Fitness
Can stress trigger a second heart attack? Yes, new research suggests
Patients who developed ischemia with mental stress had more than two times the risk of having a repeat heart attack or dying from heart disease compared with those who did not develop ischemia during mental stress.

We all have stress in our lives–whether it’s due to financial woes, work pressures, relationship issues, illness or even natural disasters or health crises like the emerging coronavirus. For some people who survive a heart attack, it seems mental stress–as opposed to physical stress–may be a stronger predictor of a repeat heart attack or dying from heart disease, according to research.
Traditional stress tests, in which someone exercises on a treadmill or takes a medicine that makes the heart beat faster and harder as if the person was actually exercising, have long been used to check blood flow to the heart and gauge the risk of heart problems. Researchers at Emory University sought to investigate whether myocardial ischemia–when blood flow to the heart is reduced such that the heart muscle doesn’t get enough oxygen–induced by mental stress was associated with poor outcomes among heart attack survivors and how this type of stress testing compares with conventional stress brought on by exercise.
Among more than 300 young and middle-aged individuals enrolled in the study, those who endured myocardial ischemia with mental stress had a two-fold higher likelihood of having another heart attack or dying from heart disease compared with those who did not have cardiac ischemia induced by mental stress.
“In our study, myocardial ischemia provoked by mental stress was a better risk indicator than what we were able to see with conventional stress testing,” said Viola Vaccarino, MD, PhD, Wilton Looney Professor of Cardiovascular Research in the department of epidemiology at Emory University Rollins School of Public Health in Atlanta, and the study’s principal investigator, adding that this is the only study of its kind in this relatively young adult population of heart attack survivors. “These data point to the important effect that psychological stress can have on the heart and on the prognosis of patients with heart disease. It gives us tangible proof of how psychological stress, which is not specifically addressed in current clinical guidelines, can actually affect outcomes.”
She added that taking into account patients’ psychological stress may help clinicians better evaluate the risk of recurrent heart attacks or death seen in some patients surviving a heart attack. These results also underscore the need for strategies to identify the best stress management interventions for these patients.
The investigators studied 306 adults aged 61 years or younger (50 years on average and ranging from 22-61 years), who had been in the hospital for a heart attack in the previous eight months. Participants were recruited in the Atlanta metro area and represented a diverse group of patients; half were women and 65% were African American. All participants underwent two types of “stress” testing to examine blood flow to the heart: mental stress testing (provoked by giving one speech with emotional content in front of an intimidating, seemingly disinterested audience followed by myocardial perfusion imaging), and conventional stress testing (pharmacologic or exercise). Patients were followed for a median of three years for the primary endpoint, which included a combination of either the occurrence of a repeat heart attack or cardiovascular death. These were adjudicated through an independent medical record review and examination of death records. Ischemia was defined as a new or worsening disruption in adequate blood flow to the heart and was assessed using cardiac nuclear imaging scans.
Overall, mental stress induced myocardial ischemia occurred in 16% of patients and conventional ischemia in 35%, suggesting that traditional ischemia due to exercise or drug-induced stress is more common. Over a three-year follow-up, 10% of patients (28 individuals) had another heart attack and two died of heart-related problems. The incidence of heart attack or cardiovascular-related death was more than doubled in patients with mental stress induced ischemia compared with those without mental stress ischemia, occurring in 10 (20%) and 20 (8%) patients, respectively. The relationship between acute mental stress and heart attack or death remained even after adjusting for clinical risk factors and symptoms of depression. In contrast, conventional stress ischemia was not significantly related to the primary endpoint.
“Patients who developed ischemia with mental stress had more than two times the risk of having a repeat heart attack or dying from heart disease compared with those who did not develop ischemia during mental stress,” Vaccarino said. “What this means is that the propensity to have a reduction in blood flow to the heart during acute psychological stress poses substantial future risk to these patients.”
Such reduction in blood flow, when it occurs in real life, could trigger a heart attack or serious heart rhythm problems, she said. Another interesting finding, according to Vaccarino, is that ischemia with mental stress and with conventional stress were not strongly related to each other, suggesting that they occur through different pathways.
“This points to the fact that stress provoked by emotions has a distinct mechanism of risk for heart disease and its complications compared with physical stress,” she said.
Vaccarino and her team plan to expand this research using a larger sample size and a longer follow-up time to determine if there are specific subgroups of patients that are especially at risk of adverse outcomes when they develop ischemia from mental stress. Because of the relatively small sample size, the investigators were not able to determine if such risk differs by sex or race, for example, or whether past exposures to social stressors or trauma play a role. Furthermore, the investigators plan to examine whether myocardial ischemia induced by mental stress in the lab reflects enhanced physiological responses to stress in real life.
Fitness
Treatment options to help overcome knee pain for sports enthusiasts
“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.

