Department of Exercise Sciences, Faculty of Physical Education and Health, University of Toronto, Toronto, ON, Canada.
Appl Physiol Nutr Metab. 2011 Jul;36 Suppl 1:S14-32. doi: 10.1139/h11-048.
Increased physical activity (PA) is associated with improved health and quality of life in the general population. A dose-response effect is evident between increasing levels of PA participation and a lower relative risk for cardiovascular disease and all-cause mortality. However, there is also clear evidence that PA acutely increases the risk of an adverse cardiovascular (CV) event and sudden cardiac death (SCD) significantly above levels expected at rest. Adverse CV events during PA may be triggered acutely by the physiological stress of exercise. This investigation will review the available literature describing the CV risks of exercise testing and PA participation in apparently healthy individuals. A systematic review of the literature was performed using electronic databases, including Medline, CINAHL, SPORT discus, EMBASE, Cochrane DSR, ACP Journal Club, and DARE; additional relevant articles were hand-picked and the final grouping was used for the review using the AGREE process to assess the impact and quality of the selected articles. Six hundred and sixteen relevant articles were reviewed with 51 being identified as describing adverse CV events during exercise and PA. Data suggests the risks of fatal and nonfatal events during maximal exercise testing in apparently healthy individuals rarely occur (approximately <0.8 per 10 000 tests or 1 per 10 000 h of testing). The incidence of adverse CV events is extremely low during PA of varying types and intensities, with data limited almost exclusively to fatal CV events, as nonfatal events are rarely reported. However, this risk is reduced by 25%-50% in those individuals who have prior experience with increased levels of PA, particularly vigorous PA. Throughout a wide age range, the risk of SCD and nonfatal events during PA remain extremely low (well below 0.01 per 10 000 participant hours), but both increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, undetected pre-existing disease is present and SCD is typically the first clinical event. The risks of an adverse CV event during exercise testing and PA are rare and are outweighed by the health benefits. Given this risk-benefit relationship, the PAR-Q is an appropriate method to identify those at higher risk across a wide age span and should be used in conjunction with appropriate clinical guidelines for guiding individuals towards graduated PA. There are not adequate data to describe the risks of PA in those individuals considered to be at higher risk but without cardiovascular disease.
增加身体活动（PA）与改善普通人群的健康和生活质量有关。在 PA 参与水平不断提高与心血管疾病和全因死亡率相对风险降低之间存在明显的剂量反应关系。然而，也有明确的证据表明，PA 会急性增加不良心血管（CV）事件和心源性猝死（SCD）的风险，明显高于休息时的预期水平。PA 期间的不良 CV 事件可能会因运动的生理应激而急性触发。本研究将综述描述在看似健康的个体中进行运动试验和 PA 参与的 CV 风险的现有文献。使用电子数据库（包括 Medline、CINAHL、SPORT discus、EMBASE、Cochrane DSR、ACP 期刊俱乐部和 DARE）进行文献系统综述，此外还手工挑选了其他相关文章，并使用 AGREE 过程对最终分组进行了综述，以评估所选文章的影响和质量。共审查了 616 篇相关文章，其中 51 篇文章描述了在看似健康的个体中运动和 PA 期间发生的不良 CV 事件。数据表明，在看似健康的个体中进行最大运动试验时发生致命和非致命事件的风险很少（大约<0.8 例/10000 次测试或 1 例/10000 小时测试）。在不同类型和强度的 PA 期间发生不良 CV 事件的发生率极低，数据几乎仅局限于致命 CV 事件，因为很少报告非致命事件。然而，在具有较高水平 PA 既往经验的个体中，这种风险降低了 25%-50%，特别是剧烈 PA。在广泛的年龄范围内，PA 期间发生 SCD 和非致命事件的风险仍然极低（远低于 0.01 例/10000 名参与者小时），但随着年龄的增长和 PA 强度的增加，风险也随之增加。在大多数与运动相关的 SCD 中，都存在未被发现的预先存在的疾病，SCD 通常是首次临床事件。在运动试验和 PA 期间发生不良 CV 事件的风险很少见，但与健康益处相比是微不足道的。鉴于这种风险效益关系，PAR-Q 是一种识别广泛年龄段内高风险人群的合适方法，应与适当的临床指南结合使用，以指导个体逐渐进行 PA。没有足够的数据来描述那些被认为有更高风险但没有心血管疾病的个体进行 PA 的风险。
