15. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Cardiorespiratory fitness (CRF) also is a strong prognostic marker for cardiovascular health. Incidence, cause, and comparative frequency of sudden cardiac death in national collegiate athletic association athletes: a decade in review. The roundtable proposed a new evidence-informed model for exercise preparticipation health screening on the basis of three factors: 1) the individual's current level of physical activity, 2) presence of signs or symptoms and/or known cardiovascular, metabolic, or renal disease, and 3) desired exercise intensity, as these variables have been identified as risk modulators of exercise-related cardiovascular events. AEDs are computerized devices with voice and visual cues that guide exercise professionals and bystanders to defibrillate pulseless ventricular tachycardia or ventricular fibrillation (VF). min1) Evolution of the ACSM Guidelines - LWW Loprinzi PD, Cardinal BJ. 21. The purpose of the American College of Sports Medicine_s (ACSM) exercise preparticipation health screening process is toidentify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. 2000;61 (6):1901-1904. 6. Appropriate HR, BP, and rhythm responses to exercise (see Chapters 4 and 5) Questions and answers on workup diagnosis and risk stratification: a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. Early defibrillation is critical for the successful survival of VF, the most frequent type of SCD. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Roule V, Alexandre J, Lemaitre A, Chrtien B, Sassier M, Fedrizzi S, Beygui F, Dolladille C. Cardiovasc Drugs Ther. Myocardial infarction is a disease that occurs due to sudden occlusion of the coronary arteries leading to ischemic necrosis of the heart muscle 1.One of the most important strategies for cardiac . Association of weather with day-to-day incidence of myocardial infarction: a SWEDEHEART nationwide observational study. 0000007509 00000 n Unauthorized use of these marks is strictly prohibited. startxref 23. Page RL, Husain S, White LY, et al. You may be trying to access this site from a secured browser on the server. An RPE of 11 to 13 (fairly light to somewhat hard) on the Borg Scale is an appropriate method for determining initial loads for RT exercises (2,3). PPHS should be performed for new members and prospective users of these facilities at the time of enrollment following an informed consent process with subsequent facility access granted or withheld pending the need for medical clearance. Isometric exercises and resistance bands and machines are all acceptable options, if tolerated. Champaign, IL: Human Kinetics . M.D., FACSM; Franklin, Barry A. Ph.D., FACSM, ACSM-CEP; Jaworski, Carrie A. Eur Heart J. The most well-known benefit of RT is increased muscular strength and endurance (1,4-10). RESISTANCE TRAINING FOR CARDIAC PATIENTS: Maximizing Rehabil : ACSM Abstract. Health/fitness facilities must have a written emergency response plan that is reviewed quarterly and physically rehearsed at least twice annually (Table 4). National Strength and Conditioning Association. Williams, M.A., W.L. 74 49 0000003189 00000 n Third universal definition of myocardial infarction. The underlying pathology of exercise-related cardiovascular events differs between younger and older adults. The location of all emergency equipment, including automated external defibrillators (AEDs), emergency phone, and the entry/exit locations for access by emergency medical response system (EMS) personnel, should be clearly delineated. Latest in ED Risk Stratification of Chest Pain: hs-cTn and Risk Scores He serves as team cardiologist and physician for numerous athletic organizations, including U.S. Soccer, U.S. Rowing, Harvard University Athletics, New England Patriots, Boston Bruins, and New England Revolution, and is a medical director for the BAA Boston Marathon. Questions and answers on antithrombotic therapy and revascularization strategies in non-ST-elevation acute coronary syndrome (NSTE-ACS): a companion document of the 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Barbato E, Mehilli J, Sibbing D, Siontis GCM, Collet JP, Thiele H; ESC Scientific Document Group. Please enable it to take advantage of the complete set of features! National Strength and Conditioning Association. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. 