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Almost all you need to know in Sports Cardiology, even things you don't dare to ask about

Comment by Luis Serratosa, EACPR Sports Cardiology Section

Exercise and the heart: the good, the bad and the ugly.

S Sharma, A Merghani, Ll Mont.
European Heart Journal (2015) 36, 1445-1453.

Sports Cardiology


This is an excellent updated review in which the authors summarise in a very clear and concise way the physiological adaptations and the numerous beneficial effects of practicing regular physical activity for the cardiovascular system. They also provide us with clear and specific clues to help in differentiating the athlete’s heart from cardiomyopathy and finally describe the potential risks of too much exercise and of using performance enhancing agents. The article is illustrated with simple but at the same time very clear and instructive figures and tables, and includes most of the essential references related with all these aspects.

The good. Chronic intensive endurance training induces cardiovascular electrical, structural and functional adaptations to promote the generation of the required large and sustained increase in cardiac output. In certain cases with extreme adaptations, differentiating athlete’s heart from mild expressions of the commonest cardiomyopathies causing sudden cardiac death in young athletes may be challenging. Most of the beneficial effects, including improved life expectancy, are dose dependent, with a minimum recommended of 150 minutes of moderate intensity exercise per week.

The bad. Over the past two decades, some authors have suggested that the exercise dose may have an upper threshold, probably specific to each individual, above which long-term intense endurance training would be associated with adverse cardiac remodelling, myocardial fibrosis, atrial and ventricular arrhythmias, and possibly coronary artery disease, in individuals with otherwise normal hearts. Some of these theories are still speculative and not well enough supported. Further prospective studies in large cohorts are required to draw more accurate conclusions concerning the potentially deleterious effects of exercise.

The ugly. Some of the prohibited and probably more widely used performance enhancing drugs are cardio-toxic and may likely be implicated in arrhythmogenic substrates.

All this information summarised in just 10 pages that should definitely be considered a must read for all those involved or interested in exercise cardiovascular physiology and/or sports cardiology.

Author: Luis Serratosa
EACPR Sports Cardiology Section

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology