Exercise and Sudden Cardiac Death

Neil L. Coplan, M.D., Gilbert W. Gleim, Ph.D., and James A. Nicholas, M.D.

From the Nicholas Institute of Sports Medicine and Athletic Trauma, and the Division of Cardiology, Department of Medicine, Lenox Hill Hospital

Studies have shown that regular exercise is associated with a substantially lower over-all risk for sudden death and cardiovascular mortality. However, performing exercise is associated with a small but statistically significant increase in the risk for sudden death. Siscovick et al. showed that exercise is associated with varying degrees of both short-term risk and long-term benefit, with the magnitude of risk and benefit dependent upon the degree of habitual vigorous exercise performed.

Obstructive coronary artery disease secondary to atherosclerosis is the most frequent cause of exercise-related sudden death in patients over the age of 35, whereas hypertrophic cardiomyopathy and congenital coronary artery disease are the major etiologies underlying exercise-related mortality in younger patients. The goal of the clinician is to determine the presence and extent of underlying disease that may predispose to morbidity and mortality, and to make a recommendation regarding how to maximize benefit and minimize risk from exercise.

Am. Heart J., 1988;115:207-212