0000049830 00000 n Prog Cardiovasc Dis. American College of Sports Medicine and the American Heart Association. 14. The next section provides recommendations based on the standards set forth by ACSMs Health/Fitness Facility Standards and Guidelines (29) to prevent and appropriately respond to cardiovascular emergencies. Pollack CV, Amin A, Wang T, Deitelzweig S, Cohen M, Slattery D, Fanikos J, DiLascia C, Tuder R, Kaatz S. Hosp Pract (1995). In response to the morbidity and mortality imposed . PDF Acsm Guidelines For Exercise Testing And Prescription Abstract The purpose of the American College of Sports Medicine's (ACSM) exercise preparticipation health screening process is to identify individuals who may be at elevated risk for exercise-related sudden cardiac death and/or acute myocardial infarction. Select 8 to 10 exercises (1 exercise for each major muscle group). Acsm Guidelines For Exercise Testing And Prescription . ACSM's Guidelines for Exercise Testing and Prescription This training is particularly important at unstaffed facilities. 14. 10. Combination of upper or lower (dual action) extremity cycle ergometer Association between biologic outcomes and objectively measured physical activity accumulated in 10-minute bouts and <10-minute bouts. Participation in cardiac rehab after suffering or undergoing an indexed cardiac-related event represents guideline-based care to reduce the risk for: experiencing a second event, 5. 0000002127 00000 n 0000054009 00000 n Eur Heart J. Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. 0000019425 00000 n European Society of Cardiology; Guidelines; acute cardiac care; acute coronary syndrome; angioplasty; anticoagulation; antiplatelet; apixaban; aspirin; atherothrombosis; betablockers; bivalirudin; bleedings; bypass surgery; cangrelor; chest pain unit; clopidogrel; dabigatran; diabetes; dual antithrombotic therapy; early invasive strategy; edoxaban; enoxaparin; fondaparinux; glycoprotein IIb/IIIa inhibitors; heparin; high-sensitivity troponin; minoca; myocardial infarction; myocardial ischaemia; nitrates; non-ST-elevation myocardial infarction; platelet inhibition; prasugrel; recommendations; revascularization; rhythm monitoring; rivaroxaban; stent; ticagrelor; triple therapy; unstable angina. Vanbiervliet, W., J. Plissier, B. Ldermann, et al. Therefore, the 2018 guidelines highlight that there are health benefits attributable to any level of PA. For those individuals who perform little to no MVPA, even replacing sedentary behavior with light-intensity PA reduces the risk of all-cause mortality, CVD incidence and mortality, and the incidence of type 2 diabetes (8). Congenital and hereditary abnormalities, including hypertrophic cardiomyopathy and coronary artery abnormalities, are commonly cited causes of exercise-related SCD in young athletes, although recent autopsy studies of high school and college athletes have identified no structural cause in some cases (23). With the various modes of RT and exercise equipment available to the health and fitness professional, each cardiac patient must be evaluated on an individual basis. FOIA A well-organized emergency response system is critical to providing a safe environment for exercise participants. 2021 Jan 21;42(4):352. doi: 10.1093/eurheartj/ehaa927. Give a loading dose of aspirin as soon as possible to any patient with suspected . In addition to providing a safe environment, it is important to remember that the risk of exercise-related adverse CVD events can be mitigated by adopting a progressive transitional phase of approximately 2 to 3 months during which exercise duration and intensity are gradually increased. The type of heart attack (also called myocardial infarction, or MI) you experienced determines the treatments that your medical team will recommend. Habitual MVPA also lowers the risk of cardiovascular disease (CVD) by favorably modifying blood lipid profiles, blood pressure, C-reactive protein, and insulin sensitivity. 0000030201 00000 n Upright and recumbent cycle ergometer This guideline covers the early and longer-term (rehabilitation) management of acute coronary syndromes. Eur Heart J. Adults: National Health and Nutrition Examination Survey 2001-2004. Champaign (IL): Human Kinetics; 2019. 61 terms. Dr. Churilla is a member of the ACSM; the American Heart Associations Council on Nutrition, Physical Activity and Metabolism; and the National Strength and Conditioning Association. 