The DOI matches its Crossref record; 47 of the 47 references it cites were found in a registry or an index; 3 of the 11 sources its claims cite were checked for support.
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.
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
16 Own result · 6 Own method · 5 No full text of the sources · 5 Own interpretation · 2 Supported so far · 2 No basis given
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Abstract
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Also stated in: § RESULTS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 1. C HARACTERISTICS OF THE S UBJECTS W HO D IED S UDDENLY AND T HOSE W
plaincorrelationaln = 122- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The relative risk associated with an acute episode of vigorous exertion was not significantly modified by the time of death.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Effect of Time of Death
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 1. C HARACTERISTICS OF THE S UBJECTS W HO D IED S UDDENLY AND T HOSE W
plaincorrelationaln = 122- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Overall Risk Associated with Vigorous Exercise at Base Line
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 1. C HARACTERISTICS OF THE S UBJECTS W HO D IED S UDDENLY AND T HOSE W
plaincorrelationaln = 122- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Abstract
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it was 14.6 (95 percent confidence interval, 9.10 to 23.4) when the duration was estimated to be 40 minutes.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Abstract
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- Also stated in: § Overall Risk Associated with Vigorous Exercise at Base Line · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Sensitivity Analyses
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- It may state two separate claims as one. 5
- Probably not a substantial claim. 6
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 3. R ELATIVE R ISK OF S UDDEN D EATH A SSOCIATED WITH AN E PISODE OF V IGOROUS E XERTION , A CCORDING TO THE TIME OF DEATH.
What the sources say
- Supportedcites [17] source
The source reports findings on myocardial infarction after heavy exertion, including a higher risk in the hour after exertion and a lower relative risk among people who exercised regularly (Results, p. 1). It therefore supports the comparison with nonfatal myocardial infarction. The cardiac-arrest study is cited separately as reference 11 and is not attributed to this source. (LLM, conf=0.93)
- Supportedcites [25] source
This source supports the nonfatal-myocardial-infarction portion of the sentence, to which its citation is attached. The Study Population (p. 2) identifies patients with documented nonfatal myocardial infarctions, and the Discussion (p. 4) reports increased risk during strenuous physical activity or within an hour afterward. The cardiac-arrest study is attached to a different citation and is not attributed to this source. (LLM, conf=0.91)
- Not checked — no full text of the sourcecites [11] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
- The authors state this as an assumption: Each episode of exertion was associated with 60 minutes of exposure time.
- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 3. R ELATIVE R ISK OF S UDDEN D EATH A SSOCIATED WITH AN E PISODE OF V IGOROUS E XERTION , A CCORDING TO THE TIME OF DEATH.
What the sources say
- Supportedcites [32] source
The Discussion reports that brisk walking, a moderate-intensity activity, was associated with a 30–40% lower risk of coronary events among women. In the citing sentence, the cardiac-arrest claim has a separate citation (37), so it is not attributed to this source. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [36] source
- Not checked — no full text of the sourcecites [37] source
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Effect of Time of Death
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 3. R ELATIVE R ISK OF S UDDEN D EATH A SSOCIATED WITH AN E PISODE OF V IGOROUS E XERTION , A CCORDING TO THE TIME OF DEATH.
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Definitions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“The casecrossover study design permits the assessment of change in the risk of an event during a brief”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Study Design
What the sources say
- Not checked — no full text of the sourcecites [13] Maclure M, 1991, Am J Epidemiol source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Third, the rarity of exertion-related sudden death limits the statistical power of the study and tends to produce unstable estimates of risk.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 3. R ELATIVE R ISK OF S UDDEN D EATH A SSOCIATED WITH AN E PISODE OF V IGOROUS E XERTION , A CCORDING TO THE TIME OF DEATH.
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Overall Risk of Sudden and Nonsudden Death from Cardiac Causes
What the sources say
- Not checked — no full text of the sourcecites [23] Cox DR, 1972, J R Stat Soc [B] source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“An end-points committee of physicians confirmed all events by review of medical records.”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Definitions
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
In the paper
“However, habitual vigorous exertion increases basal vagal tone, resulting in increased cardiac electrical stability and in protection against ventricular fibrillation.27”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > T ABLE 3. R ELATIVE R ISK OF S UDDEN D EATH A SSOCIATED WITH AN E PISODE OF V IGOROUS E XERTION , A CCORDING TO THE TIME OF DEATH.
