The effects of endurance exercise on the heart: panacea or poison?

Nature Reviews. Cardiology
Gemma Parry-Williams, Sanjay Sharma

Abstract

Regular aerobic physical exercise of moderate intensity is undeniably associated with improved health and increased longevity, with some studies suggesting that more is better. Endurance athletes exceed the usual recommendations for exercise by 15-fold to 20-fold. The need to sustain a large cardiac output for prolonged periods is associated with a 10-20% increase in left and right ventricular size and a substantial increase in left ventricular mass. A large proportion of endurance athletes have raised levels of cardiac biomarkers (troponins and B-type natriuretic peptide) and cardiac dysfunction for 24-48 h after events, but what is the relevance of these findings? In the longer term, some endurance athletes have an increased prevalence of coronary artery disease, myocardial fibrosis and arrhythmias. The inherent association between these 'maladaptations' and sudden cardiac death in the general population raises the question of whether endurance exercise could be detrimental for some individuals. However, despite speculation that these abnormalities confer an increased risk of future adverse events, elite endurance athletes have an increased life expectancy compared with the general population.

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Citations

Sep 10, 2020·The New England Journal of Medicine·George Chalikias, Dimitrios Tziakas
Sep 10, 2020·The New England Journal of Medicine·Matthieu Legrand, Patrick Rossignol
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Feb 6, 2021·European Heart Journal Cardiovascular Imaging·Luna CavigliFlavio D'Ascenzi
May 5, 2021·Heart Failure Reviews·Koichi Narita, Eisuke Amiya
May 4, 2021·Frontiers in Cell and Developmental Biology·Bing BoJianshe Wei
Sep 21, 2021·Sports Medicine·Volker ScheerDaniel Rojas-Valverde

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