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Emotional stress and physical exertion including, in rare cases, sexual activity, can trigger heart attacks in people with pre-existing heart disease, researchers report.

But they also note that regular physical exercise also helps keep heart disease at bay.

"Patients need to realize that they would still benefit greatly from regular physical activity," co-researcher Andrew Steptoe of University College London said in a prepared statement.

Reporting in the March issue of Psychosomatic Medicine, he and co-author Phillip Strike reviewed dozens of studies conducted between 1970 and 2004.

"The evidence of triggering by physical exertion and emotional stress is compelling," the study authors wrote. They said that it`s "likely that triggers are more potent when acting in combination or when they are present at particular times of day."

One study found that couch-potato types who suddenly engaged in strenuous exertion were seven times more likely to suffer a heart attack after that exertion compared with individuals who exercised regularly.

Still, even in these sedentary types, the absolute risk of heart attack linked to any strenuous event, including sex, is very small -- less than one chance in a million, the researchers said.

With respect to sex, in particular, Steptoe`s view is that "it is much more important for people to maintain good personal and sexual relationships than it is to worry about this small increase in risk."

Natural disasters, war and sporting events are other potential heart attack triggers, the researchers noted.

The findings highlight the importance of doctors talking with patients who`ve had a heart attack about their experiences and circumstances in the hours before they suffered the cardiac event. For example, if a person suffers a heart attack following exercise, they may be afraid to exercise, the researchers said. But those patients also need to realize that they can benefit greatly from regular physical activity, the scientists said.

The British study ties in with a recent Journal of the American College of Cardiology article on the emerging field of behavioral cardiology.

"The real battlefield has become, `What should cardiologists do with this information?` given that there are no guidelines for integrating the management of psychological factors into cardiac practice," wrote study lead author Dr. Alan Rozanski of St. Luke`s-Roosevelt Hospital Center and Columbia University, in New York City.

Rozanski and his colleagues suggested that, at least for now, heart specialists screen patients for psychosocial issues. Some of these issues can be dealt with within the cardiac practice, while patients with severe psychological problems can be referred to specialists.