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Volume 329:1677-1683 December 2, 1993 Number 23 Next

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ABSTRACT

Background Despite anecdotal evidence suggesting that heavy physical exertion can trigger the onset of acute myocardial infarction, there have been no controlled studies of the risk of myocardial infarction during and after heavy exertion, the length of time between heavy exertion and the onset of symptoms (induction time), and whether the risk can be modified by regular physical exertion. To address these questions, we collected data from patients with confirmed myocardial infarction on their activities one hour before the onset of myocardial infarction and during control periods.

Methods Interviews with 1228 patients conducted an average of four days after myocardial infarction provided data on their usual annual frequency of physical activity and the time, type, and intensity of physical exertion in the 26 hours before the onset of myocardial infarction. We compared the observed frequency of heavy exertion (6 or more metabolic equivalents) with the expected values using two types of self-matched analyses based on a new case-crossover study design. The low frequency of heavy exertion during the control periods was validated by data from a population-based control group of 218 subjects.

Results Of the patients, 4.4 percent reported heavy exertion within one hour before the onset of myocardial infarction. The estimated relative risk of myocardial infarction in the hour after heavy physical exertion, as compared with less strenuous physical exertion or none, was 5.9 (95 percent confidence interval, 4.6 to 7.7). Among people who usually exercised less than one, one to two, three to four, or five or more times per week, the respective relative risks were 107 (95 percent confidence interval, 67 to 171), 19.4 (9.9 to 38.1), 8.6 (3.6 to 20.5), and 2.4 (1.5 to 3.7). Thus, increasing levels of habitual physical activity were associated with progressively lower relative risks. The induction time from heavy exertion to the onset of myocardial infarction was less than one hour, and symptoms usually began during the activity.

Conclusions Heavy physical exertion can trigger the onset of acute myocardial infarction, particularly in people who are habitually sedentary. Improved understanding of the mechanisms by which heavy physical exertion triggers the onset of myocardial infarction and the manner in which regular exertion protects against it would facilitate the design of new preventive approaches.

Source Information

From the Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Deaconess Hospital, and Harvard Medical School, Boston (M.A.M., M.M., G.H.T., J.B.S., J.E.M.); the Department of Epidemiology, Harvard School of Public Health, Boston (M.A.M., M.M.); and the Department of Medicine, University of Massachusetts Medical School, Worcester (R.J.G.). Presented in part at the 64th Annual Scientific Sessions of the American Heart Association, Anaheim, Calif., November 11-14, 1991.The participants in the study are listed in the Appendix.

Address reprint requests to Dr. Mittleman at the Institute for Prevention of Cardiovascular Disease, Cardiovascular Division, Deaconess Hospital, 1 Autumn St., 5th Fl., Boston, MA 02215.

Full Text of this Article

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Triggering of Acute Myocardial Infarction by Exercise
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Extract | Full Text  
N Engl J Med 1994; 330:1156-1157, Apr 21, 1994. Correspondence

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