2023 Apr 28. doi: 10.1007/s00063-023-01009-8. The emergency response plan should address medical emergencies that are reasonably foreseeable in an exercise setting (e.g., common orthopedic injuries, sudden cardiac arrest, AMI, stroke, hypoglycemia, and heat illness) and must provide specific instructions for how an emergency situation is handled by the staff. ACSM's Health & Fitness Journal24(6):10-17, November/December 2020. Although there is an increased relative risk of AMI and SCD during vigorous-intensity exercise, the absolute risk of exercise remains extremely low. For example, the Physicians Health Study (17) and Nurses Health Study (25) reported only 1 SCD per 1.5 million hours of vigorous PA in men and per 36.5 million hours of MVPA in women. Eur Heart J. Whitfield GP, Riebe D, Magal M, Liguori G. Med Sci Sports Exerc. <>>> Paul is coeditor for ACSM's Certified News and an editorial board member for ACSM's Health & Fitness Journal. Sasson C, Rogers MA, Dahl J, Kellermann AL. Ex Rx for cardiac transplantation does not include target HR but instead, an extended warm-up and cool-down to patient tolerance if the patient is limited by muscular deconditioning, The benefits obtained from RT will compliment the cardiorespiratory component of cardiac rehabilitation. 0000007882 00000 n Early Recurrence of Attack after Myocardial Infarction with Deborah Riebe, Ph.D., FACSM, ACSM-EP,is a professor and associate dean of the College of Health Sciences at the University of Rhode Island.Dr. American College of Sports Medicine Health/Fitness Facility Standards and Guidelines, 2nd Ed. Get new journal Tables of Contents sent right to your email inbox, November-December 2008 - Volume 12 - Issue 6, RESISTANCE TRAINING FOR CARDIAC PATIENTS: Maximizing Rehabilitation, Articles in PubMed by Paul Sorace, M.S., RCEP, CSCS, Articles in Google Scholar by Paul Sorace, M.S., RCEP, CSCS, Other articles in this journal by Paul Sorace, M.S., RCEP, CSCS, Practical Recommendations for High-Intensity Interval Training for Adults with Cardiovascular Disease, Just What the Doctor Ordered: A Guide to Robust Assessment and Exercise Prescription in Older Adults, A Guide to the Assessment of Function and Fitness in Older Adults, EXERCISE CONSIDERATIONS FOR TYPE 1 AND TYPE 2 DIABETES, Privacy Policy (Updated December 15, 2022), Use lighter weights (50% of 1-repetition maximum) (, Select 8 to 10 exercises for the major muscle groups (, Select a resistance allowing performance of 12 to 15 repetitions (, Avoid tight gripping and breath holding (Valsalva maneuver) (, Use a BP cutoff of 220/105 mmHg during RT (. The six-minute walk test (6MWT) is a simple, low cost, reliable, and valid method for evaluating the functional capacity of cardiac patients. Mohammad MA, Koul S, Rylance R, et al. 14. In addition, safety concerns and guidelines and how to develop, implement, and monitor an RT program for patients in cardiac rehabilitation and after cardiac rehabilitation will be presented. Riebe, Deborah Ph.D., FACSM, ACSM-EP; Baggish, Aaron L. Pandolf KB, Cafarelli E, Noble BJ, Metz KF. Recent successful percutaneous intervention or revascularization surgery without residual obstructive coronary artery disease. doi: 10.1097/MJT.0b013e31804c7238. 2021 Apr 7;42(14):1289-1367. doi: 10.1093/eurheartj/ehaa575. Eur Heart J. The New ACSM Recommendations for Preventing Cardiovascular : ACSM's The Role and Indications of ICD in Patients With Ischemic 1 The initial presentation and electrocardiogram (ECG) changes of COVID 19 infection can resemble with STEMI. 0000032044 00000 n revascularization, and pacemaker defib. Sensors (Basel). Douda, P.F. I: seated or standing resting HR +20 beats/min for patient w MI and +30 b/m for patients recovering from heart surgery The main sample included 3,648 AMI inpatients with a median age of 61.0 years, and 68.9% were male. 2020 ESC Guidelines for the management of acute coronary - PubMed 0000042862 00000 n 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial . Thompson PD, Arena R, Riebe D, Pescatello LS; American College of Sports Medicine. 