What the sources say
- Not checked — no full text of the sourcecites [27] Hull SS, 1994, Circulation source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
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 source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“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 cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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]
The cited source says what the claim attributes to it.
In the citing paper
“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.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > Abstract
“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).”
§ TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXER TION TRIGGERING OF SUDDEN DEATH FROM CARDIAC CAUSES BY VIGOROUS EXERTION > RESULTS
“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.”
Citations
Cites
Regression Models and Life-Tables
Cox, D. R. (1972) · Journal of the Royal Statistical Society Series B: Statistical Methodology · doi:10.1111/j.2517-6161.1972.tb00899.x · Cited by 39,793
Regression Models and Life-Tables
Cox, D. R. (1992) · Springer Series in Statistics · doi:10.1007/978-1-4612-4380-9_37 · Cited by 26,297
The Case-Crossover Design: A Method for Studying Transient Effects on the Risk of Acute Events
Maclure, M. (1991) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115853 · Cited by 2,327
Final Report on the Aspirin Component of the Ongoing Physicians' Health Study
Steering Committee of the Physicians' Health Study Research Group (1989) · New England Journal of Medicine · doi:10.1056/nejm198907203210301 · Cited by 2,267
Paffenbarger, R. S., Hyde, R. T., Wing, A. L., Lee, I.-M., Jung, D. L., & Kampert, J. B. (1993) · New England Journal of Medicine · doi:10.1056/nejm199302253280804 · Cited by 1,972
Self-citationBlair, S. N. (1996) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1996.03540030039029 · Cited by 1,819
Mittleman, M. A., Maclure, M., Tofler, G. H., Sherwood, J. B., Goldberg, R. J., & Muller, J. E. (1993) · New England Journal of Medicine · doi:10.1056/nejm199312023292301 · Cited by 1,431
Self-citationA meta-analysis of physical activity in the prevention of coronary heart disease.
BERLIN, J. A., & COLDITZ, G. A. (1990) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115704 · Cited by 1,382
Circadian variation in the frequency of sudden cardiac death.
Muller, J. E., Ludmer, P. L., Willich, S. N., Tofler, G. H., Aylmer, G., Klangos, I., & Stone, P. H. (1987) · Circulation · doi:10.1161/01.cir.75.1.131 · Cited by 1,083
Manson, J. E., Hu, F. B., Rich-Edwards, J. W., Colditz, G. A., Stampfer, M. J., Willett, W. C., Speizer, F. E., & Hennekens, C. H. (1999) · New England Journal of Medicine · doi:10.1056/nejm199908263410904 · Cited by 1,005
Self-citationLeon, A. S. (1987) · JAMA · doi:10.1001/jama.258.17.2388 · Cited by 842
The Incidence of Primary Cardiac Arrest during Vigorous Exercise
Siscovick, D. S., Weiss, N. S., Fletcher, R. H., & Lasky, T. (1984) · New England Journal of Medicine · doi:10.1056/nejm198410043111402 · Cited by 838
Estimation of a Common Effect Parameter from Sparse Follow-Up Data
Greenland, S., & Robins, J. M. (1985) · Biometrics · doi:10.2307/2530643 · Cited by 798
Physical Fitness as a Predictor of Mortality among Healthy, Middle-Aged Norwegian Men
Sandvik, L., Erikssen, J., Thaulow, E., Erikssen, G., Mundal, R., & Rodahl, K. (1993) · New England Journal of Medicine · doi:10.1056/nejm199302253280803 · Cited by 788
VIGOROUS EXERCISE IN LEISURE-TIME: PROTECTION AGAINST CORONARY HEART DISEASE
Morris, J. N., Pollard, R., Everitt, M. G., Chave, S. P. W., & Semmence, A. (1980) · The Lancet · doi:10.1016/s0140-6736(80)92476-9 · Cited by 707
Physical Exertion as a Trigger of Acute Myocardial Infarction
Willich, S. N., Lewis, M., Lowel, H., Arntz, H.-R., Schubert, F., & Schroder, R. (1993) · New England Journal of Medicine · doi:10.1056/nejm199312023292302 · Cited by 682
Clinical classification of cardiac deaths.
