Skip to main content
SpringerLink
Log in

Endurance Exercise and the Heart: Friend or Foe?

  • Current Opinion
  • Published:
Sports Medicine Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

References

  1. Horneffer A. Herodot. Historien. Stuttgart: Kröner Comp; 1971.

  2. Lavie CJ, Arena R, Swift DL, et al. Exercise and the cardiovascular system: clinical science and cardiovascular outcomes. Circ Res. 2015;117(2):207–19.

    Article  CAS  PubMed  Google Scholar 

  3. Sanchis-Gomar F, Lucia A, Levine BD. Relationship between strenuous exercise and cardiac “morbimortality”: benefits outweigh the potential risks. Trends Cardiovasc Med. 2015. pii: S1050-1738(15)00189-9 (Epub 5 Aug 2015). doi:10.1016/j.tcm.2015.07.008.

    PubMed  Google Scholar 

  4. O’Keefe JH, Patil HR, Lavie CJ, et al. Potential adverse cardiovascular effects from excessive endurance exercise. Mayo Clin Proc. 2012;87(6):587–95.

    Article  PubMed  PubMed Central  Google Scholar 

  5. O’Keefe JH, Franklin B, Lavie CJ. Exercising for health and longevity vs peak performance: different regimens for different goals. Mayo Clin Proc. 2014;89(9):1171–5.

    Article  PubMed  Google Scholar 

  6. Williams PT, Thompson PD. Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors. Mayo Clin Proc. 2014;89(9):1187–94.

    Article  PubMed  Google Scholar 

  7. Mons U, Hahmann H, Brenner H. A reverse J-shaped association of leisure time physical activity with prognosis in patients with stable coronary heart disease: evidence from a large cohort with repeated measurements. Heart. 2014;100(13):1043–9.

    Article  PubMed  Google Scholar 

  8. Heggie V. A century of cardiomythology: exercise and the heart c.1880–1980. Soc Hist Med. 2010;23(2):280–98.

    Article  PubMed Central  Google Scholar 

  9. Lavie CJ, Lee DC, Sui X, et al. Effects of running on chronic diseases and cardiovascular and all-cause mortality. Mayo Clin Proc. 2015;90(11):1541–52. doi:10.1016/j.mayocp.2015.08.001.

    Article  Google Scholar 

  10. Lavie CJ, O’Keefe JH, Sallis RE. Exercise and the heart: the harm of too little and too much. Curr Sports Med Rep. 2015;14(2):104–9.

    Article  PubMed  Google Scholar 

  11. O’Keefe JH, Lavie CJ, Guazzi M. Part 1: potential dangers of extreme endurance exercise: how much is too much? Part 2: screening of school-age athletes. Prog Cardiovasc Dis. 2015;57(4):396–405.

    Article  PubMed  Google Scholar 

  12. Lee DC, Lavie CJ, Vedanthan R. Optimal dose of running for longevity: is more better or worse? J Am Coll Cardiol. 2015;65(5):420–2.

    Article  PubMed  Google Scholar 

  13. Sanchis-Gomar F, Joyner MJ, Lucia A. Letter by Sanchis-Gomar et al. regarding article, “Cardiac remodeling in response to 1 year of intensive endurance training”. Circulation. 2015;132(11):e146.

    Article  PubMed  Google Scholar 

  14. Sanchis-Gomar F, Santos-Lozano A, Garatachea N, et al. My patient wants to perform strenuous endurance exercise. What’s the right advice? Int J Cardiol. 2015;197:248–53.

    Article  PubMed  Google Scholar 

  15. Galderisi M, Cardim N, D’Andrea A, et al. The multi-modality cardiac imaging approach to the Athlete’s heart: an expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16:353.

    Article  PubMed  Google Scholar 

  16. Pelliccia A, Maron BJ, Spataro A, et al. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med. 1991;324(5):295–301.

    Article  CAS  PubMed  Google Scholar 

  17. Fagard R, Van den Broeke C, Amery A. Left ventricular dynamics during exercise in elite marathon runners. J Am Coll Cardiol. 1989;14(1):112–8.

    Article  CAS  PubMed  Google Scholar 

  18. Fagard RH. Impact of different sports and training on cardiac structure and function. Cardiol Clin. 1997;15(3):397–412.

    Article  CAS  PubMed  Google Scholar 

  19. Maron BJ, Pelliccia A, Spataro A, et al. Reduction in left ventricular wall thickness after deconditioning in highly trained Olympic athletes. Br Heart J. 1993;69(2):125–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Pelliccia A, Maron BJ, De Luca R, et al. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation. 2002;105(8):944–9.