0000052903 00000 n 2012 Mar-Apr;54(5):445-50. doi: 10.1016/j.pcad.2012.01.001. doi: 10.2196/45244. endobj 18. Management of ST elevation myocardial infarction (STEMI) with primary PDF ACSM Certified Exercise Physiologist - American College of Sports Medicine Type 2 myocardial infarction: the chimaera of cardiology? Some error has occurred while processing your request. Whang W, Manson JE, Hu FB, et al. PDF ACSM Certified Exercise Physiologist - American College of Sports Medicine A scientific update from the American Heart Association Council on Clinical Cardiology and Council on Nutrition, Physical Activity, and Metabolism. Eur Heart J. 2020 non-ST-segment elevation acute coronary syndrome guidelines on pre-treatment: primum non nocere! Safety and efficacy of weight training soon after acute myocardial infarction. Hyperthermia: effect on exercise prescription. 0000031118 00000 n PPHS has been proposed as a tool capable of identifying people at high risk for adverse cardiovascular events during exercise so that they can be referred for medical clearance, providing an opportunity for disease diagnosis and management. Stair climber Hemodynamic responses during aerobic and. The site is secure. 2023 Mar 15;12:e45244. Please try again soon. Because health and fitness facilities vary greatly in their scope of offerings and clientele, the following elements should be incorporated at a level appropriate for each facility. A myocardial infarction (commonly called a heart attack) is an extremely dangerous condition that happens because of a lack of blood flow to your heart muscle. 30. 1 0 obj A patient with a shoulder impingement should keep movements below 90 degrees of shoulder abduction and flexion and keep arms slightly in front of the body in the scapular plane. 2021 May 21;42(20):2020-2021. doi: 10.1093/eurheartj/ehaa909. 0000002983 00000 n Clin Sports Med. The presence of diabetes and renal disease seems to increase the risk of adverse cardiovascular events during exercise due in part to their pathogenic association with atherosclerotic CAD (17,18). -CVD risk factors, Routine pre-exercise assessment of risk for exercise should be performed before, during and after each rehab session includes, -HR 25. Jiang X, Yan Y, Yang Z, Wen M, Long Y, Fu B, Jiang J. BMC Cardiovasc Disord. Aaron L. Baggish, M.D., FACSM, is the director of the Cardiovascular Performance Program at the Massachusetts General Hospital Heart Center. <]/Prev 373569>> The AED should be inspected and maintained according to manufacturers specifications, and all related information should be carefully documented and maintained as a part of the facilitys emergency response system records. A. Our study investigates the in-hospital outcomes and the impact of transfer and COVID-19 infection status on mortality in STEMI patients. Rhabdomyolysis with Co-Administration of Statins and Antiplatelet Therapies-Analysis of the WHO Pharmacovigilance Database. 23. Swain, and R.J. Shephard. sharing sensitive information, make sure youre on a federal Deborah Riebe, Ph.D., FACSM, ACSM-EP,is a professor and associate dean of the College of Health Sciences at the University of Rhode Island. The effects of resistance training on cardiovascular patients. Highlight selected keywords in the article text. Upper-extremity strength may be decreased from lack of use. Exercise within a pain-free range of motion. In addition, a 46% improvement in muscle power has been observed in frail individuals who perform RT (4). DrSaraLevineChiro. Zoeller Exam 2 RX -dont forget article. hb```f``e`c`PUdd@ A; Gim~50ps:iX0OBa*G%]aR!KAOaUyf]\Y+y. Eur Heart J. Estimating effectiveness of cardiac arrest interventions: a logistic regression survival model. ST-elevation myocardial infarction (STEMI) presents with central chest pain that is classically heavy in nature, like a sensation of pressure or squeezing. AHA/ACSM Joint Position Statement - LWW learn more about the steps that exercise professionals can take to promote safety in health fitness facilities. Avoid rapid changes of body position, and provide close supervision (some persons with osteoporosis may have postural changes that may negatively affect their balance). to maintaining your privacy and will not share your personal information without Check out the new look and enjoy easier access to your favorite features. Additional RT safety precautions and suggestions for specific conditions include the following: Continuous breathing during RT is particularly important for cardiac patients, to avoid the Valsalva maneuver. Please try after some time. National Center for Biotechnology Information Acute systemic illness or fever This article has been copublished in the Journal of the American College of . 