Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-10T06:16:14.479Z Has data issue: false hasContentIssue false
  • English
  • Français

Morbidities in the ultra-athlete and marathoner

Published online by Cambridge University Press:  13 January 2017

Taylor C. Cunningham ,
Khadijah Maghrabi  and
Shubhayan Sanatani
Taylor C. Cunningham
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s Heart Centre, British Columbia’s Children’s Hospital, Vancouver, British Columbia, Canada
Khadijah Maghrabi
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s Heart Centre, British Columbia’s Children’s Hospital, Vancouver, British Columbia, Canada
Shubhayan Sanatani*
Affiliation:
Department of Pediatrics, Division of Cardiology, Children’s Heart Centre, British Columbia’s Children’s Hospital, Vancouver, British Columbia, Canada
*
Correspondence to: Dr S. Sanatani, Division Head, Division of Cardiology, Children’s Heart Centre, British Columbia’s Children’s Hospital, 4480 Oak St 1F9, Vancouver, BC, Canada V6H 3V4. Tel: 604 875 3619; Fax: 604 875 3463; E-mail: ssanatani@cw.bc.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

The cardiovascular benefits of habitual exercise are well documented. In the current era, more of the population is exceeding the recommendations for physical activity as the popularity of endurance events increases. Recent data have proposed a U-shaped relationship between exercise intensity and cardiovascular outcomes. Regular participation in endurance activities has been shown to result in structural and functional changes in the heart. This re-modelling may be the substrate for cardiac dysfunction or arrhythmias. The risk of sudden cardiac death may also be elevated; however, in most cases of sudden cardiac death, the cause can be linked to an underlying cardiac pathology where exercise acted as the trigger for a lethal arrhythmia. This article serves to review whether excessive exercise may result in harm in some athletes.

Keywords

Endurance athletearrhythmiasexercisesudden cardiac deathathlete’s heart
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Supplement S1: Sudden Cardiac Arrest in the Young: A Contemporary Perspective , January 2017 , pp. S94 - S100
Copyright
© Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Stanley, E. The conduct of life. Address at Liverpool College. 1873.Google Scholar
2. Seidell, JC, Halberstadt, J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab 2015; 66 (Suppl 2): 7–12.Google Scholar
3. Pescatello, LS, Franklin, BA, Fagard, R, et al. American College of Sports Medicine position stand. Exercise and hypertension. Med Sci Sports Exerc 2004; 36: 533–553.Google Scholar
4. Kelley, GA, Kelley, KS, Tran, ZV. Walking, lipids, and lipoproteins: a meta-analysis of randomized controlled trials. Prev Med 2004; 38: 651–661.Google Scholar
5. Goodpaster, BH, Delany, JP, Otto, AD, et al. Effects of diet and physical activity interventions on weight loss and cardiometabolic risk factors in severely obese adults: a randomized trial. JAMA 2010; 304: 1795–1802.Google Scholar
6. Boule, NG, Haddad, E, Kenny, GP, Wells, GA, Sigal, RJ. Effects of exercise on glycemic control and body mass in type 2 diabetes mellitus: a meta-analysis of controlled clinical trials. JAMA 2001; 286: 1218–1227.Google Scholar
7. Mora, S, Cook, N, Buring, JE, Ridker, PM, Lee, IM. Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms. Circulation 2007; 116: 2110–2118.Google Scholar
8. Smith, TC, Wingard, DL, Smith, B, Kritz-Silverstein, D, Barrett-Connor, E. Walking decreased risk of cardiovascular disease mortality in older adults with diabetes. J Clin Epidemiol 2007; 60: 309–317.Google Scholar
