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Dimitriadis K, Bletsa E, Lazarou E, Leontsinis I, Stampouloglou P, Dri E, Sakalidis A, Pyrpyris N, Tsioufis P, Siasos G, Tsiachris D, Tsioufis K. A Narrative Review on Exercise and Cardiovascular Events: “Primum Non Nocere”. HEART AND MIND 2022. [DOI: 10.4103/hm.hm_25_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Zhang CD, Xu SL, Wang XY, Tao LY, Zhao W, Gao W. Prevalence of Myocardial Fibrosis in Intensive Endurance Training Athletes: A Systematic Review and Meta-Analysis. Front Cardiovasc Med 2020; 7:585692. [PMID: 33102537 PMCID: PMC7545401 DOI: 10.3389/fcvm.2020.585692] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 08/25/2020] [Indexed: 01/22/2023] Open
Abstract
Objective: To review the published literature reporting on the incidence of myocardial fibrosis (MF) in high-intensity endurance athletes measured by late gadolinium enhancement (LGE) with cardiac magnetic resonance imaging (CMR). Methods: Five databases (PubMed, Cochrane Controlled Trials Register, EMBASE, Web of Science, and SPORTDiscus) were searched to obtain case cohort studies published before November 10, 2019. From 96 abstracts or reports extracted, 18 full-text articles were reviewed. The incidence of LGE was reported as outcome measures. Subgroup analysis was performed by age (under or above 50 years). Pooled estimates were obtained using a fixed-effects model. Results: After a full-text assessment, 12 studies involving 1,359 participants were included for analysis. Among them, 163/772 participants in the endurance athletes group showed LGE positive, compared with 19/587 participants in the comparison group. The results of the meta-analysis suggested that the prevalence of LGE was higher in the athletes group with long-term endurance exercise (OR 7.20;95%CI: 4.51-11.49). In addition, the same conclusion was drawn after the stratification of age. Conclusions: The available evidence demonstrates that high-intensity endurance athletes is associated with an increased incidence of LGE positive.
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Affiliation(s)
- Cheng-Duo Zhang
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Shun-Lin Xu
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Xin-Yu Wang
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Li-Yuan Tao
- Department of Epidemiology, Peking University Third Hospital, Beijing, China
| | - Wei Zhao
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
| | - Wei Gao
- National Health Commission Key Laboratory of Cardiovascular Molecular Biology and Regulatory Peptides, Key Laboratory of Molecular Cardiovascular Science, Ministry of Education, Beijing Key Laboratory of Cardiovascular Receptors Research, Department of Cardiology and Institute of Vascular Medicine, Peking University Third Hospital, Beijing, China
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Wundersitz DWT, Gordon BA, Lavie CJ, Nadurata V, Kingsley MIC. Impact of endurance exercise on the heart of cyclists: A systematic review and meta-analysis. Prog Cardiovasc Dis 2020; 63:750-761. [PMID: 32663493 DOI: 10.1016/j.pcad.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 07/06/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To compare heart structure and function in endurance athletes relative to participants of other sports and non-athletic controls in units relative to body size. A secondary objective was to assess the association between endurance cycling and cardiac abnormalities. PATIENTS AND METHODS Five electronic databases (CINAHL, Cochrane Library, Medline, Scopus, and SPORTdiscus) were searched from the earliest record to 14 December 2019 to identify studies investigating cardiovascular structure and function in cyclists. Of the 4865 unique articles identified, 70 met inclusion criteria and of these, 22 articles presented 10 cardiovascular parameters in units relative to body size for meta-analysis and five presented data relating to incidence of cardiac abnormalities. Qualitative analysis was performed on remaining data. The overall quality of evidence was assessed using GRADE. Odds ratios were calculated to compare the incidence of cardiac abnormality. RESULTS Heart structure was significantly larger in cyclists compared to non-athletic controls for left ventricular: mass; end-diastolic volume, interventricular septal diameter and internal diameter; posterior wall thickness, and end-systolic internal diameter. Compared to high static and high dynamic sports (e.g., kayaking and canoeing), low-to-moderate static and moderate-to-high dynamic sports (e.g., running and swimming) and moderate-to-high static and low-to-moderate dynamic sports (e.g., bodybuilding and wrestling), endurance cyclists end-diastolic left ventricular internal diameter was consistently larger (mean difference 1.2-3.2 mm/m2). Cardiac abnormalities were higher in cyclists compared to controls (odds ratio: 1.5, 95%CI 1.2-1.8), but the types of cardiac abnormalities in cyclists were not different to other athletes. CONCLUSION Endurance cycling is associated with a larger heart relative to body size and an increased incidence of cardiac abnormalities relative to controls.
