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Exertion-Related Acute Cardiovascular Events: Pathophysiologic Considerations, Risk Modulators, and Prophylactic Interventions

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Cardiorespiratory Fitness in Cardiometabolic Diseases

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Abstract

Although considerable evidence strongly supports that regular aerobic exercise, increased lifestyle physical activity (PA), improved cardiorespiratory fitness, or combinations thereof, may protect against the development of cardiovascular disease (CVD), exertion-related cardiovascular events have been reported in the medical literature and the lay press, suggesting that vigorous PA (≥6 metabolic equivalents) may trigger sudden cardiac death (SCD) or acute myocardial infarction (AMI) in persons with known or occult CVD. Structural cardiovascular abnormalities, most commonly hypertrophic cardiomyopathy, are the major causes of SCD in younger individuals, whereas atherosclerotic CVD is the most common autopsy finding in individuals >40 years of age. The estimated relative risk of exercise-related cardiac events is inversely related to the individual’s habitual frequency of PA (bouts/week), generally ranges from 2 to 56, and in some cases may increase >100-fold. In the general population, the absolute risk that a cardiovascular event will occur during or soon after vigorous PA has been estimated to be between 1 in 500,000 and 1 in 2.6 million hours. Although higher event rates are reported in exercise-based cardiac rehabilitation, the associated fatality rate remains low in medically supervised programs that are equipped to handle cardiovascular emergencies. Racquet sports, water or cross-country skiing, marathon and triathlon events, highly competitive sports (e.g., basketball), deer hunting, and snow removal are associated with a greater incidence of AMI and SCD than other activities. In conclusion, if the current mantra “exercise is medicine” is embraced, underdosing and overdosing are possible. Thus, exercise may have a typical dose-response curve with a plateau in benefit or even adverse effects, in some individuals, at more extreme levels (i.e., reverse J-shaped curve).

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Acknowledgment

The authors thank Brenda White for her assistance with the preparation of this manuscript.

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Authors and Affiliations

  1. Preventive Cardiology and Cardiac Rehabilitation, Department of Cardiovascular Diseases, Beaumont Health and Wellness Center, Royal Oak, MI, USA

    Barry A. Franklin

  2. Oakland University William Beaumont School of Medicine, Rochester, MI, USA

    Barry A. Franklin

  3. Veterans Affairs Medical Center, Department of Cardiology, Washington, DC, USA

    Peter Kokkinos

  4. Georgetown University School of Medicine, Washington, DC, USA

    Peter Kokkinos

  5. Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA

    Peter Kokkinos

  6. George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Kokkinos

  7. University of South Carolina, Department of Exercise Science, Arnold School of Public Health, Columbia, SC, USA

    Peter Kokkinos

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  1. Barry A. Franklin
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Correspondence to Peter Kokkinos .

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Editors and Affiliations

  1. Veterans Affairs Medical Center, Georgetown University School of Medicine, Rutgers University Department of Kinesiology and Health, University of South Carolina Arnold School of Public Health, George Washington University School of Medicine and Health Sciences, Washington, DC, USA

    Peter Kokkinos

  2. Clinical Research Institute of Northern Virginia, Burke, VA, USA

    Puneet Narayan

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Franklin, B.A., Kokkinos, P. (2019). Exertion-Related Acute Cardiovascular Events: Pathophysiologic Considerations, Risk Modulators, and Prophylactic Interventions. In: Kokkinos, P., Narayan, P. (eds) Cardiorespiratory Fitness in Cardiometabolic Diseases. Springer, Cham. https://doi.org/10.1007/978-3-030-04816-7_7

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