The U-shaped relationship between exercise and cardiac morbidity

Trends in Cardiovascular Medicine

Volumn 26, Issue 3, 2016, Pages 232-240

  Merghani, Ahmed ^a   Malhotra, Aneil ^a   Sharma, Sanjay ^a  

^a ST GEORGE S HOSPITAL   (United Kingdom)

Author keywords

Athlete's Heart; Atrial fibrillation; Cardiomyopathy; Myocardial fibrosis; Sports cardiology; Sudden cardiac death; Veteran athlete

Indexed keywords

ATHLETE; BRADYCARDIA; CARDIOVASCULAR MORTALITY; CAUSE OF DEATH; CONGESTIVE CARDIOMYOPATHY; CORONARY ARTERY CALCIFICATION; ELECTROCARDIOGRAPHY; ENERGY EXPENDITURE; EXERCISE; EXERCISE INTENSITY; HEART; HEART ATRIUM ARRHYTHMIA; HEART DISEASE; HEART FUNCTION; HEART LEFT VENTRICLE HYPERTROPHY; HEART MUSCLE FIBROSIS; HEART RIGHT VENTRICLE DYSPLASIA; HEART VENTRICLE ARRHYTHMIA; HEART VENTRICLE REMODELING; HUMAN; HYPERTROPHIC CARDIOMYOPATHY; MORBIDITY; PATHOPHYSIOLOGY; PHYSICAL ACTIVITY; PRIORITY JOURNAL; REVIEW; RISK FACTOR; SINUS ARRHYTHMIA; SINUS BRADYCARDIA; SINUS NODE DISEASE; SPORT; SUDDEN CARDIAC DEATH; VENTRICULAR NONCOMPACTION; DEATH, SUDDEN, CARDIAC; EXERCISE INDUCED CARDIOMEGALY; HEART DISEASES; MORTALITY; PROTECTION; RISK ASSESSMENT; RISK REDUCTION; SEDENTARY LIFESTYLE;

CARDIOMEGALY, EXERCISE-INDUCED; DEATH, SUDDEN, CARDIAC; EXERCISE; HEART DISEASES; HUMANS; PROTECTIVE FACTORS; RISK ASSESSMENT; RISK FACTORS; RISK REDUCTION BEHAVIOR; SEDENTARY LIFESTYLE;

EID: 84941896577     PISSN: 10501738     EISSN: 18732615     Source Type: Journal    
DOI: 10.1016/j.tcm.2015.06.005     Document Type: Review

References (62)