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Affiliation(s)
- Daniel W T Wundersitz
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia.
| | - Brett A Gordon
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia
| | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, LA, USA
| | | | - Michael I C Kingsley
- Holsworth Research Initiative, La Trobe Rural Health School, La Trobe University, Flora Hill, Australia; Department of Exercise Sciences, University of Auckland, Auckland, New Zealand
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Franklin BA, Thompson PD, Al-Zaiti SS, Albert CM, Hivert MF, Levine BD, Lobelo F, Madan K, Sharrief AZ, Eijsvogels TMH. Exercise-Related Acute Cardiovascular Events and Potential Deleterious Adaptations Following Long-Term Exercise Training: Placing the Risks Into Perspective-An Update: A Scientific Statement From the American Heart Association. Circulation 2020; 141:e705-e736. [PMID: 32100573 DOI: 10.1161/cir.0000000000000749] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological and biological plausibility studies support a cause-and-effect relationship between increased levels of physical activity or cardiorespiratory fitness and reduced coronary heart disease events. These data, plus the well-documented anti-aging effects of exercise, have likely contributed to the escalating numbers of adults who have embraced the notion that "more exercise is better." As a result, worldwide participation in endurance training, competitive long distance endurance events, and high-intensity interval training has increased markedly since the previous American Heart Association statement on exercise risk. On the other hand, vigorous physical activity, particularly when performed by unfit individuals, can acutely increase the risk of sudden cardiac death and acute myocardial infarction in susceptible people. Recent studies have also shown that large exercise volumes and vigorous intensities are both associated with potential cardiac maladaptations, including accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, and atrial fibrillation. The relationship between these maladaptive responses and physical activity often forms a U- or reverse J-shaped dose-response curve. This scientific statement discusses the cardiovascular and health implications for moderate to vigorous physical activity, as well as high-volume, high-intensity exercise regimens, based on current understanding of the associated risks and benefits. The goal is to provide healthcare professionals with updated information to advise patients on appropriate preparticipation screening and the benefits and risks of physical activity or physical exertion in varied environments and during competitive events.
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Wundersitz D, Williamson J, Nadurata V, Nolan K, Lavie C, Kingsley M. The impact of a 21-day ultra-endurance ride on the heart in young, adult and older adult recreational cyclists. Int J Cardiol 2019; 286:137-142. [PMID: 30904280 DOI: 10.1016/j.ijcard.2019.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/25/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study assessed the acute effect of 21 days of challenging exercise on heart structure and function in recreationally active people across a range of age categories. METHODS 15 recreationally active people completed a 21-day fundraising cycling ride (MADRIDE) over a distance of 3515 km. Twenty-four hour Holter electrocardiography and blood biochemistry analyses were performed before and after the MADRIDE. RESULTS Incidence of cardiac arrhythmia was higher after MADRIDE (OR: 5.93; 95% CI: 5.68-6.19), with increases in both ventricular arrhythmias (OR: 9.90; 95% CI: 9.27-10.57) and supraventricular arrhythmias (OR: 3.09; 95% CI: 2.91-3.29). Adults (OR: 11.45; 95% CI: 7.41-17.69) and older adults (OR: 10.42 95% CI 9.83-11.05) were approximately 10 times more likely to experience arrhythmias after the MADRIDE. Whereas, young participants experienced 18% less cardiac arrhythmias after MADRIDE (OR: 0.82; 95% CI: 0.75-0.90). Aortic valve max velocity was reduced (MD: -0.12 m/s; 95% CI: -0.19-0.05 m/s) and mitral valve deceleration time was slower (MD: -28.91 m/s; 95% CI: -50.97-6.84 m/s) after MADRIDE. Other structural and functional characteristics along with heart rate variability were not different after MADRIDE. CONCLUSIONS Multi-day challenging exercise increased the incidence of both supraventricular and ventricular arrhythmias in active adults and older adults. Increases in arrhythmia rates after MADRIDE occurred without changes in cardiac structure and autonomic control. Further exploration is necessary to identify the causes of exercise-induced cardiac arrhythmia in adult and older adults.