9. Stamatakis, E, Hamer, M, Lawlor, DA. Physical activity, mortality, and cardiovascular disease: is domestic physical activity beneficial? The Scottish Health Survey – 1995, 1998, and 2003. Am J Epidemiol 2009; 169: 1191–1200.Google Scholar
10. van Dam, RM, Li, T, Spiegelman, D, Franco, OH, Hu, FB. Combined impact of lifestyle factors on mortality: prospective cohort study in US women. Br Med J 2008; 337: a1440.Google ScholarPubMed
11. Mozaffarian, D, Benjamin, EJ, Go, AS, et al. Heart disease and stroke statistics–2015 update: a report from the American Heart Association. Circulation 2015; 131: e29–e322.Google Scholar
12. Lovett, C. Olympic Marathon. Greenwood Publishing Group Inc., Reed Elsevier (1997), London, UK.Google Scholar
13. Merghani, A, Malhotra, A, Sharma, S. The U-shaped relationship between exercise and cardiac morbidity. Trends Cardiovasc Med 2016; 26: 232–240.Google Scholar
14. Brawner, C. Graded exercise testing. In: Kraus W, Keteyian S (eds.). Contemporary Cardiology: Cardiac Rehabilitation. Humana Press Inc., Totowa, NJ, 2007: 111–119.Google Scholar
15. Beswick, FW, Jordan, RC. Cardiological observations at the Sixth British Empire and Commonwealth Games. Br Heart J 1961; 23: 113–130.Google Scholar
16. LaPorta, MA, Linde, HW, Bruce, DL, Fitzsimons, EJ. Elevation of creatine phosphokinase in young men after recreational exercise. JAMA 1978; 239: 2685–2686.Google Scholar
17. Siegel, AJ, Silverman, LM, Lopez, RE. Creatine kinase elevations in marathon runners: relationship to training and competition. Yale J Biol Med 1980; 53: 275–279.Google Scholar
18. Schiff, HB, MacSearraigh, ET, Kallmeyer, JC. Myoglobinuria, rhabdomyolysis and marathon running. Q J Med 1978; 47: 463–472.Google ScholarPubMed
19. 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.Google Scholar
20. 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.Google Scholar
21. Neilan, TG, Januzzi, JL, Lee-Lewandrowski, E, et al. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation 2006; 114: 2325–2333.Google Scholar
22. Shave, RE, Whyte, GP, George, K, Gaze, DC, Collinson, PO. Prolonged exercise should be considered alongside typical symptoms of acute myocardial infarction when evaluating increases in cardiac troponin T. Heart 2005; 91: 1219–1220.Google Scholar
23. Benito, B, Gay-Jordi, G, Serrano-Mollar, A, et al. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 2011; 123: 13–22.Google Scholar
24. O’Keefe, JH, Patil, HR, Lavie, CJ, Magalski, A, Vogel, RA, McCullough, PA. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc 2012; 87: 587–595.Google Scholar
25. Mousavi, N, Czarnecki, A, Kumar, K, et al. Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. Am J Cardiol 2009; 103: 1467–1472.Google Scholar
26. George, K, Shave, R, Oxborough, D, 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.Google Scholar
27. Sharma, S, Merghani, A, Mont, L. Exercise and the heart: the good, the bad, and the ugly. Eur Heart J 2015; 36: 1445–1453.Google Scholar
28. Prior, DL, La Gerche, A. The athlete’s heart. Heart 2012; 98: 947–955.Google Scholar
29. Fagard, R. Athlete’s heart. Heart 2003; 89: 1455–1461.Google Scholar
30. La Gerche, A, Burns, AT, Taylor, AJ, Macisaac, AI, Heidbuchel, H, Prior, DL. Maximal oxygen consumption is best predicted by measures of cardiac size rather than function in healthy adults. Eur J Appl Physiol 2012; 112: 2139–2147.Google Scholar
31. Steding, K, Engblom, H, Buhre, T, et al. Relation between cardiac dimensions and peak oxygen uptake. J Cardiovasc Magn Reson 2010; 12: 8.Google Scholar
32. Abergel, E, Chatellier, G, Hagege, AA, et al. Serial left ventricular adaptations in world-class professional cyclists: implications for disease screening and follow-up. J Am Coll Cardiol 2004; 44: 144–149.Google Scholar
