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Excessive endurance exercise - not only beneficial?

Comment by Erik Ekker Solberg, EACPR Sports Cardiology Section

Potential Adverse Cardiovascular Effects From Excessive Endurance Exercise
J. H. O'Keefe et al.
Mayo Clin Proc 2012; 87: 587‑595


Exercise is highly effective for prevention and treatment of diseases. Additionally, it improves cardiovascular health and longevity. This well written American review discusses, however, emerging data suggesting that long-term excessive endurance exercise may induce pathologic structural remodelling of the heart and large arteries. The mechanism may be acute volume overload of the atria and right ventricle, leading to transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which to return to normal within a week. In some individuals these repetitive injuries over time may lead to patchy myocardial fibrosis in the affected areas, 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.

The hypothesis that long-term excessive endurance exercise may induce adverse CV remodelling, though, is still hypothetical, and there is inconsistency in the reported findings. For example, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis is of clear interest and warrants further investigation to identify the mechanisms and individuals at risk, thus being able to formulate physical fitness regimens for conferring optimal cardiovascular health and longevity.

In a discussion about optimal training doses, the authors confer positive health effects of up to one hour vigorous training per day. Beyond which more exercise does not yield further benefits.

When the positive effects of physical exercise is well documented, the balance between physical stress and recovery time needs to be understood better.