004) · Circulation · doi:10.1161/01.cir.0000124726.72615.60 · Cited by 153 · see citing works
Cardiac autonomic modulation during recovery from acute endurance versus resistance exercise
Heffernan, K. S., Kelly, E. E., Collier, S. R., & Fernhall, B. (2006) · European Journal of Cardiovascular Prevention & Rehabilitation · doi:10.1097/01.hjr.0000197470.74070.46 · Cited by 149 · see citing works
Risgaard, B., Winkel, B. G., Jabbari, R., Glinge, C., Hansen, O. I., Thomsen, J. L., Ottesen, G. L., Haunsø, S., Holst, A. G., & Tfelt‐Hansen, J. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.05.026 · Cited by 145 · see citing works
Physical Activity, Obesity and Cardiovascular Diseases
Lakka, T. A., & Bouchard, C. (2005) · Handbook of experimental pharmacology · doi:10.1007/3-540-27661-0_4 · Cited by 140 · see citing works
Biological Influence of Physical Exercise on Hemostasis
Lippi, G., & Maffulli, N. (2009) · Seminars in Thrombosis and Hemostasis · doi:10.1055/s-0029-1222605 · Cited by 139 · see citing works
“9), but offers protection against this risk in trained subjects.(32) Therefore, although growing evidence indicates that benefit of physical activity may result to some extent from effects on hemostasis and inflammation, the increased burden of cardiovascular complications and sudden death occurring during and immedia…”
BackgroundSudden Cardiac Death in the Older Athlete
Chugh, S. S., & Weiss, J. B. (2015) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2014.10.064 · Cited by 139 · see citing works
Effect of marathon running on inflammatory and hemostatic markers
Siegel, A. J., Stec, J. J., Lipinska, I., Cott, E. M. V., Lewandrowski, K. B., Ridker, P. M., & Tofler, G. H. (2001) · The American Journal of Cardiology · doi:10.1016/s0002-9149(01)01909-9 · Cited by 139 · see citing works
Circumstances of death in adult congenital heart disease
Zomer, A. C., Vaartjes, I. C. H., Uiterwaal, C. S. P. M., van der Velde, E. T., van den Merkhof, L. F. M., Baur, L. H. B., Ansink, T. J. M., Cozijnsen, L., Pieper, P. G., Meijboom, F. J., et al. (2010) · International Journal of Cardiology · doi:10.1016/j.ijcard.2010.09.015 · Cited by 138 · see citing works
“Heavy physical exercise as trigger for sudden death (SD) in adults with CHD has been suggested, but is not as well reported as for coronary artery disease, (isolated) coronary artery anomalies, and hypertrophic cardiomyopathy [19–23].”
BackgroundEvidence for an exercise induced increase of TNF ‐α and IL ‐6 in marathon runners
Bernecker, C., Scherr, J., Schinner, S., Braun, S., Scherbaum, W. A., & Halle, M. (2011) · Scandinavian Journal of Medicine and Science in Sports · doi:10.1111/j.1600-0838.2011.01372.x · Cited by 139 · see citing works
“However, prolonged strenuous exercise such as marathon running may trigger acute myocardial infarction and sudden cardiac death (Maron et al., 1996; Albert et al., 2000).”
BackgroundBigler, E. D. (2004) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617704105146 · Cited by 132 · see citing works
Anderson, C., Mhurchu, C. N., Scott, D. S., Bennett, D., Jamrozik, K., & Hankey, G. (2003) · Stroke · doi:10.1161/01.str.0000077015.90334.a7 · Cited by 147 · see citing works
Incidence of sudden cardiac arrest in high school student athletes on school campus
Toresdahl, B. G., Rao, A. L., Harmon, K. G., & Drezner, J. A. (2014) · Heart Rhythm · doi:10.1016/j.hrthm.2014.04.017 · Cited by 128 · see citing works
Exercise Guidelines in Pregnancy
Zavorsky, G. S., & Longo, L. D. (2011) · Sports Medicine · doi:10.2165/11583930-000000000-00000 · Cited by 127 · see citing works
Williams, P. T., & Thompson, P. D. (2014) · Mayo Clinic Proceedings · doi:10.1016/j.mayocp.2014.05.006 · Cited by 123 · see citing works
Sudden Cardiac Death in the Athlete
Link, M. S., & Estes, N. A. M. (2012) · Circulation · doi:10.1161/circulationaha.111.023861 · Cited by 123 · see citing works
Effect of Sildenafil on Cardiac Performance in Patients With Heart Failure
Hirata, K., Adji, A. I., Vlachopoulos, C. V., & O’Rourke, M. F. (2005) · The American Journal of Cardiology · doi:10.1016/j.amjcard.2005.06.091 · Cited by 122 · see citing works
- Authors
- Albert, C. M., Mittleman, M. A., Chae, C. U., Lee, I.-M., Hennekens, C. H., & Manson, J. E.
- Affiliations
- Brigham and Women's Hospital (US)
- Beth Israel Deaconess Medical Center (US)
- University of Miami (US)
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2000-11-09
- Volume
- 343
- Issue
- 19
- Pages
- 1355-1361
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2319521698
- Cited by
- 1,020
- References
- 44
- Citations by year
- 2026: 8 · 2025: 27 · 2024: 32 · 2023: 36 · 2022: 42 · 2021: 37 · 2020: 45 · 2019: 41 · 2018: 47 · 2017: 61 · 2016: 51 · 2015: 78 · 2014: 43 · 2013: 43 · 2012: 41
- FWCI
- 14.56
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Heart, Lung, and Blood Institute (HL-34595, R01HL034595, K08HL003783)
- National Cancer Institute (R01CA040360, CA 40360)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Effects of Exercise
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- sudden cardiac death, physical activity, habitual exercise, cardiac arrest, coronary heart disease mortality, male physicians, exercise intensity, risk factor control
- MeSH terms
- Adult, Aged, Aged, 80 and over, Coronary Disease, Physical Exertion, Humans, Male, Middle Aged, Prospective Studies, Risk, Risk Factors, Exercise, Proportional Hazards Models, Case-Control Studies, Death, Sudden, Cardiac
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