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  • Review Article
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Exercise: friend or foe?

Nature Reviews Cardiology volume 10, pages 495–507 (2013)Cite this article

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Abstract

Physical activity and exercise have been associated with reduced cardiovascular risk, morbidity, and mortality, as well as all-cause mortality, both in the general population and in patients with various forms of cardiovascular disease. Increasing amounts of exercise are associated with incremental reductions in mortality, but considerable benefits have been found even with a low level of exercise. Exercise is beneficial for most individuals, but risks exist. Exercise is associated with reduced long-term morbidity and mortality, but acute exercise can transiently increase the risk of fatal or nonfatal cardiovascular events. Although tragic, these events are very rare, and even to some extent preventable with screening programmes. Low-intensity physical activity is important and beneficial to all individuals, including those with a high risk of adverse cardiovascular events. In individuals who are physically fit and who do not have genetic predisposition to, or signs of, cardiovascular disease, the greater the intensity and amount of exercise, the greater the health benefits. Nevertheless, effective strategies to encourage exercise in the population are lacking. A sustained increase in physical activity is likely to require more than individual advice, and needs to include urban planning and possibly even legislation.

Key Points

  • An increased level of physical activity decreases cardiovascular risk factors in the general population

  • The largest benefits of exercise occur when individuals who are least fit become physically active, even to a low intensity

  • Controlled exercise is safe and beneficial even for patients with cardiac disease

  • The risk of adverse events is associated with strenuous exercise, not low-intensity physical activity

  • The effects of resistance and endurance training have been shown to be similarly beneficial

  • Robust strategies are needed to increase physical activity at a population level; implementation might require supportive legislation

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Figure 1: Relationship between level of physical activity and reduction in mortality from various causes.
Figure 2: Relationship between daily duration of physical activity and reduction in all-cause mortality.
Figure 3: Causes of SCD in various populations.
Figure 4: Factors contributing to exercise-induced cardiovascular risk during and after vigorous physical activity in individuals with undetected CHD.
Figure 5: Recommended diagnostic algorithm for families of a proband with sudden arrhythmic death syndrome.

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Authors and Affiliations

  1. National Centre for Cardiovascular Prevention and Outcomes, 170 Tottenham Court Road, London, W1T 7HA, UK

    Frida J. Dangardt & John E. Deanfield

  2. The Heart Hospital, University College London, 16–18 Westmoreland Street, London, W1G 8PH, UK

    William J. McKenna

  3. University Hospital Zurich, Rämistrasse 100, Zurich, CH-8091, Switzerland

    Thomas F. Lüscher

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  1. Frida J. Dangardt
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  2. William J. McKenna
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  3. Thomas F. Lüscher
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F. J. Dangardt researched data for the article. F. J. Dangardt, W. J. McKenna, and J. E. Deanfield contributed substantially to discussions of its content. F. J. Dangardt wrote the manuscript, and W. J. McKenna, T. F. Lüscher, and J. E. Deanfield reviewed/edited the article before submission.

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Correspondence to John E. Deanfield.

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Dangardt, F., McKenna, W., Lüscher, T. et al. Exercise: friend or foe?. Nat Rev Cardiol 10, 495–507 (2013). https://doi.org/10.1038/nrcardio.2013.90

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