Abstract
Objective
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.
Results
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.
Conclusion
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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: August 12, 2014
Footnotes
For editorial comment, see page 1171; for a related article, see page 1195
Grant Support: This research was supported by grant HL094717 from the National Heart, Lung, and Blood Institute and was conducted at the Ernest Orlando Lawrence Berkeley National Laboratory (Department of Energy DE-AC03-76SF00098 to the University of California). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Identification
Copyright
© 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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- Cardiovascular Disease Mortality and Excessive Exercise in Heart Attack SurvivorsMayo Clinic ProceedingsVol. 90Issue 1
- PreviewIn 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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