Exercise at the extremes: The amount of exercise to reduce cardiovascular events

Journal of the American College of Cardiology

Volumn 67, Issue 3, 2016, Pages 316-329

  Eijsvogels, Thijs M H ^a,b   Molossi, Silvana ^c   Lee, Duck Chul ^d   Emery, Michael S ^e   Thompson, Paul D ^f  

^a LIVERPOOL JOHN MOORES UNIVERSITY   (United Kingdom)

^b RADBOUD UNIVERSITY MEDICAL CENTER   (Netherlands)

^c BAYLOR COLLEGE OF MEDICINE   (United States)

^d IOWA STATE UNIVERSITY   (United States)

^e INDIANA UNIVERSITY SCHOOL OF MEDICINE   (United States)

^f HARTFORD HOSPITAL   (United States)

Author keywords

athletes; cardiac patients; coronary artery disease; health; heart failure; longevity; mortality; myocardial infarction; physical activity

Indexed keywords

TROPONIN I; TROPONIN T;

AEROBIC EXERCISE; ATHLETE; CARDIORESPIRATORY FITNESS; CARDIOVASCULAR DISEASE; CARDIOVASCULAR FUNCTION; CARDIOVASCULAR RISK; CYCLING; DANCING; ENDURANCE TRAINING; EVENT FREE SURVIVAL; EXERCISE INTENSITY; GARDENING; HEART ARRHYTHMIA; HEART MUSCLE FIBROSIS; HEART MUSCLE ISCHEMIA; HEART REHABILITATION; HUMAN; LIFESTYLE; LONGEVITY; META ANALYSIS (TOPIC); METABOLIC EQUIVALENT; MORBIDITY; MORTALITY; PHYSICAL ACTIVITY; PRACTICE GUIDELINE; PRIMARY PREVENTION; PRIORITY JOURNAL; RANDOMIZED CONTROLLED TRIAL (TOPIC); REVIEW; RISK ASSESSMENT; RISK BENEFIT ANALYSIS; RISK REDUCTION; SECONDARY PREVENTION; TENNIS; WALKING; CARDIOVASCULAR DISEASES; HEALTH STATUS; MOTOR ACTIVITY; PSYCHOLOGY;

CARDIOVASCULAR DISEASES; HEALTH STATUS; HUMANS; LIFE STYLE; LONGEVITY; MOTOR ACTIVITY; RISK ASSESSMENT; RISK REDUCTION BEHAVIOR;

EID: 84957805404     PISSN: 07351097     EISSN: 15583597     Source Type: Journal    
DOI: 10.1016/j.jacc.2015.11.034     Document Type: Review

References (110)