26. The prevalence of myocardial infarction in older Americans aged 65-69 yr is 18.0% and 9.7% for men . Providing a safe exercise environment is of the utmost importance in health fitness facilities. Participant safety is of utmost importance to all those who work in health fitness facilities. 2021 Apr 7;42(14):1379-1386. doi: 10.1093/eurheartj/ehaa602. Staffed exercise facilities should have at least one staff member who is currently trained and certified in CPR and in the use of an AED on duty during all operating hours (29). Ades, et al. Sorace, Paul M.S., RCEP, CSCS; Ronai, Peter M.S., RCEP, CSCS*D, NSCA-CPT; Churilla, James R. Ph.D., M.P.H., RCEP, CSCS. 2023 Apr 19;12(8):2971. doi: 10.3390/jcm12082971. Following the proper time-course, safety considerations, and programming guidelines will ensure resistance training helps maximize recovery from a cardiac event and improve quality of life. Following should be considered in determination of appropriateness for independent exercise, Cardiac symptoms that are stable or absent Sanders M, editor. Cardiac resynchronization therapy pacemakers that have three leads; one in right atrium, one in right ventricle, and one in coronary sinus or, less commonly, the left ventricular myocardium via an external surgical approach. There is an additional challenge for management of other emergencies like, Acute Coronary Syndrome (ACS), particularly ST elevation myocardial infarction (STEMI). Myocardial Infarction Therapeutics Market Size, Status - MarketWatch Health and fitness facility members and users can play an important role in the prompt response to cardiovascular emergencies. He is a previous member of the ACSM Registered Clinical Exercise Physiologist Practice Board and Continuing Professional Education Committee. Antiplatelet intervention in acute coronary syndrome. Myocardial infarction (MI), a subset of acute coronary syndrome, is damage to the cardiac muscle as evidenced by elevated cardiac troponin levels in the setting of acute ischemia. The ACSM PPHS procedure includes the following: 1) a determination of current exercise habits; 2) the identification of established cardiovascular, metabolic, and renal diseases; and 3) the delineation of signs and/or symptoms at rest or during physical exertion, suggesting underlying CVD. Briffa, and J. Many studies have shown that low-risk (e.g., functional capacity, 7 metabolic equivalents [METs]) and moderate-risk (e.g., mild to moderate silent ischemia during exercise testing or recovery) cardiac patients can engage in RT without excessive myocardial strain (6-12). MeSH However, the updated document presents new approaches to client safety based on the latest scientific advances. Stay and Quality of Care in Patients With Acute Coronary Syndromes (from the American Heart Association's Get With the Guidelines--Coronary Artery Disease Data Set). Franklin, B.A., D.P. Table 2 outlines the time course for initiating RT in low- to moderate-risk cardiac patients. *}v2m(FbS5Os5x(Q > | R>@_PlZt m @cS9,2h }!Et6@*|slBIHTPe#DQhe3"2ezxbMb? 13. Special RT precautions need to be taken with patients who have had myocardial infarction (MIs), coronary artery bypass surgery (CABG), implantable defibrillators (ICDs), pacemakers, diabetes, and hypertension (1-3,8-11). Haskell, P.A. 2021 Jul 8;42(26):2605-2606. doi: 10.1093/eurheartj/ehaa858. myocardial infarction or during a cardiac procedure). Preventive measures, including proper signage, ongoing surveillance of facility safety, and member education, also are part of a comprehensive risk management plan. Disclaimer. See Table 1 for a summary of RT benefits for cardiac patients. Repetitions should be added as tolerated. Significant ventricular or atrial arrhythmias with or without associated signs/symptoms T: 30-60m/d A cardiac patient with osteoporosis should perform all exercises with an upright posture and avoid spinal flexion (forward and lateral) and spinal rotation (twisting) (2,23). 2023 Apr 28;23(1):220. doi: 10.1186/s12872-023-03224-9. Cardiac patients were (and sometimes still are) told not to lift anything heavier than 5 to 10 lbs for an indefinite time period after a cardiac event or procedure (11). 