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Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise

      Abstract

      A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, creating a substrate for atrial and ventricular arrhythmias. Additionally, long-term excessive sustained exercise may be associated with coronary artery calcification, diastolic dysfunction, and large-artery wall stiffening. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.

      Abbreviations and Acronyms:

      CAC ( coronary artery calcium), CHD ( coronary heart disease), CV ( cardiovascular), EF ( ejection fraction), ET ( exercise training), LV ( left ventricular), MRI ( magnetic resonance imaging), PA ( physical activity), RA ( right atrium), RV ( right ventricular), SCD ( sudden cardiac death), VA ( ventricular arrhythmia)

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      Linked Article

      • Correction
        Mayo Clinic ProceedingsVol. 87Issue 7
        • In Brief
          In the article entitled, “Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise” published in the June 2012 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2012;87(6):587-595), reference 7 should have read as follows: 7. Lee DC, Pate RR, Lavie CJ, Blair SN. Running and all-cause mortality risk—is more better? Med Sci Sports Exerc 2012;44(5):S699.
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      • Potential, but Unobserved, Adverse Cardiovascular Effects From Endurance Exercise
        Mayo Clinic ProceedingsVol. 87Issue 11
        • In Brief
          The review by O'Keefe et al1 in the June 2012 issue of Mayo Clinic Proceedings discusses the hypothesis that excessive strenuous exercise may result in adverse cardiovascular effects. Data from Wen et al2 are cited as supportive evidence that the mortality benefits of exercise “peak at 50 to 60 minutes of vigorous exercise per day.” The reproduced figure, however, does not show a peak; rather, it possibly shows a plateau in the benefit of exercise at the highest level observed, and even the case for a plateau is unconvincing.
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