1. P.D. Thompson, D. Buchner, I.L. Pina, and et al. Exercise and physical activity in the prevention and treatment of atherosclerotic cardiovascular disease: a statement from the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity) Circulation 107 2003 3109 3116
2. G.F. Fletcher, G. Balady, S.N. Blair, and et al. Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Association Circulation 94 1996 857 862
3. Physical Activity Guidelines Advisory Committee. Physical Activity Guidelines Advisory Committee Report, 2008. Washington DC, U.S. Department of Health and Human Services.
4. Centers for Disease Control and Prevention. Nutrition, physical activity and obesity: data, trends and maps. Available at: http://nccd.cdc.gov/NPAO-DTM. Accessed September 30, 2015.
5. B. Knechtle, P. Knechtle, and R. Lepers Participation and performance trends in ultra-triathlons from 1985 to 2009 Scand J Med Sci Sports 21 2011 e82 e90
6. Running USA. Statistics. Available at: http://www.runningusa.org/statistics. Accessed August 5, 2015.
7. P. Schnohr, J.H. O'Keefe, J.L. Marott, P. Lange, and G.B. Jensen Dose of jogging and long-term mortality: the Copenhagen City Heart Study J Am Coll Cardiol 65 2015 411 419
8. M.E. Armstrong, J. Green, G.K. Reeves, V. Beral, B.J. Cairns for the Million Women Study Collaborators Frequent physical activity may not reduce vascular disease risk as much as moderate activity: large prospective study of women in the United Kingdom Circulation 131 2015 721 729
9. U. Mons, H. Hahmann, and H. Brenner 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 100 2014 1043 1049
10. P.T. Williams, and P.D. Thompson Increased cardiovascular disease mortality associated with excessive exercise in heart attack survivors Mayo Clin Proc 89 2014 1187 1194
11. T.M. Eijsvogels, and P.D. Thompson Exercise is Medicine: at any dose? JAMA 314 2015 1915 1916
12. Centers for Disease Control and Prevention. General physical activities defined by level of intensity. Available at: http://www.cdc.gov/nccdphp/dnpa/physical/pdf/PA-Intensity-table-2-1.pdf. Accessed September 18, 2015.
13. J.N. Morris, J.A. Heady, P.A. Raffle, C.G. Roberts, and J.W. Parks Coronary heart-disease and physical activity of work Lancet 265 1953 1111 1120 concl
14. R.S. Paffenbarger Jr., A.L. Wing, and R.T. Hyde Physical activity as an index of heart attack risk in college alumni Am J Epidemiol 108 1978 161 175
15. R.S. Paffenbarger Jr., R.T. Hyde, A.L. Wing, and C.C. Hsieh Physical activity, all-cause mortality, and longevity of college alumni N Engl J Med 314 1986 605 613
16. R.S. Paffenbarger Jr., M.E. Laughlin, A.S. Gima, and R.A. Black Work activity of longshoremen as related to death from coronary heart disease and stroke N Engl J Med 282 1970 1109 1114
17. K.E. Powell, P.D. Thompson, C.J. Caspersen, and J.S. Kendrick Physical activity and the incidence of coronary heart disease Annu Rev Public Health 8 1987 253 287
18. Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service 1964 U.S. Department of Health, Education, And Welfare Washington D.C. 1 386 Available at: http://profiles.nlm.nih.gov/NN/B/B/M/Q/. Accessed August 14, 2015.
19. S. Mann, C. Beedie, and A. Jimenez Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendations Sports Med 44 2014 211 221
20. S.P. Whelton, A. Chin, X. Xin, and J. He Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials Ann Intern Med 136 2002 493 503
21. D.E. Thomas, E.J. Elliott, and G.A. Naughton Exercise for type 2 diabetes mellitus Cochrane Database Syst Rev 2006 CD002968
22. J. Szostak, and P. Laurant The forgotten face of regular physical exercise: a 'natural' anti-atherogenic activity Clin Sci (Lond) 121 2011 91 106
23. S. Mora, N. Cook, J.E. Buring, P.M. Ridker, and I.M. Lee Physical activity and reduced risk of cardiovascular events: potential mediating mechanisms Circulation 116 2007 2110 2118