    Article  PubMed  Google Scholar 

  21. Urhausen A, Albers T, Kindermann W. Are the cardiac effects of anabolic steroid abuse in strength athletes reversible? Heart. 2004;90(5):496–501.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Pelliccia A, Culasso F, Di Paolo FM, et al. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med. 1999;130(1):23–31.

    Article  CAS  PubMed  Google Scholar 

  23. Morganroth J, Maron BJ, Henry WL, et al. Comparative left ventricular dimensions in trained athletes. Ann Intern Med. 1975;82(4):521–4.

    Article  CAS  PubMed  Google Scholar 

  24. D’Andrea A, Limongelli G, Caso P, et al. Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete’s heart. Int J Cardiol. 2002;86(2–3):177–84.

    Article  PubMed  Google Scholar 

  25. George KP, Warburton DE, Oxborough D, et al. Upper limits of physiological cardiac adaptation in ultramarathon runners. J Am Coll Cardiol. 2011;57(6):754–5.

    Article  PubMed  Google Scholar 

  26. Arbab-Zadeh A, Perhonen M, Howden E, et al. Cardiac remodeling in response to 1 year of intensive endurance training. Circulation. 2014;130(24):2152–61.

    Article  PubMed  Google Scholar 

  27. La Gerche A, Claessen G. Is exercise good for the right ventricle? Concepts for health and disease. Can J Cardiol. 2015;31(4):502–8.

    Article  PubMed  Google Scholar 

  28. La Gerche A, Heidbuchel H. Can intensive exercise harm the heart? You can get too much of a good thing. Circulation. 2014;130(12):992–1002.

    Article  PubMed  Google Scholar 

  29. Trivax JE, Franklin BA, Goldstein JA, et al. Acute cardiac effects of marathon running. J Appl Physiol (1985). 2010;108(5):1148–53.

    Article  CAS  Google Scholar 

  30. La Gerche A, Burns AT, Mooney DJ, et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J. 2012;33(8):998–1006.

    Article  PubMed  CAS  Google Scholar 

  31. Wen CP, Wai JP, Tsai MK, et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet. 2011;378(9798):1244–53.

    Article  PubMed  Google Scholar 

  32. D’Andrea A, Riegler L, Golia E, et al. Range of right heart measurements in top-level athletes: the training impact. Int J Cardiol. 2013;164(1):48–57.

    Article  PubMed  Google Scholar 

  33. Elliott AD, La Gerche A. The right ventricle following prolonged endurance exercise: are we overlooking the more important side of the heart? A meta-analysis. Br J Sports Med. 2014;49(11):724–9.

    Article  PubMed  Google Scholar 

  34. Angell PJ, Chester N, Sculthorpe N, et al. Performance enhancing drug abuse and cardiovascular risk in athletes: implications for the clinician. Br J Sports Med. 2012;46(Suppl 1):i78–84.

    Article  PubMed  Google Scholar 

  35. O’Hanlon R, Wilson M, Wage R, et al. Troponin release following endurance exercise: is inflammation the cause? A cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2010;12:38.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Regwan S, Hulten EA, Martinho S, et al. Marathon running as a cause of troponin elevation: a systematic review and meta-analysis. J Interv Cardiol. 2010;23(5):443–50.

    Article  PubMed  Google Scholar 

  37. Scherr J, Braun S, Schuster T, et al. 72-h kinetics of high-sensitive troponin T and inflammatory markers after marathon. Med Sci Sports Exerc. 2011;43(10):1819–27.

    Article  CAS  PubMed  Google Scholar 

  38. Scharhag J, Lollgen H, Kindermann W. Competitive sports and the heart: benefit or risk? Dtsch Arztebl Int. 2013;110(1–2):14–23 (quiz 4, e1–2).

    PubMed  PubMed Central  Google Scholar 

  39. Hanssen H, Keithahn A, Hertel G, et al. Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running. Clin Sci (Lond). 2011;120(4):143–52.

    Article  PubMed  Google Scholar 

  40. Mousavi N, Czarnecki A, Kumar K, et al. Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. Am J Cardiol. 2009;103(10):1467–72.

