Is endurance training bad for you?May 31, 2016
In 2012, Belgium scientists published a study that concluded that repeated bouts of intensive endurance exercise at the elite level may result in the pathological enlargement of the right ventricle, which, according to the article, is associated with potential health hazards including sudden cardia death. The publication was the cause of considerable debate among experts in the medical and sports communities. Sports medicine physicians at Saarland University have now tested the conclusions of the 2012 study by examining the hearts of elite master endurance athletes. Their findings refute the hypothesis proposed by their Belgian colleagues. The Saarland research team could find no evidence that years of elite-level endurance training causes any long-term damage to the right ventricle. The study has been published in the respected medical journal 'Circulation'.
The media reports with depressing regularity the sudden cardiac death of endurance athletes. Just a few weeks ago, television channels, newspapers and the internet reported that Dutch professional cyclist Gijs Verdick had died in hospital a week after suffering a double heart attack during a race.
The potential hazards that endurance exercise poses to the heart have been the subject of discussion in the medical community for over a century. Although there is now general consensus that the enlarged heart of an athlete is a healthy reaction reflecting the adjustment of the organ to regular endurance training, a number of studies seem to suggest that high levels of endurance exercise can cause pathological changes to the structure of the heart. This was the conclusion reached by a team of Belgian cardiologists and sports medicine physicians in a study published in 2012 that received considerable global attention. The researchers established a link between extreme endurance exercise training and the acute enlargement and functional impairment of the right ventricle immediately after exercise. More precisely, they observed enlargement and reduced functionality of the right ventricle in athletes who had taken part in several hours of competitive endurance sport. However, longitudinal studies have so far failed to confirm the hypothesis formulated by the authors that endurance exercise results in long-term damage to the right ventricle, now referred to as 'exercise-induced arrhythmogenic right ventricular cardiomyopathy' (ARVC). It was therefore not clear whether the acute enlargement of the right ventricle after extreme endurance activity, which the Belgian group had identified and which had been frequently discussed among professionals, actually did lead to a potentially life-threatening chronic condition.
For the Saarbrücken research team led by cardiologist and sports medicine physician Prof. Dr. Jürgen Scharhag and Dr. Philipp Bohm, the hypothesis that endurance exercise leads to the pathological enlargement of the right ventricle was not immediately obvious. Scientists at the Saarbrücken Institute of Sports and Preventive Medicine have for years been examining elite athletes from a wide variety of disciplines, including triathletes, swimmers and professional footballers. In all that time, the Saarbrücken researchers never found any evidence underpinning the hypothesis posited by the Belgian team. They therefore decided to test the hypothesis explicitly.
They examined 33 elite master athletes (average age: 47) and compared them to a control group of 33 men who were similar in terms of age, size and weight but who had not done any kind of endurance exercise. The group of athletes, which included former Olympians as well as previous Ironman participants and champions, have been training at an elite level for around 30 years and still continue to train for an average of about 17 hours a week.
The Saarbrücken scientists were able to confirm that the hearts of these athletes, who have been engaged in elite level endurance activities for many years, were, as expected, significantly larger and stronger than those of members of the control group. 'But we found no evidence of lasting damage, pathological enlargement or functional impairment of either the right or left ventricle in the athletes who had been doing long-term intensive elite-level endurance exercise,' explains Philipp Bohm, who is now working at the Cardiology Centre at the University Hospital Zürich.
By focusing on highly trained and active elite master athletes, the Saarbrücken research team found a clever means of circumventing a problem faced by researchers interested in these questions. Although cardiovascular magnetic resonance imaging (cardiac MRI) is the best method of examining the heart and, in particular, the right ventricle, it has not been available for very long and it is not a routine technique for examining athletes. Systematic long-term MRI-based studies of athlete hearts will therefore not be available in the foreseeable future. Data from longitudinal studies, in which subjects have been monitored by MRI for years, potentially decades, simply does not exist. 'Our cohort of elite master athletes therefore represents our best means of investigating the long-term impact of years of competition-level endurance sport,' explains Jürgen Scharhag.
