Document Detail

Potential adverse cardiovascular effects from excessive endurance exercise.
MedLine Citation:
PMID:  22677079     Owner:  NLM     Status:  MEDLINE    
A routine of regular exercise is highly effective for prevention and treatment of many common chronic diseases and improves cardiovascular (CV) health and longevity. However, long-term excessive endurance exercise may induce pathologic structural remodeling of the heart and large arteries. Emerging data suggest that chronic training for and competing in extreme endurance events such as marathons, ultramarathons, ironman distance triathlons, and very long distance bicycle races, can cause transient acute volume overload of the atria and right ventricle, with transient reductions in right ventricular ejection fraction and elevations of cardiac biomarkers, all of which return to normal within 1 week. Over months to years of repetitive injury, this process, in some individuals, may lead to patchy myocardial fibrosis, particularly in the atria, interventricular septum, and right ventricle, 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. However, this concept is still hypothetical and there is some inconsistency in the reported findings. Furthermore, lifelong vigorous exercisers generally have low mortality rates and excellent functional capacity. Notwithstanding, the hypothesis that long-term excessive endurance exercise may induce adverse CV remodeling warrants further investigation to identify at-risk individuals and formulate physical fitness regimens for conferring optimal CV health and longevity.
James H O'Keefe; Harshal R Patil; Carl J Lavie; Anthony Magalski; Robert A Vogel; Peter A McCullough
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Mayo Clinic proceedings     Volume:  87     ISSN:  1942-5546     ISO Abbreviation:  Mayo Clin. Proc.     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-06-08     Completed Date:  2012-08-09     Revised Date:  2013-12-13    
Medline Journal Info:
Nlm Unique ID:  0405543     Medline TA:  Mayo Clin Proc     Country:  England    
Other Details:
Languages:  eng     Pagination:  587-95     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2012 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Arrhythmias, Cardiac / physiopathology
Cardiomyopathies / physiopathology
Cardiovascular Diseases / epidemiology,  physiopathology
Coronary Vessels / pathology
Exercise / physiology*
Magnetic Resonance Imaging
Physical Endurance / physiology*
Risk Assessment
Risk Factors
Running / physiology
Stroke Volume
Comment In:
Mayo Clin Proc. 2012 Nov;87(11):1133; author reply 1133-4   [PMID:  23127741 ]
Erratum In:
Mayo Clin Proc. 2012 Jul;87(7):704

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