    Article  PubMed  Google Scholar 

  41. Neilan TG, Yoerger DM, Douglas PS, et al. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J. 2006;27(9):1079–84.

    Article  PubMed  Google Scholar 

  42. Gaudreault V, Tizon-Marcos H, Poirier P, et al. Transient myocardial tissue and function changes during a marathon in less fit marathon runners. Can J Cardiol. 2013;29(10):1269–76.

    Article  PubMed  Google Scholar 

  43. Saltin B. Aerobic work capacity and circulation at exercise in man. With special reference to the effect of prolonged exercise and/or heat exposure. Acta Physiol Scand Suppl. 1964;Suppl 230:1–52.

  44. Utomi V, Oxborough D, Ashley E, et al. Predominance of normal left ventricular geometry in the male ‘athlete’s heart’. Heart. 2014;100(16):1264–71.

    Article  PubMed  Google Scholar 

  45. Rimensberger C, Carlen F, Brugger N, et al. Right ventricular adaptations and arrhythmias in amateur ultra-endurance athletes. Br J Sports Med. 2014;48(15):1179–84.

    Article  PubMed  Google Scholar 

  46. Sanchis-Gomar F, Garatachea N, Catalan P, et al. Strenuous endurance exercise and right ventricular systolic function: no evidence of long-term sequelae. Int J Cardiol. 2015;179:297–8.

    Article  PubMed  Google Scholar 

  47. La Gerche A, Connelly KA, Mooney DJ, et al. Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart. 2008;94(7):860–6.

    Article  PubMed  Google Scholar 

  48. La Gerche A, Heidbuchel H, Burns AT, et al. Disproportionate exercise load and remodeling of the athlete’s right ventricle. Med Sci Sports Exerc. 2011;43(6):974–81.

    Article  PubMed  Google Scholar 

  49. Scharhag J, Schneider G, Urhausen A, et al. Athlete’s heart: right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol. 2002;40(10):1856–63.

    Article  PubMed  Google Scholar 

  50. Dalla Vecchia L, Traversi E, Porta A, et al. On site assessment of cardiac function and neural regulation in amateur half marathon runners. Open Heart. 2014;1(1):e000005.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Schattke S, Xing Y, Lock J, et al. Increased longitudinal contractility and diastolic function at rest in well-trained amateur Marathon runners: a speckle tracking echocardiography study. Cardiovasc Ultrasound. 2014;12:11.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Zaidi A, Ghani S, Sharma R, et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation. 2013;127(17):1783–92.

    Article  PubMed  Google Scholar 

  53. Dangardt FJ, McKenna WJ, Luscher TF, et al. Exercise: friend or foe? Nat Rev Cardiol. 2013;10(9):495–507.

    Article  PubMed  Google Scholar 

  54. Pluim BM, Zwinderman AH, van der Laarse A, et al. The athlete’s heart a meta-analysis of cardiac structure and function. Circulation. 2000;101(3):336–44.

    Article  CAS  PubMed  Google Scholar 

  55. Maron BJ, Pelliccia A. The heart of trained athletes: cardiac remodeling and the risks of sports, including sudden death. Circulation. 2006;114(15):1633–44.

    Article  PubMed  Google Scholar 

  56. Ector J, Ganame J, van der Merwe N, et al. Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: a quantitative angiographic assessment. Eur Heart J. 2007;28(3):345–53.

    Article  PubMed  Google Scholar 

  57. Heidbuchel H, Hoogsteen J, Fagard 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(16):1473–80.

    Article  PubMed  Google Scholar 

  58. Arbab-Zadeh A, Dijk E, Prasad A, et al. Effect of aging and physical activity on left ventricular compliance. Circulation. 2004;110(13):1799–805.

    Article  PubMed  Google Scholar 

  59. Bhella PS, Hastings JL, Fujimoto N, et al. Impact of lifelong exercise “dose” on left ventricular compliance and distensibility. J Am Coll Cardiol. 2014;64(12):1257–66.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Waterhouse DF, Ismail TF, Prasad SK, et al. Imaging focal and interstitial fibrosis with cardiovascular magnetic resonance in athletes with left ventricular hypertrophy: implications for sporting participation. Br J Sports Med. 2012;46(Suppl 1):i69–77.

    Article  PubMed  Google Scholar 

  61. Naylor LH, George K, O’Driscoll G, et al. The athlete’s heart: a contemporary appraisal of the ‘Morganroth hypothesis’. Sports Med. 2008;38(1):69–90.

    Article  PubMed  Google Scholar 

  62. Löllgen H, Löllgen R. Genetics, genetic testing and sports: aspects from sports cardiology. Genomics Soc Policy. 2012;8:32–47.