Hinkle, L. E., & Thaler, H. T. (1982) · Circulation · doi:10.1161/01.cir.65.3.457 · Cited by 640
Work Activity and Coronary Heart Mortality
Paffenbarger, R. S., & Hale, W. E. (1975) · New England Journal of Medicine · doi:10.1056/nejm197503132921101 · Cited by 585
Meta-analysis of Epidemiologic Dose-Response Data
Berlin, J. A., Longnecker, M. P., & Greenland, S. (1993) · Epidemiology · doi:10.1097/00001648-199305000-00005 · Cited by 563
Incidence of Death During Jogging in Rhode Island From 1975 Through 1980
Thompson, P. D. (1982) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.1982.03320430039028 · Cited by 523
Incidence of death during jogging in Rhode Island from 1975 through 1980
Thompson, P. D. (1982) · JAMA: The Journal of the American Medical Association · doi:10.1001/jama.247.18.2535 · Cited by 517
Plaque Rupture and Sudden Death Related to Exertion in Men With Coronary Artery Disease
BURKE, A. P., Farb, A. A., Malcom, G. T., Liang, Y.-H., Smialek, J. E., & Virmani, R. (1999) · JAMA · doi:10.1001/jama.281.10.921 · Cited by 454
Physical Activity and Mortality in Postmenopausal Women
Kushi, L. H. (1997) · JAMA · doi:10.1001/jama.277.16.1287 · Cited by 397
Control Sampling Strategies for Case-Crossover Studies: An Assessment of Relative Efficiency
Mittleman, M. A., Maclure, M., & Robins, J. M. (1995) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a117550 · Cited by 340
Self-citationBlair, S. N. (1996) · JAMA · doi:10.1001/jama.276.3.205 · Cited by 334
A MAIL SURVEY OF PHYSICAL ACTIVITY HABITS AS RELATED TO MEASURED PHYSICAL FITNESS
Kohl, H. W., Blair, S. N., Paffenbarger, R. S., MACERA, C. A., & Kronenfeld, J. J. (1988) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114915 · Cited by 325
Hull, S. S., Vanoli, E., Adamson, P. B., Verrier, R. L., Foreman, R. D., & Schwartz, P. J. (1994) · Circulation · doi:10.1161/01.cir.89.2.548 · Cited by 299
A Mail Survey of Physical Activity Habits as Related to Measured Physical Fitness
Kohl, H. W., Blair, S. N., Paffenbarger, R. S., Macera, C. A., & Kronenfeld, J. J. (1988) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-198810000-00012 · Cited by 298
Exercise and Risk of Stroke in Male Physicians
Lee, I.-M. M., Hennekens, C. H., Berger, K., Buring, J. E., & Manson, J. E. (1999) · Stroke · doi:10.1161/01.str.30.1.1 · Cited by 272
Self-citationSudden cardiac death. Support for a role of triggering in causation.
Willich, S. N., Maclure, M., Mittleman, M. A., Arntz, H. R., & Muller, J. E. (1993) · Circulation · doi:10.1161/01.cir.87.5.1442 · Cited by 246
Self-citationSUDDEN CORONARY DEATH: THE FRAMINGHAM STUDY*
Kannel, W. B., & Thomas, H. E. (1982) · Annals of the New York Academy of Sciences · doi:10.1111/j.1749-6632.1982.tb55203.x · Cited by 239
SELF-REPORTED PHYSICAL ACTIVITY COMPARED WITH MAXIMAL OXYGEN UPTAKE
Siconolfi, S. F., Lasater, T. M., SNOW, R. C. K., & Carleton, R. A. (1985) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a114068 · Cited by 228
Risk Factors for Sudden Cardiac Death in Middle-Aged British Men
Wannamethee, S. G., Shaper, A. G., Macfarlane, P. W., & Walker, M. (1995) · Circulation · doi:10.1161/01.cir.91.6.1749 · Cited by 210
Plasma norepinephrine response to exercise before and after training in humans
Peronnet, F., Cleroux, J., Perrault, H., Cousineau, D., de Champlain, J., & Nadeau, R. (1981) · Journal of Applied Physiology · doi:10.1152/jappl.1981.51.4.812 · Cited by 144
Time Trends in Physical Activity among College Alumni, 1962–1988
Lee, I., Paffenbarger, R. S., & Hsieh, C. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116387 · Cited by 136
Self-citationExercise: A risk for sudden death in patients with coronary heart disease
