Background
Methods
Search strategy
Study selection
Data extraction
Statistical methods
Results
First author, publication year, country | Study name or description | Study period | Number of participants, number of cases | Type of physical activity, subgroup | Comparison | Relative risk (95% confidence interval) | Adjustment for confounders |
---|---|---|---|---|---|---|---|
Leon AS et al., 1987 [20], USA | The Multiple Risk Factor Intervention Trial | 1973–1976 - 1982, 7 years follow-up | 12,138 men, age 35–57 years: 143 sudden cardiac deaths | Leisure-time physical activity | 1 2 3 | 1.00 0.64 (0.54–0.96) 0.67 (0.45–1.00) | Age, diastolic blood pressure, total cholesterol, cigarettes per day, treatment group |
Wannamethee G et al., 1995 [19], United Kingdom | British Regional Heart Study | 1978–1980 - NA, 8 years follow-up | 7730 men, age 40–59 years: 117 sudden cardiac deaths | Leisure-time physical activity | None-occasional Light Moderate Moderately vigorous-vigorous | 1.0 0.7 (0.5–1.1) 0.6 (0.4–1.1) 0.4 (0.2–0.7) | Age |
Jouven X et al., 2001 [21], France | Paris Prospective Study 1 | 1967–1972 - 1994, 23 years follow-up | 7079 men and women, age 42–53 years: 118 sudden deaths | Sports activity | Yes vs. no | 0.43 (0.08–1.42) | Age, parental sudden death, parental myocardial infarction, diabetes, tobacco, BMI, resting heart rate, systolic blood pressure, total cholesterol |
Chiuve SE et al., 2011 [9], USA | Nurses’ Health Study | 1984–2010, 26 years follow-up | 81,722 women, age 38–63 years: 321 sudden cardiac deaths | Exercise | < 1 h/wk. 1–1.9 2–3.4 3.5–5.9 ≥6.0 | 1.00 0.86 (0.60–1.23) 0.84 (0.58–1.21) 0.72 (0.50–1.04) 0.47 (0.30–0.72) | Age, family history of myocardial infarction, menopausal status, current hormone therapy use, diabetes, hypertension, high cholesterol, cancer, coronary heart disease, stroke |
Lahtinen AM et al., 2012 [12], Finland | FINRISK 1992 | 1992–2008, ~ 16 years follow-up | 5345 men and women, mean age 44.3 years: 129 sudden cardiac deaths | Leisure-time physical activity | Moderate/high vs. low | 0.56 (0.41–0.78) | Age, sex, geographic region, HDL/TC ratio, systolic blood pressure, smoking, diabetes, BMI, prevalent coronary heart disease, QT-prolonging drug, digoxin |
Lahtinen AM et al., 2012 [12], Finland | FINRISK 1997 | 1997–2008, ~ 11 years follow-up | 7672 men and women, mean age 48.4 years: 178 sudden cardiac deaths | Leisure-time physical activity | Moderate/high vs. low | 0.58 (0.42–0.80) | Age, sex, geographic region, HDL/TC ratio, systolic blood pressure, smoking, diabetes, BMI, prevalent coronary heart disease, QT-prolonging drug, digoxin |
Lahtinen AM et al., 2012 [12], Finland | FINRISK 2002 | 2002–2008, ~ 6 years follow-up | 8212 men and women, mean age 48.0 years: 75 sudden cardiac deaths | Leisure-time physical activity | Moderate/high vs. low | 0.42 (0.26–0.66) | Age, sex, geographic region, HDL/TC ratio, systolic blood pressure, smoking, diabetes, BMI, prevalent coronary heart disease, QT-prolonging drug, digoxin |
Lahtinen AM et al., 2012 [12], Finland | Health 2000 | 2000–2008, ~ 8 years follow-up | 6400 men and women, mean age 53.0 years: 112 sudden cardiac deaths | Leisure-time physical activity | Moderate/high vs. low | 0.45 (0.31–0.65) | Age, sex, geographic region, HDL/TC ratio, systolic blood pressure, smoking, diabetes, BMI, prevalent coronary heart disease, QT- prolonging drug, digoxin |
Hamer M et al., 2018 [32], United Kingdom | The Health Survey for England and the Scottish Health Surveys | 1994, 1995, 1997, 1998, 1999, 2003, 2004, 2006, 2008–2009, 9.4 years follow-up | 65,093 men and women, age ≥ 40 years: 70 arrhythmia/ sudden cardiac deaths | Leisure-time physical activity - meeting recommendations Leisure-time physical activity | Inactive Insufficient Sufficient High < 1.64 MET-hours/wk. 1.65–9.37 9.38–19.30 19.31–37.60 > 37.60 | 1.00 0.48 (0.14–1.20) 0.52 (0.12–2.15) 0.33 (0.10–2.38) 1.00 0.96 (0.53–1.76) 0.68 (0.32–1.43) 0.49 (0.20–1.16) 0.18 (0.04–0.76) | Age, sex, smoking, social occupational group, chronic illnesses, psychological distress |
