Physical Activity Risks

The statement that exercise is good for you is, in the 21st century, noncontroversial. The volume and quality of data that demonstrate the positive health outcomes associated with either an active lifestyle or with systematic exercise training in either healthy individuals or those with cardiovascular disease is substantial. This concept is supported by an organizational theme used by the American College of Sports Medicine, “Exercise Is Medicine,” which suggests that the health impact of regular exercise is of the same order of magnitude as the benefits of pharmacological therapy for hypercholesterolemia, hypertension, and smoking cessation. Guidelines, whether for habitual activity or structured exercise training, have been widely accepted, and there are extensive public health recommendations regarding exercise training.

However, regardless of the benefits of exercise, there is an appreciable risk of significant morbidity and mortality during exercise. Because complications during exercise represent a “man bites dog” situation, they are highly visible and widely reported. The topic has been the subject of a recent Scientific Statement from the American Heart Association, in collaboration with the American College of Sports Medicine. The risk of exercise must be interpreted against the context of classic data from the Framingham heart study demonstrating that the first presentation of cardiovascular disease is fatal in 33% of men and 10% to 15% of women. Thus, the risk of exercise, which might serve to provoke the presentation of cardiovascular disease, is not trivial and health care professionals must consider the best ways to help individuals achieve the benefits of exercise while minimizing the risk of complications.