Sport medicine in Saarbrücken has a long tradition of researching the medical aspects of elite sport and sport cardiology. Saarland's experts in sports medicine are working with FIFA, the international governing body of football, to research sudden cardiac death in football players. Institute Director Professor Tim Meyer is also team doctor for the German national football squad, as was Meyer's predecessor Professor Wilfried Kindermann. Jürgen Scharhag performs the same function for the German Football Association's U21 squad. Medical physicians at the Institute have provided and continue to provide medical supervision and assistance to many of Germany's Olympic teams, national sports teams and to the athletes who train at the Olympic Training Base in Saarbrücken.
Internet access to the publication is available at:
„Right and Left Ventricular Function and Mass in Male Elite Master Athletes" (12 April 2016): http://www.ncbi.nlm.nih.gov/pubmed/27073129
For further information, please contact:
Prof. Dr. Jürgen Scharhag
Tel.: +49 (0)681) 302-70400
Dr. med. Philipp Bohm
Related Sudden Cardiac Death Articles:
A new report presents 10 quality and performance measures that are intended to help stakeholders--including health systems, legislative bodies, and nongovernmental organizations, as well as healthcare practitioners, patients, families and communities -- in the effort to prevent sudden cardiac death.
The sudden death of a 13-year-old boy resulted in more than 20 relatives to be incorrectly diagnosed as having a potentially lethal heart rhythm condition.
The risk of sudden cardiac death was significantly greater in patients with thyroid hormone levels at the higher end of normal, compared to patients with levels at the low end.
Researchers from Emory's Rollins School of Public Health developed a sudden cardiac death (SCD) predictive model that can help identify and prevent the disease in individuals at high risk.
For the first time, a team of researchers led by Rajat Deo, MD, MTR, an assistant professor of Cardiovascular Medicine in the Perelman School of Medicine at the University of Pennsylvania, has developed and validated a prediction model to determine sudden cardiac death risk in adults without a history of cardiovascular disease (CVD).
Researchers from Baylor College of Medicine report how a mutation in a gene involved in the regulation of calcium inside brain cells can help trigger blackouts of the brainstem, the center that controls heartbeat and breathing, and increase the risk of sudden unexpected death.
One in nine men may be at higher risk of premature death due to sudden cardiac death - usually with no warning.
Sudden deaths in young, seemingly healthy competitive athletes are tragic events.
Genetic testing has shed new light on the deaths of nearly 500 young Australians and New Zealanders who died from sudden cardiac death in a three-year period, the New England Journal of Medicine reports today.
A research team has developed a non-invasive 3-D virtual heart to help doctors determine who faces the highest risk of a life-threatening arrhythmia and would benefit from a defibrillator implant.
Related Sudden Cardiac Death Reading:
Sudden Cardiac Death in the Young and Athletes: Text Atlas of Pathology and Clinical Correlates
by Gaetano Thiene (Author), Domenico Corrado (Author), Cristina Basso (Author)
This text atlas focuses on the pathology and molecular genetics of sudden cardiac death in the young and in athletes, presenting the state of the art in the field as the basis for development and implementation of more effective prevention strategies, including, ultimately, molecular therapy that will cure the underlying biological defect. A wealth of high-resolution color images, accompanied by clear supporting text, are presented to document the anatomic pathology of the cardiac diseases most frequently responsible for sudden cardiac death in this population, including coronary artery... View Details
One Beat at a Time - Living with Sudden Cardiac Death
by Matthew D. Noble (Author)
Not many twenty eight years olds have enough life experiences to write an entertaining autobiography. Matthew D. Noble could have written three by now. Born in 1976 with an abnormal heart, he spent his formative years literally wondering if his next heartbeat would be his last. He escaped sudden cardiac death five times before the age of 18, amazing when you consider that over 95% of people who have an episode like Matthew’s don’t survive. How did he survive five? This book details the miraculous stories of how two nurses; a gym teacher, an implantable defibrillator (ICD) and an... View Details
Clinical Approach to Sudden Cardiac Death Syndromes
by Josep Brugada (Adapter), Pedro Brugada (Adapter), Ramon Brugada (Adapter)
Clinical cardiologists are encountering an important challenge in the caring of families with inherited cardiac diseases. The majority of the inherited cardiac diseases causing sudden death express themselves at variable ages in the form of altered muscle function (i.e hypertrophic or dilated cardiomyopathy) or in the form of arrhythmias (i.e. Brugada syndrome, long QT syndrome). However, it is not uncommon that the first sign of the disease may actually be sudden cardiac death, even before the identification of clear clinical abnormalities. In this last decade, with more than 50 new... View Details
Cardiac Arrhythmias, Pacing and Sudden Death (Cardiovascular Medicine)
by Peter Kowey (Editor), Jonathan P. Piccini (Editor), Gerald Naccarelli (Editor), James A. Reiffel (Editor)
This book provides up-to-date, user-friendly and comprehensive guidance on the evaluation, diagnosis, and medical and surgical treatment of cardiac arrhythmias. This ensures that that this title aids every trainee and practicising cardiologist, cardiac electrophysiologist, cardiac surgeon, vascular surgeon, diabetologist, cardiac radiologist and any physician who manages cardiac patients.