    Google Scholar 

  63. Levine BD. Can intensive exercise harm the heart? The benefits of competitive endurance training for cardiovascular structure and function. Circulation. 2014;130(12):987–91.

    Article  PubMed  Google Scholar 

  64. Breuckmann F, Mohlenkamp S, Nassenstein K, et al. Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology. 2009;251(1):50–7.

    Article  PubMed  Google Scholar 

  65. Wilson M, O’Hanlon R, Prasad S, et al. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol (1985). 2011;110(6):1622–6.

    Article  CAS  Google Scholar 

  66. Prakken NH, Teske AJ, Cramer MJ, et al. Head-to-head comparison between echocardiography and cardiac MRI in the evaluation of the athlete’s heart. Br J Sports Med. 2012;46(5):348–54.

    Article  PubMed  Google Scholar 

  67. Marra MP, De Lazzari M, Zorzi A, et al. Impact of the presence and amount of myocardial fibrosis by cardiac magnetic resonance on arrhythmic outcome and sudden cardiac death in nonischemic dilated cardiomyopathy. Heart Rhythm. 2014;11(5):856–63.

    Article  Google Scholar 

  68. Guasch E, Mont L. Exercise and the heart: unmasking Mr Hyde. Heart. 2014;100(13):999–1000.

    Article  PubMed  Google Scholar 

  69. 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(1):68–77.

    Article  PubMed  Google Scholar 

  70. Wilhelm M, Roten L, Tanner H, et al. Atrial remodeling, autonomic tone, and lifetime training hours in nonelite athletes. Am J Cardiol. 2011;108(4):580–5.

    Article  PubMed  Google Scholar 

  71. Turagam MK, Velagapudi P, Kocheril AG. Atrial fibrillation in athletes. Am J Cardiol. 2012;109(2):296–302.

    Article  PubMed  Google Scholar 

  72. Turagam MK, Velagapudi P, Alpert MA. Does exercise cause atrial fibrillation? Int J Cardiol. 2015;181:245–6.

    Article  PubMed  Google Scholar 

  73. Mozaffarian D, Furberg CD, Psaty BM, et al. Physical activity and incidence of atrial fibrillation in older adults: the Cardiovascular Health Study. Circulation. 2008;118(8):800–7.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Kwok CS, Anderson SG, Myint PK, et al. Physical activity and incidence of atrial fibrillation: a systematic review and meta-analysis. Int J Cardiol. 2014;177(2):467–76.

    Article  PubMed  Google Scholar 

  75. Drca N, Wolk A, Jensen-Urstad M, et al. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart. 2014;100(13):1037–42.

    Article  PubMed  Google Scholar 

  76. Elosua R, Arquer A, Mont L, et al. Sport practice and the risk of lone atrial fibrillation: a case-control study. Int J Cardiol. 2006;108(3):332–7.

    Article  PubMed  Google Scholar 

  77. Molina L, Mont L, Marrugat J, et al. Long-term endurance sport practice increases the incidence of lone atrial fibrillation in men: a follow-up study. Europace. 2008;10(5):618–23.

    Article  PubMed  Google Scholar 

  78. Mont L, Sambola A, Brugada J, et al. Long-lasting sport practice and lone atrial fibrillation. Eur Heart J. 2002;23(6):477–82.

    Article  CAS  PubMed  Google Scholar 

  79. Aizer A, Gaziano JM, Cook NR, et al. Relation of vigorous exercise to risk of atrial fibrillation. Am J Cardiol. 2009;103(11):1572–7.

    Article  PubMed  PubMed Central  Google Scholar 

  80. Furlanello F, Bertoldi A, Dallago M, et al. Atrial fibrillation in elite athletes. J Cardiovasc Electrophysiol. 1998;9(8 Suppl):S63–8.

    CAS  PubMed  Google Scholar 

  81. Pelliccia A, Maron BJ, Di Paolo FM, et al. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol. 2005;46(4):690–6.

    Article  PubMed  Google Scholar 

  82. 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(9):1156–9.

    Article  PubMed  Google Scholar 

  83. Thelle DS, Selmer R, Gjesdal K, et al. Resting heart rate and physical activity as risk factors for lone atrial fibrillation: a prospective study of 309,540 men and women. Heart. 2013;99(23):1755–60.

