Goodman Jack M, Burr Jamie F, Banks Laura, Thomas Scott G
Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, Ontario, Canada; UHN/Mt Sinai Division of Cardiology, Heart and Stroke/Richard Lewar Centres of Excellence in Cardiovascular Research, Toronto, Ontario, Canada.
Department of Human Health and Nutritional Sciences, College of Biological Science, University of Guelph, Guelph, Ontario, Canada.
Can J Cardiol. 2016 Apr;32(4):523-32. doi: 10.1016/j.cjca.2016.01.019. Epub 2016 Jan 23.
Increased physical activity (PA) is associated with improved quality of life and reductions in cardiovascular (CV) morbidity and all-cause mortality in the general population in a dose-response manner. However, PA acutely increases the risk of adverse CV event or sudden cardiac death (SCD) above levels expected at rest. We review the likelihood of adverse CV events related to exercise in apparently healthy adults and strategies for prevention, and contextualize our understanding of the long-term risk reduction conferred from PA.
A systematic review of the literature was performed using electronic databases; additional hand-picked relevant articles from reference lists and additional sources were included after the search.
The incidence of adverse CV events in adults is extremely low during and immediately after PA of varying types and intensities and is significantly lower in those with long-standing PA experience. The risk of SCD and nonfatal events during and immediately after PA remains extremely low (well below 0.01 per 10,000 participant hours); increasing age and PA intensity are associated with greater risk. In most cases of exercise-related SCD, occult CV disease is present and SCD is typically the first clinical event.
Exercise acutely increases the risk of adverse CV events, with greater risk associated with vigorous intensity. The risks of an adverse CV event during and immediately after exercise are outweighed by the health benefits of vigorous exercise performed regularly. A key challenge remains the identification of occult structural heart disease and inheritable conditions that increase the chances of lethal arrhythmias during exercise.
增加身体活动（PA）与改善生活质量以及降低普通人群心血管（CV）发病率和全因死亡率呈剂量反应关系。然而，PA会急性增加不良心血管事件或心源性猝死（SCD）的风险，高于静息时预期的水平。我们回顾了明显健康的成年人运动相关不良心血管事件的可能性及预防策略，并阐述了我们对PA带来的长期风险降低的理解。
使用电子数据库对文献进行系统综述；搜索后纳入从参考文献列表和其他来源精心挑选的相关文章。
在不同类型和强度的PA期间及之后即刻，成年人不良心血管事件的发生率极低，且有长期PA经历者的发生率显著更低。PA期间及之后即刻发生SCD和非致死性事件的风险仍然极低（每10000参与者小时远低于0.01）；年龄增长和PA强度增加与更高风险相关。在大多数与运动相关的SCD病例中，存在隐匿性心血管疾病，SCD通常是首个临床事件。
运动急性增加不良心血管事件的风险，高强度运动相关风险更高。定期进行高强度运动带来的健康益处超过运动期间及之后即刻发生不良心血管事件的风险。一个关键挑战仍然是识别隐匿性结构性心脏病和可增加运动期间致命性心律失常几率的遗传性疾病。
