Cardiologists Say Benefits of Sport and Recreation Physical Activities Outweigh Risks, Even for Individuals with Heart Disease

While exercise is generally beneficial for a person's overall health, physical activities may increase the risk of adverse cardiovascular disease events in certain susceptible individuals. However, cardiologists say that the benefits outweigh the risks. Findings from new data reviews in studies appearing in CJC Open opens in new tab/window and the Canadian Journal of Cardiology opens in new tab/window, published by Elsevier, detail the risks associated with various types of sport and leisure activities.

Cycling, hockey and hunting top the list of leisure activities associated with the highest number of natural deaths in Québec, of which 95% are sudden cardiac deaths. Researchers examined coroners' reports, autopsy findings, and police records to analyze the frequencies, rates, etiology, and characteristics of natural deaths related to sport and recreation in Québec, Canada, from January 2006 to December 2019. In total, they identified 2,234 deaths associated with sport and recreation over the 14-year period (averaging three per week, including unintentional injury deaths), of which 297 were attributable to natural causes. Of these, data showed that death rates increased starting from age 35, peaking in males 45 and over. In 65% of the cases recorded by the researchers, there was no automated external defibrillator (AED) readily available.

Lead investigator Philippe Richard, PhD, Direction de la sécurité dans le loisir et le sport, Ministère de l’Éducation du Québec, Trois-Rivières, Québec, Canada, and coauthor of the study "Natural Causes of Sport and Recreation-Related Deaths in the General Population: A 14-Year Review in Québec, Canada opens in new tab/window," says, "The unavailability of AEDs highlights a critical gap in emergency preparedness, especially in the context of five of the six activities with the highest death frequencies (cycling, hunting, jogging, hiking or walking, and swimming), which often occur in locations where AEDs are not readily accessible. As Québec is currently working on AED-related legislation, these results underscore the necessity for a comprehensive approach that extends beyond public places to ensure adequate (AED) coverage for activities in rural or remote areas, where the risks are pronounced and immediate access to emergency care is crucial."

Carl J. Lavie, MD, Ochsner Heart and Vascular Institute, New Orleans, coauthor of the accompanying editorial "Reducing Rates of Exercise and Sports Related Cardiac Mortality opens in new tab/window," points out, "Reducing premature mortality is a priority for most clinicians, including cardiologists, general internists, and family physicians, but certainly for those involved in the care of athletes and active individuals. While placement of AEDs in remote settings (e.g., hunting or ski cabins) or in areas with high exercise traffic, as well as drone-delivered AED networks, are intriguing strategies, maintenance requirements and financial investments may limit feasibility. While still in development and undergoing regulatory approvals in many countries, ultraportable AEDs may offer advantages in the future. However, at present, there is no convincing evidence to support device performance or clinical, or safety outcomes, calling for further research on their effectiveness, particularly in sports and recreation-related settings, before considering widespread uptake."

According to the authors of this research project led by Dr. Richard as part of an initiative from the Ministère de l'Éducation du Québec, the results of this study and their practical applications (such as identifying at-risk populations, addressing challenges in remote areas, and emphasizing the importance of medical screening, AEDs, CPR, and legislation) are transferable to other physically demanding tasks common in Canada, such as snow shoveling or gardening.

Researchers from the University of Toronto's Sports Cardiology Program have observed that many caregivers, including cardiologists and family physicians, have major concerns about the risk of sport, especially endurance sport, in individuals with any type of heart disease. They often counsel these individuals to severely limit their athletic and sport activity. However, there is a shift in philosophy, with recent research and expert guidance from professional societies downplaying the risks. The investigators have compared the risk of sport and training to risks undertaken in recreational activities and "activities of living" to provide context.

Lead investigator and author of the review article "Absolute and Relative Risk of Exercise: When in Doubt, Let Them Play opens in new tab/window" Paul Dorian, MD, MSc, FRCPC, Department of Medicine, University of Toronto, Division of Cardiology, and Sports Cardiology Toronto, Heart & Stroke/Richard Lewar Centre of Excellence in Cardiovascular Research, St. Michael’s Hospital, says, "Our prior studies have shown that sudden death during sport is an extremely rare phenomenon. Diseases or conditions, for example, hypertrophic cardiomyopathy, which are often considered conditions likely to be associated with catastrophic events such as cardiac arrest, are much less dangerous than most people believe. We believe athletes should be permitted to make their own decisions about what is safe or not safe for them depending on their values and preferences, rather than be told what is ‘allowed’ versus ’not allowed.’ Overall, we think that engaging in vigorous and even competitive physical activity for most individuals with heart disease is relatively safe."

