Dave Goldberg's unexpected death increases attention on exercise, health risks: 5 thoughts

The sudden death of Dave Goldberg, CEO of SurveyMonkey and husband of Facebook COO Sheryl Sandberg, has shocked and saddened his peers in Silicon Valley. Having occurred while running on a treadmill during a vacation, many people are questioning whether Mr. Goldberg's exercise had caused a serious health event leading to his death, according to the New York Times.

Mr. Goldberg apparently fell off the treadmill and cracked his head open and died of a traumatic brain injury and blood loss. While his death appeared to be an accident, many are inquiring into the danger of sudden death during exercise. For instance, while people who engage in regular physical activity reduce their risk of dying from heart disease more than those who do not, people have a higher likelihood of having a heart attack during strenuous cardiovascular exercise than being sedentary, according to the report.

In an interview with the New York Times, Michael Blaha, MD, director of clinical research at the Ciccarone Center for the Prevention of Heart Disease at Johns Hopkins Medicine in Lutherville, Md., and Paul D. Thompson, MD, chief of cardiology at Hartford (Conn.) Hospital, discuss the likelihood, symptoms and factors that contribute to heart attacks during exercise. Here are five key takeaways from the interview.

1. Heart attacks during exercise are rare. Dr. Thompson was among the first to publish a study on this topic back in 1982. He and his colleagues recorded the number of deaths that occurred during jogging in Rhode Island over a six-year period, and found there was approximately one death for every 15,000 joggers. Subsequent studies have produced similar results.

2. However, they do occur. Dr. Thompson affirms that exercise substantially lowers one's risk of developing heart disease, but it doesn't eliminate risk. He points out that, among young people, most sudden deaths that occur during exercise are due to previously undetected, inherited abnormalities. In adults and elderly people, especially men, atherosclerosis — the narrowing of heart arteries — is the most common cause.

3. Even people who exercise regularly are still susceptible to heart attacks. "Exercise is a form of stress, and like any stress, it stimulates reactions in the cardiovascular system that can abruptly overburden that system, even if it's withstood those stresses before," Dr. Blaha told the New York Times. There isn't something necessarily unique about physical stress from exercise that triggers heart attacks — mental and emotional stress can have similar effects, according to Dr. Blaha.

4. Be aware of certain symptoms. According to Dr. Blaha, people who exercise should be aware of persistent chest pain, more shortness of breath than usual and numbness or tingling in the left arm or jaw. Another subtle sign that is not as easily detectible is fatigue. For example, a runner who typically runs six miles a day but suddenly can't find the energy to run two could have some potential health issues that he or she should discuss with their physician.

An exercise stress test can be used to determine someone's propensity for a heart attack during exercise, but stress tests only identify atherosclerosis that already exists, while more exercise-induced heart attacks are caused by an abrupt rupture of plaque, causing a blood clot and artery blockage. According to Dr. Thompson, a stress test cannot predict these potential heart problems.

5. Overall, the benefits of exercise outweigh the risk of heart attack during a workout. While the risk of heart attacks during exercise exists, the likelihood is very slight and is not a reason to avoid exercise, according to Dr. Blaha.

"The way I look at it is that exercise is medicine and it's wonderful medicine, but like any medicine, it has potential side effects," Dr. Thompson told the New York Times. "So do most things. Having sex slightly increases the risk of a heart attack compared to not having sex, since it's a form of exertion. But that doesn't mean we should avoid sex. I tell people, if you want to live life as safely as possible, stay in bed alone. But who wants that?"

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