Original articleIncreased Cardiovascular Disease Mortality Associated With Excessive Exercise in Heart Attack Survivors
Section snippets
Patients and Methods
Subjects self-identified as having had a previous heart attack on their baseline survey questionnaires were identified from the National Runners' Health Study (recruited between 1991 and 1994 and between 1998 and 2001) and the National Walkers' Health Study (recruited between 1998 and 2001).2, 23, 24, 25 Walking energy expenditure (metabolic equivalent of task-h/d [MET-h/d]) was calculated by converting the usual distance walked per week into duration (ie, distance/mph) and then calculating the
Results
We excluded 25 of the original 2402 subjects because they survived less than 1 year since their baseline survey, leaving 942 male and 631 female heart attack survivors from the National Walkers' Health Study and 678 male and 126 female heart attack survivors from the National Runners' Health Study (Table 1). Greater energy expended by running or walking was associated with more marathons run per year, less red meat consumption, more fruit consumption, lower body mass index, greater education,
Discussion
These analyses show that greater exercise energy expenditure by walking and running was associated with a significantly lower risk for CVD-related mortality in proportion to the exercise dose through 7.2 MET-h/d, an energy expenditure approximately equivalent to running 30 miles or 50 km per week,27 or walking briskly 46 miles or 75 km per week.30 Those who expended 3.6 to 5.4 MET-h/d (equivalent to 15-23 miles/wk or 25-37 km/wk run) had 50% lower risk for CVD-related mortality than did those
Conclusion
These analyses provide what is to our knowledge the first data in humans demonstrating a statistically significant increase in cardiovascular risk with the highest levels of exercise. Moreover, we demonstrated the increased risk prospectively. These data were obtained in heart attack survivors and require confirmation in cohorts of healthy subjects before concerns about excessive exercise can be extended to the general public. Fewer than 6% of the heart attack survivors actually exceeded 7.2
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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.