Millions of people experience chronic pain, with knee pain among the most common. Athletes and active adults know the impact activities like running and skiing can have on their knees, but when chronic knee pain makes it difficult to do those activities, or even day-to-day tasks like walking up the stairs, people may often face challenges.
According to the journal “Cartilage,” unlike other tissues, cartilage does not repair itself and, without proper treatment, can worsen over time and become more difficult to treat. However, options like FDA-approved knee cartilage repair surgery MACI (autologous cultured chondrocytes on porcine collagen membrane) uses a patient’s cells to help repair cartilage defects and may help alleviate knee pain.
“Sports-related pain should be evaluated quickly, especially when it’s difficult to put weight on the knee, swelling occurs or there is restricted range of motion,” said Dr. Alexander Meininger, orthopedic surgeon and MACI consultant.
Justin Keys, a former patient of Meininger and avid skier, knows that the long-term outcomes of knee cartilage surgery can be worth the short-term sacrifices. After several injuries, including an ACL injury, Keys struggled with most activities except walking on flat, paved surfaces. After consulting with Meininger, Keys chose knee cartilage repair to help get back to his active lifestyle.
Keys considered whether to manage the injury as-is or choose MACI and undergo rehabilitation to potentially get back to his favorite activities in the future. He knew he could no longer use short-term relief methods and had to address his pain with a treatment to help provide lasting relief.
For athletes like Keys who want to fix knee pain, it’s important to consider these steps:
Discuss Options with Your Doctor
Patients should talk to their doctors and undergo an MRI to help assess the internal structures of the knee. Meininger recommends patients and their doctors discuss options for long-term knee restoration health, preserving function for future decades and recognizing the short-term sacrifice.
Set Yourself Up for Success
Experts like Meininger suggest patients take steps ahead of surgery to help their recovery.
“The important thing is to be as fit as possible and use the preseason months to undergo surgery and rehab,” Meininger said.
Patients can take steps to prep their home for recovery, which may include:
- Bringing necessities down from hard-to-reach shelves
- Moving furniture to ensure clear pathways
- Installing shower safety handles to minimize potential falls
The Road to Rehab and Recovery
Rehabilitation takes time and everyone’s experience is unique. It can be as much of a mental challenge as it is physical. Committing to a physical therapy regime, staying hydrated and eating well are important aspects to support recovery. Patients should talk to their doctors with questions and before starting any exercises.
IMPORTANT SAFETY INFORMATION
Do not use if you are allergic to antibiotics such as gentamicin or materials from cow or pig; have severe osteoarthritis of the knee, other severe inflammatory conditions, infections or inflammation in the bone joint and other surrounding tissue or blood clotting conditions; had knee surgery in the past 6 months, not including surgery for obtaining a cartilage biopsy or a surgical procedure to prepare your knee for a MACI implant; or cannot follow a rehabilitation program post-surgery.
Fitness
6 Exercise safety tips
Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.

In the wake of the COVID-19 pandemic, many Americans are more aware of their health and wellness. Now, as social restrictions ease, you may find yourself stepping up your workouts, whether you’re training for an event or working to improve your game in a recreational league.
Sprains, strains and injuries can happen to even the most seasoned athletes. When you’re testing your limits, even a minor injury can alter your performance. Consider products and supports like these from the CURAD Performance Series product line, available at Walmart and Amazon, to help you get back in the game quickly and safely.
Find more resources to support your fitness journey at CURAD.com.
Keep Dirt and Germs Away
The more active you are, the harder it can be to find a bandage that stays with you all day or all game long.
Spray Away Sore Spots
Controlling mild pain can help keep you at the top of your game, and a topical analgesic works fast to heal common pain brought on by fitness and exercise, such as pain in knees, feet, shoulders and backs.
Put Pain in the Past
When recovery becomes the name of the game and pain relief is needed after daily workouts or bodily injuries. Cold packs work to heal bruises, reduce swelling and relieve headaches and general pain points while microwavable heat packs provide satisfying heat therapy to address sore and stiff joints, muscle cramps and tension.
Reduce Impact of Knee Strain
Weak, injured or arthritic knees can come from many sources, including tendonitis and a wide range of conditions that result in strain or overuse. An adjustable band can provide support for on-field sports and during workouts or everyday activities.
Manage Pain and Relieve Pressure
If you participate in endurance and strength exercises or certain sports, you may ask a lot of your joints. Kinesiology tape can be configured a multitude of ways to help reduce pain and improve blood circulation, as well as relieve tension and pressure.
Control Back Strain
When your back is strained, your body and performance can suffer. A mild or moderate sprain can benefit from strong support and compression.
Fitness
Exercise can provide relief for dry, itchy eyes
A significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.

A team led by researchers from the University of Waterloo discovered that a significant increase in tear secretion and tear film stability after participating in aerobic exercise can be another remedy for relieving dry, itchy eyes.
Every time we blink, our eyes are covered in tear film—an essential protective coating necessary for maintaining healthy ocular function. Healthy tear film comprises three layers–oil, water, and mucin–that work together to hydrate the ocular surface and protect against infection-causing irritants like dust or dirt.
When any part of the tear film becomes unstable, the ocular surface can develop dry spots, causing eye symptoms like itchiness or stinging and burning sensations.
“With so much of our activity tied to screen usage, dry eye symptoms are becoming increasingly common,” said Heinz Otchere, a PhD candidate in vision science at Waterloo. “Instead of having to use eye drops or other alternative treatments, our study aimed to determine if remaining physically active can be an effective preventative measure against dryness.”
Fifty-two participants were divided into two groups—athlete and non-athlete—to participate in an exercise session. Participants in the athlete group exercised at least five times per week, while non-athlete participants exercised no more than once per week. Researchers, which included experts from the University of Cape Coast in Ghana, performed visual examinations before and five minutes after each exercise session, where tear secretion and tear break-up time were assessed.
While participants in the athlete group showed the largest increase, Otchere says all participants experienced a meaningful boost in tear quantity and tear film stability after the exercise session.
“It can be challenging for people to regularly exercise when the demand is there to work increasingly longer hours in front of screens,” Otchere said. “However, our findings show physical activity can be really important for not just our overall well-being, but for our ocular health too.”
The study, Differential effect of maximal incremental treadmill exercise on tear secretion and tear film stability in athletes and non-athletes, was co-authored by Otchere, the University of Cape Coast’s Samuel Abokyi, Sekyere Nyamaah, and Michael Ntodie, and Ghana’s Our Lady of Grace Hospital’s Yaw Osei Akoto. It was recently published in the Experimental Eye Research journal.
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