2 0 obj lightheadedness. A new paradigm for post-cardiac event. For more information, please refer to our Privacy Policy. Repetitive motions like RT can result in pacing and lead fractures and dislodgement. Individuals with low levels of CRF have a higher risk of CVD morbidity and mortality, but importantly, the risk decreases with improvements in CRF. 11. 13. 0000001276 00000 n -current meds including dose, route of administration and frequency Curr Sports Med Rep. 2013 Jul-Aug;12(4):215-7. doi: 10.1249/JSR.0b013e31829a68cf. In addition, the requisite force to complete these activities may exceed medically imposed lifting restrictions placed on this patient population (11). 8600 Rockville Pike Arena SK, Wilson CM, Boright L, Webster O, Pawlitz C, Kovary C, Esper E. Cureus. Resistance Training Benefits for Cardiac Patients, Time Course for Initiating RT in Cardiac Patients, Absolute and Relative Contraindications for RT in Cardiac Patients, Resistance Training Programming Guidelines for Cardiac Patients, 1. When bystander CPR is provided, the decrease in survival averages 3% to 4% per minute from collapse to defibrillation (30,31). and transmitted securely. 2021 May 21;42(20):2019. doi: 10.1093/eurheartj/ehaa906. liz_fay. 2018 Physical Activity Guidelines Advisory Committee. Machine learning for prediction of bleeding in acute myocardial Avoid "throwing" or "dropping" the resistance; always maintain control of the resistance. 2023 Apr 28. doi: 10.1007/s10557-023-07459-8. Nilsen TS, Ster M, Sarvari SI, Reinertsen KV, Johansen SH, Edvardsen ER, Halln J, Edvardsen E, Grydeland M, Kiserud CE, Lie HC, Solberg PA, Wislff T, Sharples AP, Raastad T, Haugaa KH, Thorsen L. JMIR Res Protoc. Dracup, G.C. [Guideline] Ibanez B, James S, Agewall S, et al, for the ESC Scientific Document Group . A., and S. J. Tharrett, Eds. Exercise Stress Testing: Indications and Common Questions The second letter of the code describes the chamber sensed. An official website of the United States government. Please enable scripts and reload this page. 0000020067 00000 n 0000049485 00000 n 21. Riebe is a Fellow of the American College of Sports Medicine; has served as president of the New England Chapter of the American College of Sports Medicine, chair of ACSM's Committee for Certification and Registry Boards, and chair of ACSM's Health . DeJong, A.T., C.J. Keyword Highlighting Bystander initiated actions in out-of-hospital cardiopulmonary resuscitation: results from the Amsterdam Resuscitation Study (ARRESUST). Avoid rapid changes in body position to prevent dizziness and falls. Recent embolism <> He is ACSM Program Director certified and a current member of the ACSM Publications Subcommittee. P: When continuous exercise duration reaches 10-15 min, increase intensity as tolerated within the recommended RPE and HR limits. Womack, J.A. Barthlmy O, Jobs A, Meliga E, Mueller C, Rutten FH, Siontis GCM, Thiele H, Collet JP; ESC Scientific Document Group. HIIT refers to the combination of high-intensity exercise bouts usually lasting 2 to 5 minutes with interspersed periods of more moderate or recovery exercise during the workout. The https:// ensures that you are connecting to the Both lower- and upper-body muscle groups should be trained on the same day to preserve time (5,10,26). This is important for cardiac patients because many activities of daily living require more muscular strength and endurance than what is developed from cardiorespiratory exercise. There also should be signage on the emergency plan and whom to contact and how to use the AED, especially in facilities such as hotel fitness centers that are not staffed. Please try after some time. A systematic review. 0000004306 00000 n Your message has been successfully sent to your colleague. 2003 Jan;22(1):23-35. doi: 10.1016/s0278-5919(02)00040-6. The Athlete With Cardiovascular Disease: CAD and Master Athletes Treadmill for walking He was NBCs Sports Medicine Analyst at the 1988 Olympic Games in Seoul, Korea, and served in a similar capacity for ABCs coverage of the 1991 Pan American Games in Cuba. 0000029431 00000 n Revealing concealed cardioprotection by platelet Mfsd2b-released S1P in Males are approximately 10 times more likely than females to experience an acute cardiovascular event during or immediately after vigorous exercise (14). 20. 2021 May 14;42(19):1925. doi: 10.1093/eurheartj/ehab088.
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