33. Maron, BJ, Doerer, JJ, Haas, TS, Tierney, DM, Mueller, FO. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009; 119: 1085–1092.Google Scholar
34. Kirchhof, P, Fabritz, L, Zwiener, M, et al. Age- and training-dependent development of arrhythmogenic right ventricular cardiomyopathy in heterozygous plakoglobin-deficient mice. Circulation 2006; 114: 1799–1806.CrossRefGoogle ScholarPubMed
35. Ruwald, AC, Marcus, F, Estes, NA 3rd, et al. Association of competitive and recreational sport participation with cardiac events in patients with arrhythmogenic right ventricular cardiomyopathy: results from the North American multidisciplinary study of arrhythmogenic right ventricular cardiomyopathy. Eur Heart J 2015; 36: 1735–1743.Google Scholar
36. Corrado, D, Zorzi, A. Arrhythmogenic right ventricular cardiomyopathy and sports activity. Eur Heart J 2015; 36: 1708–1710.Google Scholar
37. La Gerche, A, Robberecht, C, Kuiperi, C, et al. Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin. Heart 2010; 96: 1268–1274.Google Scholar
38. Behere, SP, Weindling, SN. Inherited arrhythmias: the cardiac channelopathies. Ann Pediatr Cardiol 2015; 8: 210–220.Google Scholar
39. Link, MS, Homoud, MK, Wang, PJ, Estes, NA 3rd. Cardiac arrhythmias in the athlete: the evolving role of electrophysiology. Curr Sports Med Rep 2002; 1: 75–85.Google Scholar
40. Farre, J, Wellens, HJ. Philippe Coumel: a founding father of modern arrhythmology. Europace 2004; 6: 464–465.Google Scholar
41. Wilhelm, M, Roten, L, Tanner, H, Wilhelm, I, Schmid, JP, Saner, H. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol 2011; 108: 580–585.Google Scholar
42. Bjornstad, H, Storstein, L, Meen, HD, Hals, O. Ambulatory electrocardiographic findings in top athletes, athletic students and control subjects. Cardiology 1994; 84: 42–50.Google Scholar
43. Haissaguerre, M, Jais, P, Shah, DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998; 339: 659–666.Google Scholar
44. Guasch, E, Benito, B, Qi, X, et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 2013; 62: 68–77.Google Scholar
45. Mont, L, Elosua, R, Brugada, J. Endurance sport practice as a risk factor for atrial fibrillation and atrial flutter. Europace 2009; 11: 11–17.Google Scholar
46. Coumel, P. Paroxysmal atrial fibrillation: a disorder of autonomic tone? Eur Heart J 1994; 15 (Suppl A): 9–16.Google Scholar
47. Liu, L, Nattel, S. Differing sympathetic and vagal effects on atrial fibrillation in dogs: role of refractoriness heterogeneity. Am J Physiol 1997; 273: H805–H816.Google Scholar
48. Stirbys, P. How much exercise is too much. J Atrial Fibrillation 2013; 5: 5–6.Google Scholar
49. Mont, L, Tamborero, D, Elosua, R, et al. Physical activity, height, and left atrial size are independent risk factors for lone atrial fibrillation in middle-aged healthy individuals. Europace 2008; 10: 15–20.Google Scholar
50. Mozaffarian, D, Furberg, CD, Psaty, BM, Siscovick, D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008; 118: 800–807.Google Scholar
51. Aizer, A, Gaziano, JM, Cook, NR, Manson, JE, Buring, JE, Albert, CM. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol 2009; 103: 1572–1577.Google Scholar
52. Sorokin, AV, Araujo, CG, Zweibel, S, Thompson, PD. Atrial fibrillation in endurance-trained athletes. Br J Sports Med 2011; 45: 185–188.Google Scholar
53. Abdulla, J, Nielsen, JR. Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 2009; 11: 1156–1159.Google Scholar
54. Furlanello, F, Bertoldi, A, Dallago, M, et al. Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol 1998; 9: S63–S68.Google Scholar
