Sudden Death During Exercise: Are You More Likely to Die While You're Working Out?

Many people exercise to improve the health of their heart and lower the risk of heart disease. But it's not uncommon to read about someone who collapses and dies of a heart attack after taking a run or working out at the gym. Of course, this raises eyebrows and causes some to wonder whether exercise can trigger sudden death in normal, healthy people. How common is it for someone to die while exercising?

Exercise and Sudden Death in Young People

You've probably read about athletes like Boston Celtics player Reggie Lewis collapsing suddenly while playing basketball. When a young, apparently healthy athlete dies while playing a sport they've played for years people suddenly wonder. If it happened to him and he's so fit, why couldn't it happen to me?

Reggie Lewis and a number of other athletes that died suddenly while playing sports suffered from a genetic condition called hypertrophic cardiomyopathy, a syndrome where the heart muscle is abnormally thickened. With hypertrophic cardiomyopathy, the chambers of the heart become so thick that the outflow of blood from the heart is reduced. People who have it are prone to irregular heart rhythms that can be fatal.

Hypertrophic cardiomyopathy is the leading cause of sudden death in young athletes, but it's still pretty uncommon. Young people can also have other congenital heart defects that put them at risk for sudden death. The risk of a healthy athlete dying unexpectedly during exercise is only about 1 in 250,000. Still, children and teen athletes are carefully screened for congenital heart conditions with a physical exam when they get a sports physical.

Exercise and Sudden Death in Older People

What about middle-aged and older people who have a little age working against them? How likely are they to die during a workout? Unlike younger people who usually have some type of congenital heart abnormality, middle-aged and older people who die from heart-related problems during exercise frequently have undiagnosed coronary artery disease.

In people who have already have plaque in their arteries from coronary artery disease, vigorous exercise can dislodge a portion of the plaque and lead to a heart attack by disrupting blood flow to the heart. In susceptible individuals, vigorous exercise can also trigger irregular heart rhythms that can be fatal.

Most older people who die suddenly during exercise have coronary artery heart disease, although they may not be aware of it, because they have few symptoms, and they may brush off the symptoms they do have as being "indigestion." Interestingly, in one study, the majority of people who died from sudden death during exercise in all age groups had symptoms before their death and reported them to close relatives. The most common were chest pain, excessive fatigue, indigestion and breathlessness. Despite this, they never saw a doctor.

Exercise Reduces the Risk of Heart Disease for Most People

In healthy individuals, the benefits of exercise far outweigh the risks. Regular physical exercise dramatically lowers the risk of heart disease and sudden death. The majority of heart-related deaths that occur in middle-aged and older people happen when they try to do a vigorous activity they're unaccustomed to doing. The key is to exercise regularly to achieve a level of cardiovascular fitness high enough to protect against sudden death.

Precautions All Athletes and Weekend Warriors Should Take

High school and college age athletes should always be carefully screened before participating in sports, and middle-aged and older people should see their doctor before starting a vigorous exercise program. Yes, exercise increases the workload on the heart while you're doing it, but it's still one of the best things you can do to protect the health of your heart longer term.

References:

Medscape.com. "Exercise and Acute Cardiovascular Events"

Exercise Physiology. Theory and Application to Fitness and Performance. Seventh edition. 2009.