Jan. 30, 2023 -- The benefits of regular exercise likely outweigh the low risk of sports-related sudden cardiac arrest among adults ages 65 and older, a new study suggests.
Just 77 (1.9%) of the 4,078 sudden cardiac arrests that occurred among close to 2 million older adults followed in Portland, OR, and Ventura County, CA, were sports-related, according to the study, published online this month in the Journal of the American College of Cardiology: Clinical Electrophysiology.
More than 90% of sports-related cardiac arrests happened among men and were associated with cycling, running, and gym activity.
"As a cardiologist who is a (slow and steady) endurance runner, I am a firm believer in the benefits of exercise," says Sumeet S. Chugh, MD, of Cedars-Sinai Health System in Los Angeles. "However, I was still surprised by the extremely low annual incidence of sports-related sudden cardiac arrest in the two communities."
Overall, those who had a sports-related sudden cardiac arrest were healthier than those whose cardiac arrest was not sports-related, with significantly fewer heart risk factors such as hypertension, diabetes, obesity, or hyperlipidemia.
"The benefits of sports activity in the older adult likely far exceeds the risk," Chugh says. "The small proportion that do suffer sports-related sudden cardiac arrest are likely to have significant coronary artery disease that went undetected, or there was an unexpected clinical event."
Sports activity was defined as any physical activity with the goal of recreation or maintenance of physical fitness or skill, Chugh says.
Most (77%) of the sports-related sudden cardiac arrests occurred during a sports activity, 17% occurred within 1 hour after stopping the activity, and 6% could not be classified in either category.
About one quarter (26%) of patients had warning symptoms -- most commonly, chest pain (55%) -- in the 24 hours preceding the event. Three (15%) had seizures and the rest had nonspecific symptoms such as dizziness or nausea.
Having a sports-related sudden cardiac arrest was also linked with being in a public location with higher rates of bystanders who witnessed the event, as well as being more likely to shock the heart into working again. As a result, survival outcomes were four times higher than for non-sports-related sudden cardiac arrest.
Talk to Your Doctor
"If you have questions regarding sports activity, discuss these with your cardiologist" or other health care provider, Chugh says. "In general, if you are an athlete by habit and do not have any symptoms, it is usually safe to continue. If you want to participate in sports but have not been doing so, meet your provider to see if you need a workup before starting. For older adults who are not accustomed to exercising, the researchers recommend a gradual increase in exercise over 6 to 8 weeks."
"Keep in mind that moderate sports activity gives you the same benefit as higher levels of exercise," Chugh says.
Nikhil Warrier, MD, medical director of electrophysiology at Memorial Care Heart & Vascular Institute at Orange Coast Medical Center in California, says his practice has a number of patients that fit the profile of those in the study, and football player Damar Hamlin's recent sudden cardiac arrest made this a hot topic in the office.
Warrier agrees that the overall benefits of sports activity likely outweigh the low risk of sudden cardiac arrest. That said, "always talk with your provider if you experience any symptoms during physical activity, as part of an assessment of your individual risk for sports-related sudden cardiac arrest," he cautions.