Cobb, L. A., & Weaver, W. D. (1986) · Journal of the American College of Cardiology · doi:10.1016/s0735-1097(86)80284-4 · Cited by 128
Triggering of Acute Myocardial Infarction by Heavy Physical Exertion
Mittleman, M. A., Maclure, M., Tofler, G. H., Sherwood, J. B., Goldberg, R. J., & Muller, J. E. (1994) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-199405010-00010 · Cited by 120
Self-citationPhysical Activity, Physical Fitness, and Sudden Cardiac Death
Kohl, H. W., Powell, K. E., Gordon, N. F., Blair, S. N., & Paffenbarger, R. S. (1992) · Epidemiologic Reviews · doi:10.1093/oxfordjournals.epirev.a036091 · Cited by 119
Leisure-Time Physical Activity and the Risk of Primary Cardiac Arrest
Lemaitre, R. N., Siscovick, D. S., Raghunathan, T. E., Weinmann, S., Arbogast, P., & Lin, D.-Y. (1999) · Archives of Internal Medicine · doi:10.1001/archinte.159.7.686 · Cited by 114
THE VALIDITY OF SELF-REPORTED EXERCISE-INDUCED SWEATING AS A MEASURE OF PHYSICAL ACTIVITY
Washburn, R. A., GOLDFIELD, S. R. W., Smith, K. W., & McKinlay, J. B. (1990) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a115622 · Cited by 111
Kannel, W. B. (1982) · JAMA · doi:10.1001/jama.1982.03330230055034 · Cited by 32
The incidence of primary cardiac arrest during vigorous exercise
Siscovick, D. S. (1985) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-198511000-00114 · Cited by 20
Manson, J. E., Hu, F. B., Rich-Edwards, J. W., et al. (2000) · Journal of Cardiopulmonary Rehabilitation · doi:10.1097/00008483-200001000-00014 · Cited by 16
Self-citationThe validity of self-reported exercise-induced sweating as a measure of physical activity
Washburn, R., R.W., G., Smith, K. W., & Mckinlay, J. (1991) · doi:10.1097/00042752-199101000-00022 · Cited by 6
Kannel, W. B. (1982) · JAMA · doi:10.1001/jama.248.23.3143 · Cited by 4
Physical activity and mortality in postmenopausal women
Kushi, L. H., Fee, R. M., Folsom, A. R., Mink, P. J., Anderson, K. E., & Sellers, T. A. (1997) · Maturitas · doi:10.1016/s0378-5122(97)11911-9
Research works printed but not linked: 2
- Rothman KJ, Greenland S. Modern epidemiology. 2nd ed. Philadelphia: Lippincott–Raven, 1998:253-79.
- Chae CU, 1997, Circulation, 96, I
Cited by
Sorted by citations
Zeppenfeld, K., Tfelt‐Hansen, J., Riva, M., Winkel, B. G., Behr, E. R., Blom, N. A., Charron, P., Corrado, D., Dagres, N., de Chillou, C., et al. (2022) · European Heart Journal · doi:10.1093/eurheartj/ehac262 · Cited by 3,432
Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., CHAITMAN, B. R., FROMER, M. A., Gregoratos, G., Klein, G. J., Myerburg, R. J., Quiñones, M. A., et al. (2006) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2006.07.010 · Cited by 1,975
2020 ESC guidelines on sports cardiology and exercise in patients with cardiovascular disease
Pelliccia, A., Sharma, S., Gati, S., Bäck, M., Börjesson, M., Caselli, S., Collet, J.-P., Corrado, D., Drezner, J. A., Halle, M., et al. (2021) · European Heart Journal · doi:10.1093/eurheartj/ehaa605 · Cited by 1,958
Zipes, D. P., Camm, A. J., Borggrefe, M., Buxton, A. E., Chaitman, B., Fromer, M., Gregoratos, G., Klein, G., Moss, A. J., Myerburg, R. J., et al. (2006) · Circulation · doi:10.1161/circulationaha.106.178233 · Cited by 1,080
Thompson (2007) · doi:10.1161/circulationaha.107.181485 · Cited by 1,000
“among young individuals and adults with both occult and diagnosed heart disease (5,7,25,29).”
BackgroundSelf-citation
Metadata
- 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 › Public Health, Environmental and Occupational Health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-12, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-12 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
