Exercise is generally considered good for you as it decreases your overall risk of heart disease and generally makes you healthier.
But the new research suggests that spikes in physical activity – such as during sex – can also have the opposite effect – triggering heart attacks and cardiac arrests.
The increased risk – as much as 2.7 times higher than normal – applies mainly to people who are otherwise unhealthy and can be reduced by regular physical activity.
But a small risk does apply to everyone.
The scientists at Tufts and Harvard Universities in Boston reviewed the results of a number of previous studies to come up with the findings.
They found that "episodic activity" was associated with more than a two and a half times increased risk of heart attack and sudden cardiac death (SCD).
However regularly indulging in exercise – including sex – offset the increased risk by almost half for each additional time per week it was carried out.
"Regular physical activity has been identified as strongly associated with a decreased risk of cardiovascular disease and related mortality," the researchers wrote.
"Despite the well-established benefits of regular physical activity, anecdotal evidence has suggested that physical activity, as well as other acute exposures, such as sexual activity and psychological stress, can act as triggers of acute cardiac events."
The researchers looked at more than 14 studies looking at what caused heart attacks and found that a small but significant number happened during physical and sexual activity.
They found that all kinds of physical activity accounted for three and a half times increased risk and sex 2.7 times.
Researchers said that most importantly the risks could be modified by "habitual physical activity" and that those who indulged regularly were much less likely to have a heart attack triggered by sex.
Heart and circulatory disease is the biggest killer in Britain and heart disease alone causes 91,000 deaths a year.
The study was published in the latest issue of the journal JAMA.
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