24. M.J. Joyner, and D.J. Green Exercise protects the cardiovascular system: effects beyond traditional risk factors J Physiol 587 2009 5551 5558
25. P.A. Beere, S. Glagov, and C.K. Zarins Experimental atherosclerosis at the carotid bifurcation of the cynomolgus monkey. Localization, compensatory enlargement, and the sparing effect of lowered heart rate Arterioscler Thromb 12 1992 1245 1253
26. K.E. Powell, A.E. Paluch, and S.N. Blair Physical activity for health: what kind? How much? How intense? On top of what? Annu Rev Public Health 32 2011 349 365
27. H.P. van der Ploeg, T. Chey, D. Ding, J.Y. Chau, E. Stamatakis, and A.E. Bauman Standing time and all-cause mortality in a large cohort of Australian adults Prev Med 69 2014 187 191
28. P.T. Katzmarzyk Standing and mortality in a prospective cohort of Canadian adults Med Sci Sports Exerc 46 2014 940 946
29. H.P. van der Ploeg, T. Chey, R.J. Korda, E. Banks, and A. Bauman Sitting time and all-cause mortality risk in 222 497 Australian adults Arch Intern Med 172 2012 494 500
30. A. Biswas, P.I. Oh, G.E. Faulkner, and et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis Ann Intern Med 162 2015 123 132
31. G.N. Healy, D.W. Dunstan, J. Salmon, and et al. Breaks in sedentary time: beneficial associations with metabolic risk Diabetes Care 31 2008 661 666
32. D.W. Dunstan, B.A. Kingwell, R. Larsen, and et al. Breaking up prolonged sitting reduces postprandial glucose and insulin responses Diabetes Care 35 2012 976 983
33. C.E. Matthews, S.C. Moore, J. Sampson, and et al. Mortality benefits for replacing sitting time with different physical activities Med Sci Sports Exerc 47 2015 1833 1840
34. D.C. Lee, R.R. Pate, C.J. Lavie, X. Sui, T.S. Church, and S.N. Blair Leisure-time running reduces all-cause and cardiovascular mortality risk J Am Coll Cardiol 64 2014 472 481
35. C.P. Wen, J.P. Wai, M.K. Tsai, and et al. Minimum amount of physical activity for reduced mortality and extended life expectancy: a prospective cohort study Lancet 378 2011 1244 1253
36. H. Arem, S.C. Moore, A. Patel, and et al. Leisure time physical activity and mortality: a detailed pooled analysis of the dose-response relationship JAMA Intern Med 175 2015 959 967
37. B.E. Ainsworth, W.L. Haskell, S.D. Herrmann, and et al. 2011 Compendium of Physical Activities: a second update of codes and MET values Med Sci Sports Exerc 43 2011 1575 1581
38. Z. Milanovic, G. Sporis, and M. Weston Effectiveness of high-intensity interval training (HIT) and continuous endurance training for VO2max improvements: a systematic review and meta-analysis of controlled trials Sports Med 45 2015 1469 1481
39. D.C. Lee, X. Sui, E.G. Artero, and et al. Long-term effects of changes in cardiorespiratory fitness and body mass index on all-cause and cardiovascular disease mortality in men: the Aerobics Center Longitudinal Study Circulation 124 2011 2483 2490
40. D.I. Feldman, M.H. Al-Mallah, S.J. Keteyian, and et al. No evidence of an upper threshold for mortality benefit at high levels of cardiorespiratory fitness J Am Coll Cardiol 65 2015 629 630
41. K. Gebel, D. Ding, T. Chey, E. Stamatakis, W.J. Brown, and A.E. Bauman Effect of moderate to vigorous physical activity on all-cause mortality in middle-aged and older australians JAMA Intern Med 175 2015 970 977
42. D.P. Swain, and B.A. Franklin Comparison of cardioprotective benefits of vigorous versus moderate intensity aerobic exercise Am J Cardiol 97 2006 141 147
43. J.H. Kim, R. Malhotra, G. Chiampas, and et al. Cardiac arrest during long-distance running races N Engl J Med 366 2012 130 140
44. M.A. Mittleman, M. Maclure, G.H. Tofler, J.B. Sherwood, R.J. Goldberg, J.E. Muller for the Determinants of Myocardial Infarction Onset Study Investigators Triggering of acute myocardial infarction by heavy physical exertion. Protection against triggering by regular exertion N Engl J Med 329 1993 1677 1683