1. Thompson P.D., Buchner D., Pina I.L., Balady G.J., Williams M.a., Marcus B.H., et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease. Circulation 2003, 107:3109-3116.
2. Wen C.P., Wai J.P.M., Tsai M.K., Yang Y.C., Cheng T.Y.D., Lee M.-C., et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study. Lancet 2011, 378:1244-1253.
3. Morris J.N., Heady J.A., Raffle P.A., Roberts C.G., Parks J.W. Coronary heart-disease and physical activity of work. Lancet 1953, 265:1111-1120.
4. Shiroma E.J., Lee I.-M. Physical activity and cardiovascular health: lessons learned from epidemiological studies across age, gender, and race/ethnicity. Circulation 2010, 122:743-752.
5. Anderson L.J., Taylor R.S. Cardiac rehabilitation for people with heart disease: an overview of Cochrane systematic reviews. Int J Cardiol 2014, 177:348-361.
6. Mozaffarian D., Furberg C.D., Psaty B.M., Siscovick D. Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008, 118:800-807.
7. Clarke P.M., Walter S.J., Hayen A., Mallon W.J., Heijmans J., Studdert D.M. Survival of the fittest: retrospective cohort study of the longevity of Olympic medallists in the modern era. Br Med J 2012, 8308:1-8.
8. Sarna S., Sahi T., Koskenvuo M., Kaprio J. Increased life expectancy of world class male athletes. Med Sci Sports Exerc 1993, 25:237-244.
9. Marijon E., Tafflet M., Antero-Jacquemin J., El Helou N., Berthelot G., Celermajer D.S., et al. Mortality of French participants in the Tour de France (1947-2012). Eur Heart J 2013, 34:3145-3150.
10. Menotti A., Amici E., Gambelli G.C., Milazzotto F., Bellotti P., Capocaccia R., Giuli B. Life expectancy in Italian track and field athletes. Eur J Epidemiol 1990, 6:257-260.
11. Saint Onge J.M., Rogers R.G., Krueger P.M. Major league baseball players' life expectancies. Soc Sci Q 2009, 89:817-830.
12. 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.
13. Nelson M.E., Rejeski W.J., Blair S.N., Duncan P.W., Judge J.O., King A.C., et al. Physical activity and public health in older adults: recommendation from the American College of Sports Medicine and the American Heart Association. Circulation 2007, 116:1094-1105.
14. Phillips S.a., Mahmoud A.M., Brown M.D., Haus J.M. Exercise interventions and peripheral arterial function: implications for cardio-metabolic disease. Prog Cardiovasc Dis 2015, 57:521-534.
15. Bhella P.S., Hastings J.L., Fujimoto N., Shibata S., Carrick-Ranson G., Palmer M.D., et al. Impact of lifelong exercise dose on left ventricular compliance and distensibility. J Am Coll Cardiol 2014, 64:1257-1266.
16. O'Donovan G., Blazevich A.J., Boreham C., Cooper A.R., Crank H., Ekelund U., et al. The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. J Sports Sci 2010, 28:573-591.
17. US department of health and social services. Physical Activity Guidelines for Americans [Internet]; 2008. Available from: [cited 22.03.15]. http://www.health.gov/paguidelines.
18. Schnohr P., O'Keefe J.H., Marott J.L., Lange P., Jensen G.B. Dose of jogging and long-term mortality. J Am Coll Cardiol 2015, 65:411-419.
19. Kokkinos P., Myers J., Faselis C., Panagiotakos D.B., Doumas M., Pittaras A., et al. Exercise capacity and mortality in older men: a 20-year follow-up study. Circulation 2010, 122:790-797.
20. Corrado D., Pelliccia A., Heidbuchel H., Sharma S., Link M., Basso C., et al. Recommendations for interpretation of 12-lead electrocardiogram in the athlete. Eur Heart J 2010, 31:243-259.
21. Gati S., Sheikh N., Ghani S., Zaidi A., Wilson M., Raju H., et al. Should axis deviation or atrial enlargement be categorised as abnormal in young athletes? The athlete's electrocardiogram: time for re-appraisal of markers of pathology. Eur Heart J 2013, 34:3641-3648.
22. Papadakis M., Basavarajaiah S., Rawlins J., Edwards C., Makan J., Firoozi S., et al. Prevalence and significance of T-wave inversions in predominantly Caucasian adolescent athletes. Eur Heart J 2009, 30:1728-1735.
23. Sharma S., Whyte G., Elliott P., Padula M., Kaushal R., Mahon N., et al. Electrocardiographic changes in 1000 highly trained junior elite athletes. Br J Sports Med 1999, 33:319-324.
24. Drezner J.a., Ackerman M.J., Anderson J., Ashley E., Asplund C.A., Baggish A.L., et al. Electrocardiographic interpretation in athletes: the Seattle criteria. Br J Sports Med 2013, 47:122-124.
25. Papadakis M., Carre F., Kervio G., Rawlins J., Panoulas V.F., Chandra N., et al. The prevalence, distribution, and clinical outcomes of electrocardiographic repolarization patterns in male athletes of African/Afro-Caribbean origin. Eur Heart J 2011, 32:2304-2313.
26. Pelliccia A., Maron B.J., Spataro A., Proschan M.A., Spirito P. The upper limit of physiologic cardiac hypertrophy in highly trained elite athletes. N Engl J Med 1991, 324:295-301.
27. Basavarajaiah S., Boraita A., Whyte G., Wilson M., Carby L., Shah A., et al. Ethnic differences in left ventricular remodeling in highly-trained athletes relevance to differentiating physiologic left ventricular hypertrophy from hypertrophic cardiomyopathy. J Am Coll Cardiol 2008, 51:2256-2262.
28. Zaidi A., Ghani S., Sharma R., Oxborough D., Panoulas V.F., Sheikh N., et al. Physiological right ventricular adaptation in elite athletes of African and Afro-Caribbean origin. Circulation 2013, 127:1783-1792.
29. Schnell F., Riding N., O'Hanlon R., Lentz P.a., Donal E., Kervio G., et al. The recognition and significance of pathological t-wave inversions in athletes. Circulation 2014, 131:165-173.
30. Sheikh N., Papadakis M., Ghani S., Zaidi A., Gati S., Adami P.E., et al. Comparison of electrocardiographic criteria for the detection of cardiac abnormalities in elite black and white athletes. Circulation 2014, 129:1637-1649.
