Exercise-Related Out-of-Hospital Cardiac Arrest in the General Population

Incidence and Prognosis

Jocelyn Berdowski; Margriet F. de Beus; Marieke Blom; Abdennasser Bardai; Michiel L. Bots; Pieter A. Doevendans; Diederick E. Grobbee; Hanno L. Tan; Jan G.P. Tijssen; RudolphW. Koster; Arend Mosterd


Eur Heart J. 2013;34(47):3616-3623. 

In This Article

Abstract and Introduction


Aims Although regular physical activity has beneficial cardiovascular effects, exercise can trigger an acute cardiac event. We aimed to determine the incidence and prognosis of exercise-related out-of-hospital cardiac arrest (OHCA) in the general population.

Methods and results We prospectively collected all OHCAs in persons aged 10–90 years from January 2006 to January 2009 in the Dutch province North Holland. The relation between exercise during or within 1 h before OHCA and outcome was analysed using multivariable logistic regression, adjusted for age, gender, location, bystander witness, bystander cardiopulmonary resuscitation (CPR), automated external defibrillator (AED) use, initial rhythm, and Emergency Medical System response time. Of 2524 OHCAs, 143 (5.7%) were exercise related (7 ≤35 years, 93% men). Exercise-related OHCA incidence was 2.1 per 100 000 person-years overall and 0.3 per 100 000 person-years in those ≤35 years. Survival after exercise-related OHCA was distinctly better than after non-exercise related OHCA (46.2 vs. 17.2%) [unadjusted odds ratio (OR) 4.12; 95%CI 2.92–5.82; P < 0.001], even after adjustment for abovementioned variables (OR 2.63; 95%CI, 1.23–5.54; P = 0.01). In the 69 victims aged ≤35 years, exercise was not associated with better survival: 14.3 vs. 17.7% in non-exercise-related OHCA (OR 0.77; 95%CI 0.08–7.08; P = 0.82).

Conclusion Exercise-related OHCA has a low incidence, particularly in the young. Cardiac arrests occurring during or shortly after exercise carry a markedly better prognosis than non-exercise-related arrests in persons >35 years. This study establishes the favourable outcome of exercise-related OHCA and should have direct implications for public health programs to prevent exercise-related sudden death.


Although regular exercise reduces the risk of cardiovascular disease, the risk of an acute cardiac event is transiently increased during and immediately after acute, mainly vigorous exercise.[1,2] This is known as the paradox of exercise.[3] Despite this paradox and the worldwide discussion on the prevention of exercise-related events,[4,5] population-based information on the incidence and prognosis of exercise-related out-of-hospital cardiac arrests (OHCA) is scarce.[6]

We set out to assess the incidence of exercise-related OHCA in the general population and to determine whether exercise-related OHCAs are associated with higher survival rates than non-exercise-related OHCAs. As pre-participation screening of athletes ≤35 years is encouraged,[4] we performed separate analyses for this age group. In the Netherlands, routine pre-participation screening is not mandatory.