45. C.M. Albert, M.A. Mittleman, C.U. Chae, I.M. Lee, C.H. Hennekens, and J.E. Manson Triggering of sudden death from cardiac causes by vigorous exertion N Engl J Med 343 2000 1355 1361
46. C.A. Warnes, R.G. Williams, T.M. Bashore, and et al. ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease) J Am Coll Cardiol 52 2008 e143 e263
47. C.T. January, L.S. Wann, J.S. Alpert, and et al. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society J Am Coll Cardiol 64 2014 e1 e76
48. E.A. Amsterdam, N.K. Wenger, R.G. Brindis, and et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 64 2014 e1391-228
49. P.T. O'Gara, F.G. Kushner, D.D. Ascheim, and et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines J Am Coll Cardiol 61 2013 e78 e140
50. S.D. Fihn, J.M. Gardin, J. Abrams, and et al. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons J Am Coll Cardiol 60 2012 e44 e164
51. S. Marzolini, P.I. Oh, and D. Brooks Effect of combined aerobic and resistance training versus aerobic training alone in individuals with coronary artery disease: a meta-analysis Eur J Prev Cardiol 19 2012 81 94
52. G.J. Balady, M.A. Williams, P.A. Ades, and et al. Core components of cardiac rehabilitation/secondary prevention programs: 2007 update: a scientific statement from the American Heart Association Exercise, Cardiac Rehabilitation, and Prevention Committee, the Council on Clinical Cardiology; the Councils on Cardiovascular Nursing, Epidemiology and Prevention, and Nutrition, Physical Activity, and Metabolism; and the American Association of Cardiovascular and Pulmonary Rehabilitation Circulation 115 2007 2675 2682
53. B.S. Heran, J.M. Chen, S. Ebrahim, and et al. Exercise-based cardiac rehabilitation for coronary heart disease Cochrane Database Syst Rev 2011 CD001800
54. P.R. Lawler, K.B. Filion, and M.J. Eisenberg Efficacy of exercise-based cardiac rehabilitation post-myocardial infarction: a systematic review and meta-analysis of randomized controlled trials Am Heart J 162 2011 571 584.e2
55. R.S. Taylor, V.A. Sagar, E.J. Davies, and et al. Exercise-based rehabilitation for heart failure Cochrane Database Syst Rev 4 2014 CD003331
56. C.M. O'Connor, D.J. Whellan, K.L. Lee, and et al. Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial JAMA 301 2009 1439 1450
57. K.E. Flynn, I.L. Pina, D.J. Whellan, and et al. Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial JAMA 301 2009 1451 1459
58. L.A. Cobb, and W.D. Weaver Exercise: a risk for sudden death in patients with coronary heart disease J Am Coll Cardiol 7 1986 215 219
59. P.D. Thompson, B.A. Franklin, G.J. Balady, and et al. Exercise and acute cardiovascular events placing the risks into perspective: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism and the Council on Clinical Cardiology Circulation 115 2007 2358 2368
60. S.J. Keteyian, E.S. Leifer, N. Houston-Miller, and et al. Relation between volume of exercise and clinical outcomes in patients with heart failure J Am Coll Cardiol 60 2012 1899 1905
61. S.G. Wannamethee, A.G. Shaper, and M. Walker Physical activity and mortality in older men with diagnosed coronary heart disease Circulation 102 2000 1358 1363
62. T. Moholdt, U. Wisloff, T.I. Nilsen, and S.A. Slordahl Physical activity and mortality in men and women with coronary heart disease: a prospective population-based cohort study in Norway (the HUNT study) Eur J Cardiovasc Prev Rehabil 15 2008 639 645
63. U. Wisloff, A. Stoylen, J.P. Loennechen, and et al. Superior cardiovascular effect of aerobic interval training versus moderate continuous training in heart failure patients: a randomized study Circulation 115 2007 3086 3094
64. A.D. Elliott, K. Rajopadhyaya, D.J. Bentley, and et al. Interval training versus continuous exercise in patients with coronary artery disease: a meta-analysis Heart Lung Circ 24 2015 149 157
65. H. Ismail, J.R. McFarlane, A.H. Nojoumian, and et al. Clinical outcomes and cardiovascular responses to different exercise training intensities in patients with heart failure: a systematic review and meta-analysis J Am Coll Cardiol HF 1 2013 514 522