Senior investigator Paul Poirier, MD, PhD, Institute of Cardiology and Pulmonology, and Faculty of Pharmacy, Laval University, and coauthor of "Natural Causes of Sport and Recreation-Related Deaths in the General Population: A 14-Year Review in Québec, Canada opens in new tab/window," underscores this and notes, "It would be a mistake to conclude that cycling, hockey, and hunting are activities to be avoided because of the risk of natural death associated with them. There are many more people dying of cardiac arrest while sleeping, sitting in an armchair, or raking. A sedentary lifestyle is much more damaging than recreation and sports."

Notes for editors

The article in CJC Open is “Natural Causes of Sport and Recreation-Related Deaths in the General Population: A 14-Year Review in Québec, Canada,” by Philippe Richard, PhD, Jérémie Sylvain-Morneau, MSc, Paul-André Perron, PhD, Philippe Joubert, MD, PhD, and Paul Poirier, MD, PhD (https://doi.org/10.1016/j.cjco.2024.09.002 opens in new tab/window). The article is openly available at https://www.cjcopen.ca/article/S2589-790X(24)00382-2/fulltext opens in new tab/window.

Journalists wishing to speak to the authors should contact Jérôme Pelletier at [email protected] opens in new tab/window.

The editorial in CJC Open is "Reducing Rates of Exercise and Sports Related Cardiac Mortality," by Carl J. Lavie, MD, Nicholas Grubic, MSc, Dermot M. Phelan, MD, PhD, and James H. O’Keefe, MD (https://doi.org/10.1016/j.cjco.2024.10.003 opens in new tab/window). The article is openly available at https://www.cjcopen.ca/article/S2589-790X(24)00446-3/fulltext opens in new tab/window.

Journalists wishing to speak to the authors should contact Carl J. Lavie at [email protected] opens in new tab/window.

Both articles appear online in CJC Open, published by Elsevier opens in new tab/window.

The article in the Canadian Journal of Cardiology is “Absolute and Relative Risk of Exercise: When in Doubt, Let Them Play,” by Paul Dorian, MD, MSc, FRCPC, Noah D.H. Lewis, MD, FRCPC, ABIM, Paul Angaran, MD, MSc, FRCPC, and Kim A. Connelly, PhD, MBBS (https://doi.org/10.1016/j.cjca.2024.10.006 opens in new tab/window). The article is openly available for 30 days at https://www.onlinecjc.ca/article/S0828-282X(24)01022-5/fulltext opens in new tab/window.

Journalists wishing to speak to the authors should contact Paul Dorian at [email protected] opens in new tab/window.

The article appears online in the Canadian Journal of Cardiology, Volume 41, Issue 3, (March 2025) published by Elsevier opens in new tab/window.

Full text of the articles is also available to credentialed journalists upon request. Contact Astrid Engelen at +31 6 14395474or [email protected] opens in new tab/window for a copy of the PDFs or more information.

About CJC Open

CJC Open is an official journal of the Canadian Cardiovascular Society opens in new tab/window and a companion title to the highly respected Canadian Journal of Cardiology (CJC) and CJC Pediatric and Congenital Heart Disease (CJCPC). It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as the major open access publication venue for Canadian cardiovascular medicine. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, viewpoints, review articles, and case reports. Papers on health outcomes, health care and public policy issues, ethics, medical history, and study design, as well as letters to the editor, are welcomed. www.cjcopen.ca opens in new tab/window

About the Editor-in-Chief of CJC Open

Editor-in-Chief Michelle Graham, MD, FRCPC, FCCS, is Professor at the University of Alberta Division of Cardiology, Edmonton, Alberta, Canada, and an interventionalist cardiologist at the University Hospital.

About the Canadian Journal of Cardiology

The Canadian Journal of Cardiology opens in new tab/window (CJC) is the official journal of the Canadian Cardiovascular Society opens in new tab/window. It is a vehicle for the international dissemination of new knowledge in cardiology and cardiovascular science, particularly serving as a major venue for the results of Canadian cardiovascular research and Society guidelines. The journal publishes original reports of clinical and basic research relevant to cardiovascular medicine as well as editorials, review articles, case reports, and papers on health outcomes, policy research, ethics, medical history, and political issues affecting practice. www.onlinecjc.ca opens in new tab/window

About the Editor-in-Chief of CJC

Editor-in-Chief Stanley Nattel, MD, is Paul-David Chair in Cardiovascular Electrophysiology and Professor of Medicine at the University of Montreal and Director of the Electrophysiology Research Program at the Montreal Heart Institute Research Center.

About the Canadian Cardiovascular Society (CCS)

The CCS opens in new tab/window is the national voice for cardiovascular clinicians and scientists, representing more than 2,300 cardiologists, cardiac surgeons and other heart health specialists across Canada. We advance heart health for all by setting standards for excellence in heart health and care, building the knowledge and expertise of the heart team, and influencing policy and advocating for the heart health of all Canadians. For further information on the CCS visit https://www.ccs.ca/en opens in new tab/window.

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