Journal of the American Society of Echocardiography
Volume 22, Issue 7 , Pages 810-813 , July 2009

Endurance Exercise and the Heart: Multiple Benefits but Many Unanswered Questions

  • Tomas G. Neilan, MD
    • ,
  • Malissa J. Wood, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Malissa J. Wood, MD, Division of Cardiology, 55 Fruit Street, VBK 508, Boston, MA, 02115-2696.

References 

  1. RunningUSA. RRIC annual marathon report. Available at: http://runningusa.org/node/16585. Accessed May 15, 2009.
  2. Mascitelli L, Pezzetta F. Effects of exercise on plasma lipoproteins. N Engl J Med. 2003;348:1494–1496
  3. Paffenbarger RS, Hyde RT, Wing AL, Lee IM, Jung DL, Kampert JB. The association of changes in physical-activity level and other lifestyle characteristics with mortality among men. N Engl J Med. 1993;328:538–545
  4. Heidbuchel H, Hoogsteen J, Fagard R, Vanhees L, Ector H, Willems R, et al. High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification. Eur Heart J. 2003;24:1473–1480
  5. Thompson PD, Franklin BA, Balady GJ, Blair SN, Corrado D, Estes NA, et al. American Heart Association Council on Nutrition, Physical Activity, and Metabolism; American Heart Association Council on Clinical Cardiology; American College of Sports Medicine. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology. Circulation. 2007;115:2358–2368
  6. Breuckmann F, Mohlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, et al. Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology. 2009;251:50–57
  7. Dimitriadou C, Dessypris A, Louizou C, Mandalaki T. Marathon run II: effects on platelet aggregation. Thromb Haemost. 1977;37:451–455
  8. Douglas PS, O'Toole ML, Hiller WD, Reichek N. Different effects of prolonged exercise on the right and left ventricles. J Am Coll Cardiol. 1990;15:64–69
  9. Northcote RJ, Ballantyne D. Sudden death in a marathon runner. Lancet. 1983;1:417
  10. Mohlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, et al. Marathon Study Investigators; Heinz Nixdorf Recall Study Investigators. Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J. 2008;29:1903–1910
  11. Sandvik L, Erikssen J, Thaulow E, Erikssen G, Mundal R, Rodahl K. Physical fitness as a predictor of mortality among healthy, middle-aged Norwegian men. N Engl J Med. 1993;328:533–537
  12. Sarna S, Sahi T, Koskenvuo M, Kaprio J. Increased life expectancy of world class male athletes. Med Sci Sports Exerc. 1993;25:237–244
  13. Siscovick DS, Weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest during vigorous exercise. N Engl J Med. 1984;311:874–877
  14. Chakravarty EF, Hubert HB, Lingala VB, Fries JF. Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med. 2008;168:1638–1646
  15. Maron BJ, Poliac LC, Roberts WO. Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol. 1996;28:428–431
  16. Neilan TG, Januzzi JL, Lee-Lewandrowski E, Yoerger DM, Jassal DS, Lewandrowski KB, et al. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston Marathon. Circulation. 2006;114:2325–2333
  17. Shave R, George K, Whyte G, Hart E, Middleton N. Postexercise changes in left ventricular function: the evidence so far. Med Sci Sports Exerc. 2008;40:1393–1399
  18. Scharhag J, Herrmann M, Urhausen A, Haschke M, Herrmann W, Kindermann W. Independent elevations of N-terminal pro-brain natriuretic peptide and cardiac troponins in endurance athletes after prolonged strenuous exercise. Am Heart J. 2005;150:1128–1134
  19. Almond CS, Shin AY, Fortescue EB, Mannix RC, Wypij D, Binstadt BA, et al. Hyponatremia among runners in the Boston Marathon. N Engl J Med. 2005;352:1550–1556
  20. Knebel F, Schimke I, Schroeckh S, et al. Myocardial function in older male marathon runners: assessment by tissue Doppler echocardiography, speckle tracking and cardiac biomarkers. J Am Soc Echocardiogr. 2009;22:803–809
  21. Douglas PS, O'Toole ML, Hiller WD, Hackney K, Reichek N. Cardiac fatigue after prolonged exercise. Circulation. 1987;76:1206–1213
  22. George K, Whyte G, Stephenson C, Shave R, Dawson E, Edwards B, et al. Postexercise left ventricular function and cTnT in recreational marathon runners. Med Sci Sports Exerc. 2004;36:1709–1715
  23. Middleton N, Shave R, George K, Whyte G, Hart E, Atkinson G. Left ventricular function immediately following prolonged exercise: a meta-analysis. Med Sci Sports Exerc. 2006;38:681–687
  24. Niemela KO, Palatsi IJ, Ikaheimo MJ, Takkunen JT, Vuori JJ. Evidence of impaired left ventricular performance after an uninterrupted competitive 24 hour run. Circulation. 1984;70:350–356
  25. George K, Shave R, Oxborough D, Cable T, Dawson E, Artis N, et al. Left ventricular wall segment motion after ultra-endurance exercise in humans assessed by myocardial speckle tracking. Eur J Echocardiogr. 2009;10:238–243
  26. Rowe WJ. Endurance exercise and injury to the heart. Sports Med. 1993;16:73–79
  27. Hassan MY, Noakes TD, Berlyn P, Shave R, George K. Preload maintenance protects against a depression in left ventricular systolic, but not diastolic, function immediately after ultraendurance exercise. Br J Sports Med. 2006;40:536–540
  28. Dawson EA, Shave R, Whyte G, Ball D, Selmer C, Jans Ø, et al. Preload maintenance and the left ventricular response to prolonged exercise in men. Exp Physiol. 2007;92:383–390