66. O. Rognmo, T. Moholdt, H. Bakken, and et al. Cardiovascular risk of high- versus moderate-intensity aerobic exercise in coronary heart disease patients Circulation 126 2012 1436 1440
67. R. Shave, A. Baggish, K. George, and et al. Exercise-induced cardiac troponin elevation: evidence, mechanisms, and implications J Am Coll Cardiol 56 2010 169 176
68. A. La Gerche, A.T. Burns, D.J. Mooney, and et al. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes Eur Heart J 33 2012 998 1006
69. D. Oxborough, K. Birch, R. Shave, and K. George "Exercise-induced cardiac fatigue" - a review of the echocardiographic literature Echocardiography 27 2010 1130 1140
70. K. Andersen, B. Farahmand, A. Ahlbom, and et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study Eur Heart J 34 2013 3624 3631
71. S. Mohlenkamp, N. Lehmann, F. Breuckmann, and et al. Running: the risk of coronary events: prevalence and prognostic relevance of coronary atherosclerosis in marathon runners Eur Heart J 29 2008 1903 1910
72. T.M.H. Eijsvogels, A.B. Fernandez, and P.D. Thompson Are there deleterious cardiac effects of acute and chronic endurance exercise? Physiol Rev 96 2016 99 125
73. A.M. Mingels, L.H. Jacobs, V.W. Kleijnen, and et al. Cardiac troponin T elevations, using highly sensitive assay, in recreational running depend on running distance Clin Res Cardiol 99 2010 385 391
74. L. Tulloh, D. Robinson, A. Patel, and et al. Raised troponin T and echocardiographic abnormalities after prolonged strenuous exercise - the Australian Ironman Triathlon Br J Sports Med 40 2006 605 609
75. G. Neumayr, R. Pfister, G. Mitterbauer, and et al. Effect of the "Race Across The Alps" in elite cyclists on plasma cardiac troponins I and T Am J Cardiol 89 2002 484 486
76. A. La Gerche, K.A. Connelly, D.J. Mooney, and et al. Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise Heart 94 2008 860 866
77. T. Eijsvogels, K. George, R. Shave, and et al. Effect of prolonged walking on cardiac troponin levels Am J Cardiol 105 2010 267 272
78. T.M. Eijsvogels, M.D. Hoogerwerf, M.H. Oudegeest-Sander, and et al. The impact of exercise intensity on cardiac troponin I release Int J Cardiol 171 2014 e3 e4
79. J. Scherr, S. Braun, T. Schuster, and et al. 72-h kinetics of high-sensitive troponin T and inflammatory markers after marathon Med Sci Sports Exerc 43 2011 1819 1827
80. H.A. Katus, A. Remppis, T. Scheffold, and et al. Intracellular compartmentation of cardiac troponin T and its release kinetics in patients with reperfused and nonreperfused myocardial infarction Am J Cardiol 67 1991 1360 1367
81. T.M. Eijsvogels, M.D. Hoogerwerf, M.F. Maessen, and et al. Predictors of cardiac troponin release after a marathon J Sci Med Sport 18 2015 88 92
82. F. Breuckmann, S. Mohlenkamp, K. Nassenstein, and et al. Myocardial late gadolinium enhancement: prevalence, pattern, and prognostic relevance in marathon runners Radiology 251 2009 50 57
83. M. Wilson, R. O'Hanlon, S. Prasad, and et al. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes J Appl Physiol 110 2011 1622 1626
84. N. Mousavi, A. Czarnecki, K. Kumar, and et al. Relation of biomarkers and cardiac magnetic resonance imaging after marathon running Am J Cardiol 103 2009 1467 1472
85. H. Hanssen, A. Keithahn, G. Hertel, and et al. Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running Clin Sci 120 2011 143 152
86. R. O'Hanlon, A. Grasso, M. Roughton, and et al. Prognostic significance of myocardial fibrosis in hypertrophic cardiomyopathy J Am Coll Cardiol 56 2010 867 874
87. R.Y. Kwong, H. Sattar, H. Wu, and et al. Incidence and prognostic implication of unrecognized myocardial scar characterized by cardiac magnetic resonance in diabetic patients without clinical evidence of myocardial infarction Circulation 118 2008 1011 1020