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Affiliation(s)
- D Wundersitz
- Exercise Physiology, La Trobe Rural Health School, La Trobe University, Australia.
| | | | | | | | - Carl Lavie
- Exercise Laboratories, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-The University of Queensland School of Medicine, New Orleans, USA.
| | - M Kingsley
- Exercise Physiology, La Trobe Rural Health School, La Trobe University, Australia.
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Schwellnus M, Kipps C, Roberts WO, Drezner JA, D'Hemecourt P, Troyanos C, Janse van Rensburg DC, Killops J, Borresen J, Harrast M, Adami PE, Bermon S, Bigard X, Migliorini S, Jordaan E, Borjesson M. Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting. Br J Sports Med 2019; 53:1048-1055. [PMID: 30796105 DOI: 10.1136/bjsports-2018-100092] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/04/2019] [Accepted: 02/08/2019] [Indexed: 12/19/2022]
Abstract
Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered 'musculoskeletal' (eg, strains) and those due to 'illness' (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer.
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Affiliation(s)
- Martin Schwellnus
- Faculty of Health Sciences, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa.,Director, IOC Research Centre of South Africa, Pretoria, Gauteng, South Africa
| | | | - William O Roberts
- Department of Family Medicine and Community Health, University of Minnesota, St Paul, Minnesota, USA
| | | | | | - Chris Troyanos
- International Institute for Race Medicine (IIRM), Boston, Massachusetts, USA
| | - Dina Christina Janse van Rensburg
- Section Sports Medicine and Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa
| | - Jannelene Killops
- Section Sports Medicine, Faculty of Health Sciences, Sport, Exercise Medicine and Lifestyle Institute (SEMLI), University of Pretoria, Pretoria, Gauteng, South Africa
| | - Jill Borresen
- Sport, Exercise Medicine and Lifestyle Institute, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Mark Harrast
- Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - Paolo E Adami
- IAAF Health and Science Department, International Association of Athletics Federations (IAAF), Rome, Italy
| | | | - Xavier Bigard
- Union Cycliste Internationale (UCI), Aigle, Switzerland
| | | | - Esme Jordaan
- Biostatistics Unit, Medical Research Council, Parow, South Africa
| | - Mats Borjesson
- Neuosciences and Physiology, Goteborgs Universitet Sahlgrenska Akademin, Goteborg, Sweden.,Ostra Sjukhuset, Goteborg, Sweden
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Schwellnus M, Swanevelder S, Derman W, Borjesson M, Schwabe K, Jordaan E. Prerace medical screening and education reduce medical encounters in distance road races: SAFER VIII study in 153 208 race starters. Br J Sports Med 2018; 53:634-639. [DOI: 10.1136/bjsports-2018-099275] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2018] [Indexed: 01/09/2023]
Abstract
ObjectivesTo examine the efficacy and feasibility of an online prerace medical screening and educational intervention programme for reducing medical complications in long-distance races.MethodsThis was an 8-year observational study of medical encounter rates among 153 208 Two Oceans race starters (21.1 and 56 km) in South Africa. After the first 4-year control (CON) period, we introduced an online prerace medical screening (based on European pre-exercise screening guidelines) and an automated educational intervention programme. We compared the incidence of medical encounters (per 1000 starters; all and serious life threatening) in the CON versus the 4-year intervention (INT) period.ResultsIn comparison to the CON period (2008–2011: 65 865 starters), the INT period (2012–2015: 87 343 starters) had a significantly lower incidence (adjusted for age group, sex, race distance) of all medical encounters by 29% (CON=8.6 (7.9–9.4); INT=6.1 (5.6–6.7), p<0.0001), in the 21.1 km race by 19% (CON=5.1 (4.4–5.9); INT=4.1 (3.6–4.8), p=0.0356) and in the 56 km race by 39% (CON=14.6 (13.1–16.3); INT=9.0 (7.9–10.1), p<0.0001). Serious life-threatening encounters were significantly reduced by 64% (CON=0.6 (0.5–0.9); INT=0.2 (0.1–0.4); p=0.0003) (adjusted for age group and sex). Registration numbers increased in the INT period (CON=81 345; INT=106 743) and overall % race starters were similar in the CON versus INT period. Wet-bulb globe temperature was similar in the CON and INT periods.ConclusionAll medical encounters and serious life-threatening encounters were significantly lower after the introduction of a prescreening and educational intervention programme, and the programme was feasible.