    Article  PubMed  Google Scholar 

  84. Andersen K, Farahmand B, Ahlbom A, et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J. 2013;34(47):3624–31.

    Article  PubMed  Google Scholar 

  85. Myrstad M, Lochen ML, Graff-Iversen S, et al. Increased risk of atrial fibrillation among elderly Norwegian men with a history of long-term endurance sport practice. Scand J Med Sci Sports. 2014;24(4):e238–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  86. Qureshi WT, Alirhayim Z, Blaha MJ, et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) Project. Circulation. 2015;131(21):1827–34.

    Article  PubMed  Google Scholar 

  87. Sofi F, Capalbo A, Cesari F, et al. Physical activity during leisure time and primary prevention of coronary heart disease: an updated meta-analysis of cohort studies. Eur J Cardiovasc Prev Rehabil. 2008;15(3):247–57.

    Article  PubMed  Google Scholar 

  88. Lollgen H, Bockenhoff A, Knapp G. Physical activity and all-cause mortality: an updated meta-analysis with different intensity categories. Int J Sports Med. 2009;30(3):213–24.

    Article  CAS  PubMed  Google Scholar 

  89. Samitz G, Egger M, Zwahlen M. Domains of physical activity and all-cause mortality: systematic review and dose-response meta-analysis of cohort studies. Int J Epidemiol. 2011;40(5):1382–400.

    Article  PubMed  Google Scholar 

  90. Nocon M, Hiemann T, Muller-Riemenschneider F, et al. Association of physical activity with all-cause and cardiovascular mortality: a systematic review and meta-analysis. Eur J Cardiovasc Prev Rehabil. 2008;15(3):239–46.

    Article  PubMed  Google Scholar 

  91. Sattelmair J, Pertman J, Ding EL, et al. Dose response between physical activity and risk of coronary heart disease: a meta-analysis. Circulation. 2011;124(7):789–95.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Moore SC, Patel AV, Matthews CE, et al. Leisure time physical activity of moderate to vigorous intensity and mortality: a large pooled cohort analysis. PLoS Med. 2012;9(11):e1001335.

    Article  PubMed  PubMed Central  Google Scholar 

  93. Schnohr P, O’Keefe JH, Marott JL, et al. Dose of jogging and long-term mortality: the Copenhagen City Heart Study. J Am Coll Cardiol. 2015;65(5):411–9.

    Article  PubMed  Google Scholar 

  94. Lee DC, Pate RR, Lavie CJ, et al. Leisure-time running reduces all-cause and cardiovascular mortality risk. J Am Coll Cardiol. 2014;64(5):472–81.

    Article  PubMed  PubMed Central  Google Scholar 

  95. Sanchis-Gomar F, Pareja-Galeano H, Santos-Lozano A, et al. Strenuous exercise worse than sedentarism? J Am Coll Cardiol. 2015;65(24):2673–4.

    Article  PubMed  Google Scholar 

  96. Schnohr P, Marott JL, Lange P, et al. Longevity in male and female joggers: the Copenhagen City Heart Study. Am J Epidemiol. 2013;177(7):683–9.

    Article  PubMed  Google Scholar 

  97. Chakravarty EF, Hubert HB, Lingala VB, et al. Reduced disability and mortality among aging runners: a 21-year longitudinal study. Arch Intern Med. 2008;168(15):1638–46.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Williams PT. Reductions in incident coronary heart disease risk above guideline physical activity levels in men. Atherosclerosis. 2009;209(2):524–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  99. Chomistek AK, Cook NR, Flint AJ, et al. Vigorous-intensity leisure-time physical activity and risk of major chronic disease in men. Med Sci Sports Exerc. 2012;44(10):1898–905.

    Article  PubMed  PubMed Central  Google Scholar 

  100. Garatachea N, Santos-Lozano A, Sanchis-Gomar F, et al. Elite athletes live longer than the general population: a meta-analysis. Mayo Clin Proc. 2014;89(9):1195–200.

    Article  PubMed  Google Scholar 

  101. Kettunen JA, Kujala UM, Kaprio J, et al. All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up. Br J Sports Med. 2015;49(13):893–7.

    Article  PubMed  Google Scholar 

  102. Farahmand BY, Ahlbom A, Ekblom O, et al. Mortality amongst participants in Vasaloppet: a classical long-distance ski race in Sweden. J Intern Med. 2003;253(3):276–83.

    Article  CAS  PubMed  Google Scholar 

  103. Kujala UM, Sarna S, Kaprio J. Use of medications and dietary supplements in later years among male former top-level athletes. Arch Intern Med. 2003;163(9):1064–8.

