“I can’t believe the way my boss treated me at work today.  I’m definitely going to catch my 6pm high intensity kick boxing class so I can take my anger towards him out on the punching bag!”  Have you ever felt similar emotions about a situation and decided to channel your anger and frustration through intense exercise?

Although for some people this may be an acceptable way to deal with anger, especially if it prevents you from getting into an altercation you might regret later, a recent study suggests that it may increase heart attack risk in others.  An analysis of the INTERHEART study population which looks at heart disease risk factors across 52 countries and involving over 12,000 heart attack patients found the odds of having a heart attack were three times greater for those who had exercised and were upset or angry in the 60 minutes leading up to their heart attack.  This effect was consistent across all regions of the world.

How could anger while exercising increase risk?

First of all, keep in mind that atherosclerosis, the process that builds artery-clogging plaques, takes several years.  If you are at a low risk for heart disease and don’t have plaques, you’re not going to instantly develop a heart attack overnight from an anger-induced exercise session.

So what’s the mechanism for this effect?  Think of anger and exercise as a double dose of high potency chemicals like adrenaline that cause physiological changes such as increased blood pressure, heart rate, and clamped or constricted blood vessels which exert a tremendous oxygen and energy demand upon your heart muscle.  If your heart is already compromised from atherosclerosis, this cumulative anger-exercise effect can be the tipping point that leads to plaque rupture and blockage of your coronary arteries, leading to a heart attack.

The real problem is that most individuals who experience this effect have no idea what their heart attack risk was prior to exercising.  These are individuals who likely have risk factors such as obesity, blood sugar problems (prediabetes, diabetes, etc.), abnormal cholesterol levels and are exercising hard with the best of intentions, not realizing that doing this with the wrong set of emotions may exacerbate their risk.

I saw this in a patient of mine who works at a Silicon Valley company.  His company offered a biometric screening event that identified him as having metabolic syndrome, a common underlying risk for heart disease.  He decided to join the boot camp offered through his work, hoping to get his numbers under control.  One evening after his boot camp he experienced chest discomfort while driving home from work and decided to head straight to the ER where he was diagnosed with a heart attack.

I don’t know if he was angry or upset during this workout, but I wanted to make the larger point that depending on your pre-exercise risk level, you may need to have a stress test (like a treadmill test), especially before engaging in high intensity exercise.

For example, if you are diabetic and plan on engaging in a high intensity exercise program, then you need to get medically cleared by a physician.  Typically doctors refer to The American College of Sports Medicine (ACSM) guidelines here on risk stratification, which involves a thoughtful physician evaluation and thorough discussion between doctor and patient.

How do I release my anger?

Consider hitting the yoga mat instead of the weight rack when you’re feeling upset, especially if you are already at risk for heart disease and are not in great physical shape.  I already mentioned that anger releases catecholamines that speed up your heart.  Your goal should be to counteract this effect with a more calming activity like meditation, yoga, tai-chi, walking, etc.  Perhaps after you’ve successfully calmed down your nervous system and had time to “reframe” your anger, you can step up your exercise intensity to an appropriate level approved by your physician if you are at significant risk for heart disease.

I personally do high intensity workouts maybe twice a week and do not do them when I’m upset or angry.  I do them when I feel rested and energized.  If you need some help with managing your stress and negative emotions, refer to some of my prior posts on stress management here and refer to my book as well.  I especially want to highlight this post which talks about an epidemic in my high stress entrepreneurs where an intense work regimen combined with an intense workout regimen led to a heart attack despite there being no obvious signs of heart disease risk.  I’m seeing this so often, that I now call it “Chronic Entrepreneur’s Syndrome.”

Bottom line is that for most individuals living in a modern world, we need to make sure we are incorporating enough rest, sleep and low to moderate intensity range activities to counteract the effects of chronic stress.  Read this post for more information on my favorite low intensity exercise and be sure you put a smile on your face and think happy thoughts during your next intense exercise session.