Cardiovascular Medicine: Cardiac Arrhythmias, Pacing and Sudden Death covers every aspect of cardiac arrhythmias, from cardiac signs and symptoms through imaging and the genetic basis... View Details
Preventing Sudden Death in Sport & Physical Activity
by Douglas J. Casa (Author), Rebecca L. Stearns (Author)
5 Stars! Doody's Review Service!
(1st Edition Review)
Preventing Sudden Death in Sport and Physical Activity, Second Edition examines the etiology, prevention, recognition, treatment, and return-to-play protocol of the common causes of sudden death in sport. Chapters are written by content area experts, offering a blend of clinical, scientific, and research expertise regarding each medical condition that is discussed.
Sudden death on the field is a growing concern in sports and physical activity. This groundbreaking text arms readers with the knowledge and skills they need to... View Details
Sudden Cardiac Death: Epidemiology, Genetics and Predictive/Prevention Strategies (Cardiology Research and Clinical Developments)
by Pasquale Santangeli (Editor)
by Hubert F. Baars (Editor), Pieter A. F. M. Doevendans (Editor), Arjan C. Houweling (Editor), J. Peter van Tintelen (Editor)
Clinical management and signs are the focus of this practical cardiogenetic reference for those who are involved in the care for cardiac patients with a genetic disease. With detailed discussion of the basic science of cardiogenetics in order to assist in the clinical understanding of the topic.
The genetic causes of various cardiovascular diseases are explained in a concise clinical way that reinforces the current management doctrine in a practical manner.
The authors will cover the principles of molecular genetics in general but also specific to cardiac... View Details
Contemporary Challenges in Sudden Cardiac Death, An Issue of Cardiac Electrophysiology Clinics, 1e (The Clinics: Internal Medicine)
by Mohammad Shenasa MD (Author), N.A. Mark Estes III MD (Author), Gordon F. Tomaselli MD (Author)
This issue of Cardiac Electrophysiology Clinics, edited by Drs. Mohammad Shenasa, N. A. Mark Estes III, and Gordon F. Tomaselli, will cover Contemporary Challenges in Sudden Cardiac Death. Topics covered in this issue include Pathophysiology; Basic electrophysiological mechanism; Channelopathy and Myopathy as causes of sudden cardiac death; Public access to defibrillation; Sudden cardiac death in children adolescence; Sudden cardiac death in specific cardiomyopathies; Ventricular arrhythmias and sudden cardiac death; lessons learned from cardiac implantable rhythm devices; future directions,... View Details
Paul Zoll MD; The Pioneer Whose Discoveries Prevent Sudden Death
by Stafford I. Cohen (Author)
Paul Zoll MD is an engaging account of the life and work of Dr. Paul M. Zoll, the physician and medical researcher behind the treatments and techniques we use today to save victims of heart attacks and to prevent premature deaths from other forms of heart failure. The book tells how one man's compassion, insight, intelligence and perseverance solved medical mysteries that had plagued people through the ages. The biography also shows the human dimensions of Dr. Zoll, including his childhood, education, military service, family relationships, recreational interests and social associations... View Details
Clinical Cardiac Electrophysiology in the Young (Developments in Cardiovascular Medicine)
by Macdonald Dick (Editor)
This volume focuses on the practical aspects of clinical electrophysiology of cardiac arrhythmias in the young as practiced in the Department of Pediatric Cardiology at the University of Michigan. Cardiac arrhythmias in children are often symptomatic as well as frightening to the child patient and parent. This volume is intended as a practical guide for the novice or seasoned physician presented with a child with a cardiac arrhythmia.View Details