Clinical paperAssociation of Exercise and Metabolic Equivalent of Task (MET) Score with Survival Outcomes after Out-of-Hospital Cardiac Arrest of Young and Middle Age

BackgroundRegular physical activity is recommended to prevent cardiovascular disease including out-of-hospital cardiac arrest (OHCA). However, it is uncertain whether the intensity during physical activity is associated with better outcomes. We studied the effect of exercise at the time of arrest and the association between metabolic equivalent of task (MET) score and survival of OHCA patients of young and middle age.MethodsAll OHCAs of presumed cardiac etiology who were 18-65 years of age and were witnessed by a layperson between 2013 and 2015 were analyzed. The main exposure of interest was physical activity at the time of, or immediately prior to, the arrest and the MET score groups (0-3 for light, 3-6 for moderate, and ≥6 for vigorous). The endpoint was survival with good neurological recovery. For the sensitivity analysis, we created a matched dataset by matching for age, gender, residential area, and comorbidities (diabetes, hypertension, heart disease, and stroke). Multivariable logistic regression analysis was performed, adjusting for patient and arrest-environmental factors.ResultsA total of 6,273 patients in the original dataset were included, and 762 (12.1%) patients had a cardiac arrest during exercise. The exercise-related OHCAs were more likely to have a good neurological recovery rate (25.9%) than the non-exercise-related OHCA (12.9%) in the original dataset (AOR (95% CI): 1.36 (1.08-1.70)) but not in the matched dataset (1.37 (0.92-1.97)). Using MET score groups, the moderate-intensity group compared with the non-exercise group was associated with better neurological outcome (1.70 (1.11-2.63)), but neither light-intensity (0.77 (0.40-1.49)) nor vigorous-intensity (1.44 (0.91-2.28)) groups were associated with better outcomes.ConclusionsPatients who had an OHCA during exercise were more likely to have neurologically intact survival compared to patients who had an OHCA during periods of non-exercise; however, only the moderate-intensity group was associated with a better neurological outcome.