31. Caselli S., Maron M.S., Urbano-Moral J.a., Pandian N.G., Maron B.J., Pelliccia A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol 2014, 114:1383-1389.
32. Malhotra a., Sheikh N., Dhutia H., Siva a., Millar L., Merghani a., et al. 91 Differentiating physiological left ventricular hypertrophy from hypertrophic cardiomyopathy in athletes: proposed echocardiographic protocol. Heart 2014, 100:A52.
33. Sharma S., Elliott P.M., Whyte G., Mahon N., Virdee M.S., Mist B., et al. Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes. J Am Coll Cardiol 2000, 36:864-870.
34. Abergel E., Chatellier G., Hagege A.A., Oblak A., Linhart A., Ducardonnet A., 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.
35. Gati S., Chandra N., Bennett R.L., Reed M., Kervio G., Panoulas V.F., et al. Increased left ventricular trabeculation in highly trained athletes: do we need more stringent criteria for the diagnosis of left ventricular non-compaction in athletes?. Heart 2013, 99:401-408.
36. Gati S., Papadakis M., Papamichael N.D., Zaidi A., Sheikh N., Reed M., et al. Reversible de novo left ventricular trabeculations in pregnant women: implications for the diagnosis of left ventricular noncompaction in low-risk populations. Circulation 2014, 130:475-483.
37. Corrado D., Basso C., Rizzoli G., Schiavon M., Thiene G. Does sports activity enhance the risk of sudden death in adolescents and young adults?. J Am Coll Cardiol 2003, 42:1959-1963.
38. Maron B.J., Doerer J.J., Haas T.S., Tierney D.M., Mueller F.O. Sudden deaths in young competitive athletes: analysis of 1866 deaths in the United States, 1980-2006. Circulation 2009, 119:1085-1092.
39. Berdowski J., de Beus M.F., Blom M., Bardai A., Bots M.L., Doevendans P.a., et al. Exercise-related out-of-hospital cardiac arrest in the general population: incidence and prognosis. Eur Heart J 2013, 34:3616-3623.
40. Marijon E., Tafflet M., Celermajer D.S., Dumas F., Perier M.-C., Mustafic H., et al. Sports-related sudden death in the general population. Circulation 2011, 124:672-681.
41. Marijon E., Uy-Evanado A., Reinier K., Teodorescu C., Narayanan K., Jouven X., et al. Sudden cardiac arrest during sports activity in middle age. Circulation 2015, 131:1384-1391.
42. Shave R., George K.P., 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.
43. Abdulla J., Nielsen J.R. 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.
44. Andersen K., Farahmand B., Ahlbom A., Held C., Ljunghall S., Michaëlsson K., et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study. Eur Heart J 2013, 34:3624-3631.
45. Elosua R., Arquer A., Mont L., Sambola A., Molina L., García-Morán E., et al. Sport practice and the risk of lone atrial fibrillation: a case-control study. Int J Cardiol 2006, 108:332-337.
46. Drca N., Wolk A., Jensen-Urstad M., Larsson S.C. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart 2014, 100:1037-1042.
47. Mont L., Tamborero D., Elosua R., Molina I., Coll-Vinent B., Sitges M., 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.
48. Mont L., Sambola a., Brugada J., Vacca M., Marrugat J., Elosua R., et al. Long-lasting sport practice and lone atrial fibrillation. Eur Heart J 2002, 23:477-482.
49. Guasch E., Benito B., Qi X., Cifelli C., Naud P., Shi Y., et al. Atrial fibrillation promotion by endurance exercise: demonstration and mechanistic exploration in an animal model. J Am Coll Cardiol 2013, 62:68-77.
50. Baldesberger S., Bauersfeld U., Candinas R., Seifert B., Zuber M., Ritter M., et al. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J 2008, 29:71-78.
51. Biffi A., Pelliccia A., Verdile L., Fernando F., Spataro A., Caselli S., et al. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2002, 40.
52. Biffi A., Maron B.J., Verdile L., Fernando F., Spataro A., Marcello G., et al. Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 2004, 44:1053-1058.
53. Heidbüchel H. High prevalence of right ventricular involvementin endurance athletes with ventricular arrhythmias Role of an electrophysiologic study in risk stratification. Eur Heart J 2003, 24:1473-1480.
54. La Gerche A., Burns A.T., Mooney D.J., Inder W.J., Taylor A.J., Bogaert J., et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 2012, 33:998-1006.
55. Sharma S., Zaidi A. Exercise-induced arrhythmogenic right ventricular cardiomyopathy: fact or fallacy?. Eur Heart J 2012, 33:938-940.
56. Pelliccia A., Kinoshita N., Pisicchio C., Quattrini F., Dipaolo F.M., Ciardo R., et al. Long-Term Clinical Consequences of Intense, Uninterrupted Endurance Training in Olympic Athletes. J Am Coll Cardiol 2010, 55:1619-1625.
57. Hood S., Northcote R.J. Cardiac assessment of veteran endurance athletes: a 12 year follow up study. Br J Sports Med 1999, 33:239-243.
58. Benito B., Gay-Jordi G., Serrano-Mollar A., Guasch E., Shi Y., Tardif J.-C., et al. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 2011, 123:13-22.
59. Bernardo B.C., Weeks K.L., Pretorius L., McMullen J.R. Molecular distinction between physiological and pathological cardiac hypertrophy: experimental findings and therapeutic strategies. Pharmacol Ther 2010, 128:191-227.
60. Breuckmann F., Lehmann N., Ladd S., Schmermund A., Schlosser T., Jo K., et al. Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners. Radiology 2009, 251:50-57.
61. Wilson M., O'Hanlon R., Prasad S., Deighan A., Macmillan P., Oxborough D., et al. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol 2011, 110:1622-1626.
62. Möhlenkamp S., Lehmann N., Breuckmann F., Bröcker-Preuss M., Nassenstein K., Halle M., et al. Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J 2008, 29:1903-1910.