Risk of death from heart attack is three times lower during exercise

There is a smaller chance of dying from sudden cardiac arrest if it is exercise-related, than cardiac arrests for other reasons, researchers from The Netherlands reported at the European Society for Cardiology 2012 Congress, in Munich, Germany. Dr Arend Mosterd, and team from the Academic Medical Center, University of Amsterdam, presented their findings from ARREST (the Amsterdam Resuscitation Study). The study has been published in Circulation.

Dr Mosterd reported, "although physical activity is the best way to promote cardiovascular health, exercise can also trigger an acute cardiac event leading to death. These dramatic and often high profile events, for example in soccer players, invariably lead to concerns and cast a shadow over the overwhelmingly positive effects of regular exercise."

ARREST is a database of all resuscitation attempts that have been performed in the metropolitan area of Amsterdam, which covers a population of approximately 2.4 million people. In the Netherlands, people dial 112 for medical emergency services, where an operator puts the caller in contact with a regional ambulance dispatch hub. If the dispatch center suspects it is a case of cardiac arrest, two ambulances of a single tier are sent out.

An AED used in CPR training

An AED (automated external defibrillator) used in CPR training

A standard ambulance includes a team which carries a manual defibrillator. The dispatcher makes sure a first responder is sent out, possibly police officers or firefighters, who carry an AED (automated external defibrillator). Many areas in the Netherlands where large numbers of people gather, such as sports venues, office buildings, airports, supermarkets, and large bus stations have an automated external defibrillator on site. Lay rescuers, who have had special training, can use the onsite AED before the emergency team arrives.

The research team gathered data from ARREST to find out how frequent exercise-related cardiac arrests were in the Amsterdam metropolitan area from 2006 to 2009. They also wanted to determine what the outcomes were for people with sports-related cardiac arrests.

They found that there were 48 out-of-hospital sports related cardiac arrests each year, equivalent to 5.8% of the total number of cardiac arrests that occur out-of-hospital.

From 2006 to 2009, in the Amsterdam metropolitan area:

Exercising at gym

According to the data gathered, 45% of people who suffered a cardiac arrest whilst exercising survived.

145 out of a total of 2,517 OHCAs (out-of-hospital cardiac arrests) were experienced by people who had been doing some kind of exercise during the cardiac arrest, or up to 60 minutes before it occured.

- 49 had been cycling

- 22 had been playing tennis

- 16 had been at the gym

- 13 had been swimming

Of the 145 cases, ten were female

7 (inc. 1 female) of the 145 cases were aged no more than 35 years

65 of the 145 cases survived the event

People with an exercise-related OHCA were found to have a 45% chance of surviving the event

People with a non-exercise OHCA had a 15% chance of surviving the event

Dr Mosterd said:

"Patients persons suffering an exercise related OHCA are three times more likely to survive the event than persons whose arrest is not exercise related. None of the survivors of exercise related OHCA suffered serious neurologic damage, which was not the case for those surviving a non exercise related OHCA."

Exercise-related OHCAs occur in more younger people than non-exercise related ones, the researchers added.

.3% of exercise-related OHCAs occurred in public places, compared to 24.3% of non-exercise related ones. This also makes it much more likely that the sports-related ones are seen and acted upon by bystanders. 86.2% of sports-related cases received bystander CPR (cardiopulmonary resuscitation), compared to 64.4% of non-sports related ones, while 35% of sports-related cases were administered shocks using automated external defibrillators, compared to 22.2% in non-sports related ones.

Dr Mosterd said:

"The remarkably good survival of victims of exercise related out-of-hospital cardiac arrest can partially be ascribed to the fact that they are younger and more likely to suffer the arrest in a public location, leading to bystander cardiopulmonary resuscitation, often with the use of an automated external defibrillator. Taking these factors into account exercise per se also contributes to a better outcome."

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