  29. Davila-Roman VG, Guest TM, Tuteur PG, Rowe WJ, Ladenson JH, Jaffe AS. Transient right but not left ventricular dysfunction after strenuous exercise at high altitude. J Am Coll Cardiol. 1997;30:468–473
  30. La Gerche A, Connelly KA, Mooney DJ, MacIsaac AI, Prior DL. Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart. 2008;94:860–866
  31. Oxborough D, Shave R, Middleton N, Whyte G, Forster J, George K. The impact of marathon running upon ventricular function as assessed by 2D, Doppler, and tissue-Doppler echocardiography. Echocardiography. 2006;23:635–641
  32. Rifai N, Douglas PS, O'Toole M, Rimm E, Ginsburg GS. Cardiac troponin T and I, echocardiographic [correction of electrocardiographic] wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon. Am J Cardiol. 1999;83:1085–1089
  33. Mols P, Huynh CH, Naeije N, Ham HR. Volumetric response of right ventricle during progressive supine exercise in men. Am J Physiol. 1991;261:H751–H754
  34. Hart BJ, Bian X, Gwirtz PA, Setty S, Downey HF. Right ventricular oxygen supply/demand balance in exercising dogs. Am J Physiol Heart Circ Physiol. 2001;281:H823–H830
  35. Grunig E, Janssen B, Mereles D, Barth U, Borst MM, Vogt IR, et al. Abnormal pulmonary artery pressure response in asymptomatic carriers of primary pulmonary hypertension gene. Circulation. 2000;102:1145–1150
  36. Ecarnot-Laubriet A, Rochette L, Vergely C, Sicard P, Teyssier JR. The activation pattern of the antioxidant enzymes in the right ventricle of rat in response to pressure overload is of heart failure type. Heart Dis. 2003;5:308–312
  37. Kihlstrom M, Ojala J, Salminen A. Decreased level of cardiac antioxidants in endurance-trained rats. Acta Physiol Scand. 1989;135:549–554
  38. Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med. 1988;318:129–133
  39. Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med. 1990;89:588–596
  40. Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D, et al. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J. 2006;27:1079–1084
  41. Shave R, Dawson E, Whyte G, George K, Gaze D, Collinson P. Altered cardiac function and minimal cardiac damage during prolonged exercise. Med Sci Sports Exerc. 2004;36:1098–1103
  42. Dokainish H, Zoghbi WA, Lakkis NM, Al-Bakshy F, Dhir M, Quinones MA, et al. Optimal noninvasive assessment of left ventricular filling pressures: a comparison of tissue Doppler echocardiography and B-type natriuretic peptide in patients with pulmonary artery catheters. Circulation. 2004;109:2432–2439
  43. George K, Oxborough D, Forster J, Whyte G, Shave R, Dawson E, et al. Mitral annular myocardial velocity assessment of segmental left ventricular diastolic function after prolonged exercise in humans. J Physiol. 2005;569:305–313
  44. Hart E, Shave R, Middleton N, George K, Whyte G, Oxborough D. Effect of preload augmentation on pulsed wave and tissue Doppler echocardiographic indices of diastolic function after a marathon. J Am Soc Echocardiogr. 2007;20:1393–1399
  45. Kalliokoski KK, Laaksonen MS, Luotolahti M, Laine H, Takala TO, Nuutila P, et al. Myocardial perfusion after marathon running. Scand J Med Sci Sports. 2004;14:208–214
  46. Scharhag J, George K, Shave R, Urhausen A, Kindermann W. Exercise-associated increases in cardiac biomarkers. Med Sci Sports Exerc. 2008;40:1408–1415
  47. Urhausen A, Scharhag J, Herrmann M, Kindermann W. Clinical significance of increased cardiac troponins T and I in participants of ultra-endurance events. Am J Cardiol. 2004;94:696–698
  48. Wu AH, Apple FS, Gibler WB, Jesse RL, Warshaw MM, Valdes R. National Academy of Clinical Biochemistry Standards of Laboratory Practice: recommendations for the use of cardiac markers in coronary artery diseases. Clin Chem. 1999;45:1104–1121
  49. Katus HA, Remppis A, Scheffold T, Diederich KW, Kuebler W. Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction. Am J Cardiol. 1991;67:1360–1367
  50. Neumayr G, Gaenzer H, Pfister R, Sturm W, Schwarzacher SP, Eibl G, et al. Plasma levels of cardiac troponin I after prolonged strenuous endurance exercise. Am J Cardiol. 2001;87:369–371
  51. Middleton N, George K, Whyte G, Gaze D, Collinson P, Shave R. Cardiac troponin T release is stimulated by endurance exercise in healthy humans. J Am Coll Cardiol. 2008;52:1813–1814
  52. Shave R, George KP, Atkinson G, Hart E, Middleton N, Whyte G, et al. Exercise-induced cardiac troponin T release: a meta-analysis. Med Sci Sports Exerc. 2007;39:2099–2106
  53. Usatyuk PV, Natarajan V. Role of mitogen-activated protein kinases in 4-hydroxy-2-nonenal-induced actin remodeling and barrier function in endothelial cells. J Biol Chem. 2004;279:11789–11797
  54. Ogawa S, Gerlach H, Esposito C, Pasagian-Macaulay A, Brett J, Stern D. Hypoxia modulates the barrier and coagulant function of cultured bovine endothelium. Increased monolayer permeability and induction of procoagulant properties. J Clin Invest. 1990;85:1090–1098

 Editorial Comments published in the Journal of the American Society of Echocardiography (JASE) reflect the opinions of their author(s), and do not necessarily represent the views of JASE, its editors, or the American Society of Echocardiography.

PII: S0894-7317(09)00480-5

doi: 10.1016/j.echo.2009.05.008

Journal of the American Society of Echocardiography
Volume 22, Issue 7 , Pages 810-813 , July 2009

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