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Increased Cardiovascular Disease Mortality Associated With Excessive Exercise in Heart Attack Survivors



      To test whether greater exercise is associated with progressively lower mortality after a cardiac event.

      Patients and Methods

      We used Cox proportional hazard analyses to examine mortality vs estimated energy expended by running or walking measured as metabolic equivalents (3.5 mL O2/kg per min per day or metabolic equivalent of task-h/d [MET-h/d]) in 2377 self-identified heart attack survivors, where 1 MET-h/d is the energy equivalent of running 1 km/d. Mortality surveillance via the National Death Index included January 1991 through December 2008.


      A total of 526 deaths occurred during an average prospective follow-up of 10.4 years, 376 (71.5%) of which were related to cardiovascular disease (CVD) (International Statistical Classification of Diseases, 10th Revision codes I00-I99). CVD-related mortality compared with the lowest exercise group decreased by 21% for 1.07 to 1.8 MET-h/d of running or walking (P=.11), 24% for 1.8 to 3.6 MET-h/d (P=.04), 50% for 3.6 to 5.4 MET-h/d (P=.001), and 63% for 5.4 to 7.2 MET-h/d (P<.001) but decreased only 12% for ≥7.2 MET-h/d (P=.68). These data represent a 15% average risk reduction per MET-h/d for CVD-related mortality through 7.2 MET-h/d (P<.001) and a 2.6-fold risk increase above 7.2 MET-h/d (P=.009). Relative to the risk reduction at 7.2 MET-h/d, the risk for ≥7.2 MET-h/d increased 3.2-fold (P=.006) for all ischemic heart disease (IHD)–related mortalities but was not significantly increased for non–IHD-CVD, arrhythmia-related CVD, or non–CVD-related mortalities.


      Running or walking decreases CVD mortality risk progressively at most levels of exercise in patients after a cardiac event, but the benefit of exercise on CVD mortality and IHD deaths is attenuated at the highest levels of exercise (running: above 7.1 km/d or walking briskly: 10.7 km/d).

      Abbreviations and Acronyms:

      CVD (cardiovascular disease), HR (hazard ratio), ICD-10 (International Statistical Classification of Diseases, 10th Revision), IHD (ischemic heart diasease), MET-h/d (metabolic equivalent of task-h/d)
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      Linked Article

      • Cardiovascular Disease Mortality and Excessive Exercise in Heart Attack Survivors
        Mayo Clinic ProceedingsVol. 90Issue 1
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          In an in-depth study of 2377 patients (mean age, 62.9 years; 32% women) published in the September 2014 issue of Mayo Clinic Proceedings, Thompson et al1 reported that higher levels of physical activity up to 7.2 metabolic equivalent of task-h/d were associated with survival benefits in heart attack survivors. Notably, physical activity beyond this level was found to be associated with poorer prognosis—a 2.6- and 3.2-fold increase in risk for all-cause and ischemic heart disease–related mortality, respectively.
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