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Antero-Jacquemin J, Pohar-Perme M, Rey G, Toussaint JF, Latouche A. The heart of the matter: years-saved from cardiovascular and cancer deaths in an elite athlete cohort with over a century of follow-up. Eur J Epidemiol 2018; 33:531-543. [PMID: 29730745 DOI: 10.1007/s10654-018-0401-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 04/25/2018] [Indexed: 12/21/2022]
Abstract
To quantify the years of life saved from cardiovascular (CVD), cancer and overall deaths among elite athletes according to their main type of physiological effort performed in the Olympic Games. All French athletes participating in the Games from 1912 to 2012, with vital status validated and cause of death (if concerned) identified by the national registries were included (n = 2814, 455 died) and classified according to 6 groups of effort: POWER (continuous effort < 45 s); INTERMEDIATE (45 s ≤ continuous effort < 600 s); ENDURANCE (continuous effort ≥ 600 s); POLYVALENT (participating in different events entering different classifications), INTERMITTENT (intermittent effort, i.e. team sports); PRECISION (targeting events). The theoretical years-lost method was adapted to calculate gains in longevity (years-saved) according to specific-risks under the competing risks model and was implemented in R software. Considering overall-deaths, all groups significantly saved, on average, 6.5 years of life (95% CI 5.8-7.2) compared to the general population. This longevity advantage is mainly driven by a lower risk of cancer which, isolated, contributed to significantly save 2.3 years of life (95% CI 1.2-1.9) on average in each group. The risk of CVD-related mortality in the ENDURANCE and PRECISION groups is not significantly different from the general population. The other groups significantly saved, on average, 1.6 years of life (95% CI 1.2-1.9) from CVD death. The longevity benefits in elite athletes are associated with the type of effort performed during their career, mainly due to differences on the CVD-risk of death.
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Affiliation(s)
- Juliana Antero-Jacquemin
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport, de l'Expertise et de la Performance (INSEP), 11 Avenue du Tremblay, 75012, Paris, France.
| | - Maja Pohar-Perme
- Institute of Biostastistics and Medical Informatics, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Grégoire Rey
- Inserm CépiDc, Epidemiology Centre on Medical Causes of Death, Le Kremlin-Bicêtre, France
| | - Jean-François Toussaint
- Institut de Recherche bioMédicale et d'Epidémiologie du Sport (IRMES), Institut National du Sport, de l'Expertise et de la Performance (INSEP), 11 Avenue du Tremblay, 75012, Paris, France.,University Paris Descartes, Sorbonne Paris Cité, Paris, France.,CIMS, Hôtel-Dieu, AP-HP, 1 Parvis Notre Dame, 75184, Paris Cedex 04, France
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Sanchis-Gomar F, Pérez LM, Joyner MJ, Löllgen H, Lucia A. Endurance Exercise and the Heart: Friend or Foe? Sports Med 2016; 46:459-66. [PMID: 26586557 DOI: 10.1007/s40279-015-0434-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although low- to moderate-intensity exercise has well-known cardiovascular benefits, it has been increasingly suggested that prolonged strenuous endurance exercise (SEE) could have potential deleterious cardiac effects. In effect, the term 'cardiac overuse injury' (or 'over-exercise') has been recently reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise'. In this article, we provide a balanced overview of the current state of knowledge regarding the 'pros' and 'cons' of SEE from a cardiological point of view.
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Affiliation(s)
- Fabian Sanchis-Gomar
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.
| | - Laura M Pérez
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain
| | | | - Herbert Löllgen
- European Federation of Sports Medicine Associations (EFSMA) and German Federation of Sports Medicine, Remscheid, Germany
| | - Alejandro Lucia
- Research Institute Hospital 12 de Octubre ('i+12'), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain.,European University, Madrid, Spain
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Exercise as an adjuvant therapy against chronic atrial fibrillation. Int J Cardiol 2016; 207:180-4. [DOI: 10.1016/j.ijcard.2016.01.140] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 01/05/2016] [Indexed: 11/18/2022]
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