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People who exercise are less likely to instantly die after a heart attack

A study published in the European Journal of Preventive Cardiology indicates that an active lifestyle is linked with a lower chance of dying immediately from a heart attack (myocardial infarction). Dr Kim Wadt Hansen (Bispebjerg Hospital, Copenhagen, Denmark) and colleagues report that even a low amount of leisure-time physical activity may in fact be beneficial against fatal heart attacks.

Hansen et al used data from 10 European observational cohorts, including healthy participants, with a baseline assessment of physical activity who had a heart attack during follow-up — a total of 28,140 individuals. Participants were categorised according to their weekly level of leisure-time physical activity as sedentary, low, moderate, or high.

They reviewed the association between activity level and the risk of death because of a heart attack (instantly and within 28 days) in each cohort separately and then the results were pooled. The analyses were adjusted for age, sex, diabetes, blood pressure, family history of heart disease, smoking, body mass index, blood cholesterol, alcohol consumption, and socioeconomic status.

A total of 4,976 (17.7%) participants died within 28 days of their heart attack. Of these, 3,101 (62.3%) died instantly. Overall, according to the authors, a higher level of physical activity was associated with a lower risk of instant and 28-day fatal heart attack, seemingly in a dose–response-like manner. Patients who had engaged in moderate and high levels of leisure-time physical activity had a 33% and 45% lower risk of instant death compared to sedentary individuals. At 28 days these numbers were 36% and 28%, respectively. The relationship with low activity did not reach statistical significance.

Dr Hansen comments: “Almost 18% of patients with a heart attack died within 28 days, substantiating the severity of this condition. We found an immediate survival benefit of prior physical activity in the setting of a heart attack, a benefit which seemed preserved at 28 days. Based on our analyses, even a low amount of leisure-time physical activity may in fact be beneficial against fatal heart attacks, but statistical uncertainty precludes us from drawing any firm conclusions on that point.”

In their paper, Hansen et al observe: “Our pooled analysis provides strong support for the recommendations on weekly physical activity in healthy adults stated in the 2016 European Guidelines on cardiovascular disease prevention in clinical practice; especially as we used cut-off values for physical activity comparable to those used in the guidelines.” The guidelines recommend that healthy adults of all ages perform at least 150 minutes a week of moderate intensity or 75 minutes a week of vigorous intensity aerobic physical activity or an equivalent combination thereof.

Hansen concluded: “There are many ways to be physically active at little or no cost. Our study provides yet more evidence for the rewards of exercise.”

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