Paffenberger RS et al., 1975, [34] USA | Longshoremen | 1951–1961 - 1972, 14.6 years follow-up | 6351 men, age 35–74 years: 184 sudden cardiac deaths | Work activity | 1 2 3 | 1.00 0.29 (0.20–0.42) 0.36 (0.22–0.59) | Age |
Albert CM et al., 2000 [33], USA | Physicians’ Health Study | 1982–1994, 12 years follow-up | 21,481 men, age 40–84 years: 109 sudden cardiac deaths | Vigorous exercise | < 1 time/wk. 1/wk. 2–4/wk. ≥5/wk | 1.00 1.68 (0.98–2.87) 1.13 (0.69–1.88) 1.36 (0.76–2.43) | Age, assignment to aspirin and beta-carotene treatment, BMI, smoking status, cigarettes per day, diabetes, hypertension, hypercholesterolemia, alcohol, vitamin E, vitamin C, multivitamin use, fish |
Jimenez-Pavon D et al., 2016 [22], USA | Aerobics Center Longitudinal Study | 1974–2002 - 2003, 14.7 years follow-up | 55,456 men and women, mean age 44.2 years: 109 sudden cardiac deaths | Cardiorespiratory fitness | 1 2 3 Per 1 MET | 1.00 0.56 (0.35–0.90) 0.52 (0.30–0.92) 0.86 (0.77–0.96) | Age, sex, examination year, BMI, smoking, alcohol, diabetes mellitus, hypertension, electrocardiogram showing abnormalities, parental history of cardiovascular disease |
Jae SY et al., 2018 [23], Finland | Kuopio Ischaemic Heart Disease Risk Factors Study | 1984–1989 - 2014, 22 years follow-up | 2357 men, age 42–60 years: 253 sudden cardiac deaths | Cardiorespiratory fitness | < 26.7 ml/kg/min 26.7–33.0 > 33.0 | 1.00 0.80 (0.58–1.10) 0.61 (0.40–0.92) | Age, smoking, SBP, HDL cholesterol, LDL cholesterol, glucose, diabetes, hypertension, FH - CHD, previous MI, physical activity, BMI |
Subgroup analyses, study quality and sensitivity analyses
Physical activity and sudden cardiac death | ||||||
---|---|---|---|---|---|---|
n | Relative risk (95% CI) | I2 (%) | Ph1 | Ph2 | ||
All studies | 8 | 0.52 (0.45–0.60) | 0 | 0.72 | ||
Sex | ||||||
Men | 2 | 0.55 (0.34–0.90) | 46.0 | 0.17 | 0.65/ 0.773 | |
Women | 1 | 0.47 (0.30–0.72) | ||||
Men, women | 5 | 0.51 (0.43–0.61) | 0 | 0.72 | ||
Follow-up | ||||||
< 10 years | 4 | 0.49 (0.39–0.62) | 11.3 | 0.34 | 0.53 | |
≥ 10 years | 4 | 0.54 (0.45–0.66) | 0 | 0.87 | ||
Recruitment year | ||||||
1951–1979 | 3 | 0.57 (0.41–0.79) | 0.3 | 0.37 | 0.27 | |
1980–1999 | 3 | 0.55 (0.45–0.67) | 0 | 0.74 | ||
2000–2018 | 2 | 0.44 (0.33–0.59) | 0 | 0.82 | ||
Geographic location | ||||||
Europe | 6 | 0.50 (0.43–0.60) | 0 | 0.75 | 0.51 | |
America | 2 | 0.57 (0.40–0.80) | 27.3 | 0.24 | ||
Asia | 0 | |||||
Number of sudden cardiac deaths | ||||||
< 125 | 4 | 0.43 (0.33–0.56) | 0 | 0.99 | 0.13 | |
≥ 125 | 4 | 0.57 (0.48–0.68) | 0 | 0.71 | ||
Study quality | ||||||
0–3 stars | 0 | 0.39 | ||||
4–6 stars | 2 | 0.45 (0.31–0.64) | 0 | 0.68 | ||
7–9 stars | 6 | 0.54 (0.46–0.63) | 0 | 0.62 | ||
Adjustment for confounding factors | ||||||
Age | Yes | 8 | 0.52 (0.45–0.60) | 0 | 0.72 | NC |
No | 0 | |||||
Family history of sudden cardiac death | Yes | 1 | 0.43 (0.08–1.42) | 0.80 | ||
No | 7 | 0.52 (0.45–0.60) | 0 | 0.61 | ||
Family history of myocardial infarction | Yes | 2 | 0.47 (0.31–0.71) | 0 | 0.91 | 0.60 |
No | 6 | 0.53 (0.45–0.62) | 0 | 0.52 | ||
Body mass index | Yes | 5 | 0.51 (0.43–0.61) | 0 | 0.72 | 0.82 |
No | 3 | 0.53 (0.39–0.71) | 16.1 | 0.30 | ||
Smoking | Yes | 6 | 0.54 (0.46–0.63) | 0 | 0.62 | 0.39 |
No | 2 | 0.45 (0.31–0.64) | 0 | 0.68 | ||
Alcohol | Yes | 0 | NC | |||
No | 8 | 0.52 (0.45–0.60) | 0 | 0.72 | ||
Diabetes mellitus | Yes | 6 | 0.51 (0.43–0.60) | 0 | 0.82 | 0.53 |
No | 2 | 0.55 (0.34–0.90) | 46.0 | 0.17 | ||
Hypertension | Yes | 1 | 0.47 (0.30–0.72) | 0.65 | ||
No | 7 | 0.53 (0.45–0.62) | 0 | 0.64 | ||
Systolic blood pressure | Yes | 5 | 0.51 (0.43–0.61) | 0 | 0.72 | 0.82 |
No | 3 | 0.53 (0.39–0.71) | 16.1 | 0.30 | ||
Blood cholesterol | Yes | 7 | 0.53 (0.45–0.62) | 0 | 0.70 | 0.43 |
No | 1 | 0.40 (0.20–0.70) |