    Article  PubMed  Google Scholar 

  104. 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(40):3145–50.

    Article  PubMed  Google Scholar 

  105. Corrado D, Basso C, Rizzoli G, et al. Does sports activity enhance the risk of sudden death in adolescents and young adults? J Am Coll Cardiol. 2003;42(11):1959–63.

    Article  PubMed  Google Scholar 

  106. Maron BJ, Doerer JJ, Haas TS, et al. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980–2006. Circulation. 2009;119(8):1085–92.

    Article  PubMed  Google Scholar 

  107. Maron BJ, Haas TS, Doerer JJ, et al. Comparison of US and Italian experiences with sudden cardiac deaths in young competitive athletes and implications for preparticipation screening strategies. Am J Cardiol. 2009;104(2):276–80.

    Article  PubMed  Google Scholar 

  108. Albert CM, Mittleman MA, Chae CU, et al. Triggering of sudden death from cardiac causes by vigorous exertion. N Engl J Med. 2000;343(19):1355–61.

    Article  CAS  PubMed  Google Scholar 

  109. Holst AG, Winkel BG, Theilade J, et al. Incidence and etiology of sports-related sudden cardiac death in Denmark: implications for preparticipation screening. Heart Rhythm. 2010;7(10):1365–71.

    Article  PubMed  Google Scholar 

  110. Kim JH, Malhotra R, Chiampas G, et al. Cardiac arrest during long-distance running races. N Engl J Med. 2012;366(2):130–40.

    Article  CAS  PubMed  Google Scholar 

  111. Mathews SC, Narotsky DL, Bernholt DL, et al. Mortality among marathon runners in the United States, 2000–2009. Am J Sports Med. 2012;40(7):1495–500.

    Article  PubMed  Google Scholar 

  112. Harris KM, Henry JT, Rohman E, et al. Sudden death during the triathlon. JAMA. 2010;303(13):1255–7.

    Article  CAS  PubMed  Google Scholar 

  113. Mohlenkamp S, Lehmann N, Breuckmann F, et al. Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J. 2008;29(15):1903–10.

    Article  PubMed  Google Scholar 

  114. Haskell WL, Sims C, Myll J, et al. Coronary artery size and dilating capacity in ultradistance runners. Circulation. 1993;87(4):1076–82.

    Article  CAS  PubMed  Google Scholar 

  115. Zilinski JL, Contursi ME, Isaacs SK, et al. Myocardial adaptations to recreational marathon training among middle-aged men. Circ Cardiovasc Imaging. 2015;8(2):e002487.

    Article  PubMed  Google Scholar 

  116. Merghani A, Malhotra A, Sharma S. The U-shaped relationship between exercise and cardiac morbidity. Trends Cardiovasc Med. 2015. pii: S1050-1738(15)00171-1 (Epub 18 Jun 2015). doi:10.1016/j.tcm.2015.06.005.

    PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Prof. Benjamin Levine for his critical review of the manuscript.

Author information

Authors and Affiliations

  1. Research Institute Hospital 12 de Octubre (‘i+12’), Edificio Actividades Ambulatorias, 6ª Planta, Avda. de Córdoba s/n, 28041, Madrid, Spain

    Fabian Sanchis-Gomar & Alejandro Lucia

  2. Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain

    Laura M. Pérez

  3. Department of Anesthesiology, Mayo Clinic, Rochester, MN, USA

    Michael J. Joyner

  4. European Federation of Sports Medicine Associations (EFSMA) and German Federation of Sports Medicine, Remscheid, Germany

    Herbert Löllgen

  5. European University, Madrid, Spain

    Alejandro Lucia

Authors
  1. Fabian Sanchis-Gomar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura M. Pérez
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael J. Joyner
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Herbert Löllgen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alejandro Lucia
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabian Sanchis-Gomar.

Ethics declarations

Funding

No sources of funding were used to assist in the preparation of this article.

Conflicts of interest

Fabian Sanchis-Gomar, Laura M. Pérez, Michael Joyner, Herbert Löllgen, and Alejandro Lucia declare that they have no conflicts of interest relevant to the content of this review.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sanchis-Gomar, F., Pérez, L.M., Joyner, M.J. et al. Endurance Exercise and the Heart: Friend or Foe?. Sports Med 46, 459–466 (2016). https://doi.org/10.1007/s40279-015-0434-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40279-015-0434-4

Keywords

Search

Navigation