55. Harmon, KG, Drezner, JA, Wilson, MG, Sharma, S. Incidence of sudden cardiac death in athletes: a state-of-the-art review. Br J Sports Med 2014; 48: 1185–1192.Google Scholar
56. Toresdahl, BG, Rao, AL, Harmon, KG, Drezner, JA. Incidence of sudden cardiac arrest in high school student athletes on school campus. Heart Rhythm 2014; 11: 1190–1194.Google Scholar
57. Pilmer, CM, Kirsh, JA, Hildebrandt, D, Krahn, AD, Gow, RM. Sudden cardiac death in children and adolescents between 1 and 19 years of age. Heart Rhythm 2014; 11: 239–245.Google Scholar
58. Harmon, KG, Asif, IM, Maleszewski, JJ, et al. Incidence, cause, and comparative frequency of sudden cardiac death in National Collegiate Athletic Association Athletes: a decade in review. Circulation 2015; 132: 10–19.Google Scholar
59. Lenhart, C, Hanlon, A, Kang, Y, Daly, B, Brown, M, Patterson, F. Gender disparity in structured physical activity and overall activity level in adolescence: evaluation of youth risk behavior surveilance data. ISRN Public Health 2012; 2012: 674936.Google Scholar
60. Dhalla, NS, Temsah, RM, Netticadan, T. Role of oxidative stress in cardiovascular diseases. J Hypertens 2000; 18: 655–673.Google Scholar
61. Maron, BJ, Araujo, CG, Thompson, PD, et al. Recommendations for preparticipation screening and the assessment of cardiovascular disease in masters athletes: an advisory for healthcare professionals from the working groups of the World Heart Federation, the International Federation of Sports Medicine, and the American Heart Association Committee on Exercise, Cardiac Rehabilitation, and Prevention. Circulation 2001; 103: 327–334.Google Scholar
62. Kim, JH, Malhotra, R, Chiampas, G, et al. Cardiac arrest during long-distance running races. N Engl J Med 2012; 366: 130–140.Google Scholar
63. Corrado, D, Schmied, C, Basso, C, et al. Risk of sports: do we need a pre-participation screening for competitive and leisure athletes? Eur Heart J 2011; 32: 934–944.Google Scholar
64. Risgaard, B, Winkel, BG, Jabbari, R, et al. Sports-related sudden cardiac death in a competitive and a noncompetitive athlete population aged 12 to 49 years: data from an unselected nationwide study in Denmark. Heart Rhythm 2014; 11: 1673–1681.Google Scholar
65. Lee, G. Exercise-induced rhabdomyolysis. R I Med J (2013) 2014; 97: 22–24.Google Scholar
66. American College of Sports, Sawka, MN, Burke, LM, et al. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 2007; 39: 377–390.Google Scholar
67. Hew, TD, Chorley, JN, Cianca, JC, Divine, JG. The incidence, risk factors, and clinical manifestations of hyponatremia in marathon runners. Clin J Sport Med 2003; 13: 41–47.Google Scholar
68. Casa, DJ, Guskiewicz, KM, Anderson, SA, et al. National athletic trainers’ association position statement: preventing sudden death in sports. J Athl Train 2012; 47: 96–118.Google Scholar
69. Marijon, E, Tafflet, M, Antero-Jacquemin, J, et al. Mortality of French participants in the Tour de France (1947-2012). Eur Heart J 2013; 34: 3145–3150.Google Scholar
70. Clarke, PM, Walter, SJ, Hayen, A, Mallon, WJ, Heijmans, J, Studdert, DM. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br Med J 2012; 345: e8308.Google Scholar
71. Saint Onge, JM, Rogers, RG, Krueger, PM. Major League Baseball players’ life expectancies. Soc Sci Q 2008; 89: 817–830.Google Scholar
72. Coate, D, Sun, R. Survival estimates for elite male and female Olympic athletes and tennis championship competitors. Scand J Med Sci Sports 2013; 23: 722–727.Google Scholar
73. Santos, MA, Oliveira, CV, Silva, AS. Adverse cardiovascular effects from the use of anabolic-androgenic steroids as ergogenic resources. Subst Use Misuse 2014; 49: 1132–1137.Google Scholar