88. H. Mahrholdt, A. Wagner, R.M. Judd, and et al. Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies Eur Heart J 26 2005 1461 1474
89. S.V. Babu-Narayan, O. Goktekin, J.C. Moon, and et al. Late gadolinium enhancement cardiovascular magnetic resonance of the systemic right ventricle in adults with previous atrial redirection surgery for transposition of the great arteries Circulation 111 2005 2091 2098
90. A. La Gerche Can intense endurance exercise cause myocardial damage and fibrosis? Curr Sports Med Rep 12 2013 63 69
91. T.G. Neilan, J.L. Januzzi, E. Lee-Lewandrowski, and et al. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon Circulation 114 2006 2325 2333
92. N. Middleton, R. Shave, K. George, and et al. Left ventricular function immediately following prolonged exercise: a meta-analysis Med Sci Sports Exerc 38 2006 681 687
93. J.M. McGavock, D.E. Warburton, D. Taylor, R.C. Welsh, H.A. Quinney, and M.J. Haykowsky The effects of prolonged strenuous exercise on left ventricular function: a brief review Heart Lung 31 2002 279 292 quiz 293-4
94. A. La Gerche, G. Claessen, S. Dymarkowski, and et al. Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes Eur Heart J 36 2015 1998 2010
95. W.T. Qureshi, Z. Alirhayim, M.J. Blaha, and et al. Cardiorespiratory fitness and risk of incident atrial fibrillation: results from the Henry Ford Exercise Testing (FIT) Project Circulation 131 2015 1827 1834
96. D. Mozaffarian, C.D. Furberg, B.M. Psaty, and D. Siscovick Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study Circulation 118 2008 800 807
97. J. Abdulla, and J.R. Nielsen Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta- analysis Europace 11 2009 1156 1159
98. P.D. Thompson Physical fitness, physical activity, exercise training, and atrial fibrillation: first the good news, then the bad J Am Coll Cardiol 66 2015 997 999
99. K. Kroger, N. Lehmann, L. Rappaport, and et al. Carotid and peripheral atherosclerosis in male marathon runners Med Sci Sports Exerc 43 2011 1142 1147
100. M.H. Criqui, J.O. Denenberg, J.H. Ix, and et al. Calcium density of coronary artery plaque and risk of incident cardiovascular events JAMA 311 2014 271 278
101. B.Y. Farahmand, A. Ahlbom, O. Ekblom, and et al. Mortality amongst participants in Vasaloppet: a classical long-distance ski race in Sweden J Intern Med 253 2003 276 283
102. M.F. Maessen, M.T. Hopman, A.L. Verbeek, and T.M. Eijsvogels Dose of jogging: mortality versus longevity J Am Coll Cardiol 65 2015 2672 2673
103. J.L. Zilinski, M.E. Contursi, S.K. Isaacs, and et al. Myocardial adaptations to recreational marathon training among middle-aged men Circ Cardiovasc Imaging 8 2015 e002487
104. P.S. Bhella, J.L. Hastings, N. Fujimoto, and et al. Impact of lifelong exercise "dose" on left ventricular compliance and distensibility J Am Coll Cardiol 64 2014 1257 1266
105. M.J. Karvonen, H. Klemola, J. Virkajarvi, and A. Kekkonen Longevity of endurance skiers Med Sci Sports 6 1974 49 51
106. P.M. Clarke, S.J. Walter, A. Hayen, and et al. Survival of the fittest: retrospective cohort study of the longevity of Olympic medalists in the modern era BMJ 345 2012 e8308
107. E. Marijon, M. Tafflet, J. Antero-Jacquemin, and et al. Mortality of French participants in the Tour de France (1947-2012) Eur Heart J 34 2013 3145 3150
108. J.A. Kettunen, U.M. Kujala, J. Kaprio, and et al. All-cause and disease-specific mortality among male, former elite athletes: an average 50-year follow-up Br J Sports Med 49 2015 893 897
109. C.A. James, A. Bhonsale, C. Tichnell, and et al. Exercise increases age-related penetrance and arrhythmic risk in arrhythmogenic right ventricular dysplasia/cardiomyopathy-associated desmosomal mutation carriers J Am Coll Cardiol 62 2013 1290 1297
110. J.A. Doll, A. Hellkamp, P.M. Ho, and et al. Participation in cardiac rehabilitation programs among older patients after acute myocardial infarction JAMA Intern Med 175 2015 1700 1702