The American Heart Association is warning that clearing snow can pose serious health risks, especially in cold weather and rural areas where emergency response times may be longer.

Research shows that the heavy exertion of shoveling snow can sharply increase the risk of heart attack or sudden cardiac arrest — even in people with no known heart disease. The strain of lifting heavy, wet snow, combined with cold air tightening blood vessels, can push the heart to dangerous levels, experts say.

“Shoveling can be as demanding as a treadmill stress test,” said Dr. Larry Markham, president of the AHA’s Indianapolis board. “For people who are out of shape or already have risk factors, it can be a perfect storm.”

The AHA says shoveling snow relies heavily on arm strength, which puts more stress

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