For whom is shoveling snow not recommended?

Snow Shoveling Contraindications and High-Risk Populations

Snow shoveling should be avoided by individuals with known coronary artery disease, cardiac risk factors, sedentary lifestyle, or prior coronary stent placement, as this activity represents strenuous physical exertion (63-75% of maximum oxygen consumption) that can trigger acute coronary syndromes and subacute stent thrombosis. 1, 2

High-Risk Populations Who Should Avoid Snow Shoveling

Absolute Contraindications

• Patients with prior coronary stent placement: Snow shoveling precipitates subacute stent thrombosis, with 25% of all stent thromboses in one series occurring during snow shoveling events 1
• Individuals with known coronary artery disease: Even asymptomatic patients with CAD experience significant cardiac stress during shoveling, reaching 60-68% of peak oxygen consumption 3
• Patients with recent myocardial infarction or acute coronary syndrome: These individuals should avoid unaccustomed vigorous physical activity including manual snow removal 4

Strong Relative Contraindications

• Men with family history of premature cardiovascular disease: 3.6 times more likely to suffer snow-shoveling-related acute coronary syndrome 5
• Male gender: 4.8 times more likely to experience snow-shoveling-related cardiac events compared to women 5
• Sedentary individuals with multiple cardiac risk factors: Including hypertension, hyperlipidemia, diabetes mellitus, and tobacco use 1, 2
• Patients with heart failure or at risk for heart failure: Snow shoveling can precipitate acute heart failure syndromes even in those with preserved ejection fraction 6

Additional High-Risk Groups

• Older adults (>60 years): Older individuals demonstrate reduced work capacity during snow shoveling (22.2 ml/kg/min vs 25.6 ml/kg/min in younger adults) 3
• Individuals with chronic stable angina: Trending toward association with snow-shoveling-related acute coronary events 5
• Patients with genetic cardiovascular diseases: Intense static exertion like snow shoveling induces Valsalva maneuver and can trigger arrhythmias or increase wall stress 4

Physiological Demands and Risks

Snow shoveling represents hard physical work with energy expenditure of 2.1-2.6 L/min oxygen consumption (63-75% of maximum capacity), heart rates averaging 141-142 beats/minute, making it unsuitable for persons with cardiac risk factors. 2

• The activity involves both dynamic and static (isometric) components, creating high hemodynamic load 4
• Combined with cold temperatures and low atmospheric pressure, winter conditions further increase adverse cardiovascular event risk 1
• Work intensity during shoveling reaches levels typically reserved for supervised cardiac rehabilitation programs 4, 3

Common Pitfalls to Avoid

• Underestimating the intensity: Snow shoveling is not "light activity" but represents vigorous exertion comparable to intense aerobic exercise 2, 3
• Assuming asymptomatic CAD is safe: Even well-compensated patients with good functional capacity experience significant cardiac stress 3
• Ignoring stent history: Patients with prior stenting face particularly high risk of acute thrombosis during this activity 1
• Overlooking family history: Strong family history of premature CVD is an independent predictor of snow-shoveling-related events 5

Alternative Recommendations

For high-risk individuals who must clear snow:

• Use mechanical snow removal equipment (snow blowers) rather than manual shoveling 2
• Hire snow removal services
• If shoveling is unavoidable, use a snow pusher rather than lifting snow, though this still represents 75% of maximum oxygen consumption 2
• Ensure optimal medical management and risk factor control before any consideration of this activity 4