May Strenuous Endurance Sports Activity Damage the Cardiovascular System of Healthy Athletes? A Narrative Review

Abstract

The positive effects of physical activity are countless, not only on the cardiovascular system but on health in general. However, some studies suggest a U-shape relationship between exercise volume and effects on the cardiovascular system. On the basis of this perspective, moderate-dose exercise would be beneficial compared to a sedentary lifestyle, while very high-dose physical activity would paradoxically be detrimental. We reviewed the available evidence on the potential adverse effects of very intense, prolonged exercise on the cardiovascular system, both acute and chronic, in healthy athletes without pre-existing cardiovascular conditions. We found that endurance sports activities may cause reversible electrocardiographic changes, ventricular dysfunction, and troponin elevation with complete recovery within a few days. The theory that repeated bouts of acute stress on the heart may lead to chronic myocardial damage remains to be demonstrated. However, male veteran athletes with a long sports career show an increased prevalence of cardiovascular abnormalities such as electrical conduction delay, atrial fibrillation, myocardial fibrosis, and coronary calcifications compared to non-athletes. It must be underlined that the cause–effect relationship between such abnormalities and the exercise and, most importantly, the prognostic relevance of such findings remains to be established.

Evolving spectrum of arrhythmogenic cardiomyopathy: Implications for Sports Cardiology

“…Therefore, ACM is a leading cause of SCD in young and athletes 10,11 . Intense and prolonged physical exercise not only favor VAs but also promotes the phenotypic expression and progression of the disease 12–14 …”

“…10,11 Intense and prolonged physical exercise not only favor VAs but also promotes the phenotypic expression and progression of the disease. [12][13][14] Preparticipation screening (PPS) offers the possibility to early identify asymptomatic patients with ACM and, by modulating the intensity and type of exercise, to reduce the risk of exercise-related disease progression and SCD. [15][16][17] However, while the classical RV or biventricular phenotype is usually suspected at PPS by resting electrocardiogram (ECG) abnormalities, variants with predominant LV involvement are often characterized by normal ECG and unremarkable echocardiography.…”

Vigorous physical activity and atrial fibrillation in healthy individuals: What is the correct approach?

“…1,11 Although exercise training is believed to improve cardiovascular health, and there is strong evidence that athletes live longer than individuals from the general population, recent studies suggest that excessive volumes of physical activity and specifically engaging in endurance type sports such a marathons and long-distance triathlons, may actually harm the heart and the cardiovascular system, predispose to atrial fibrillation (AF), and may be best avoided especially in middle-aged and older individuals. [12][13][14][15][16][17][18][19][20][21][22][23][24] We describe four individuals, all performing regular endurance sport activity who developed AF, and discuss the current treatment options.…”

New Perspectives on Risk Stratification and Treatment in Patients with Atrial Fibrillation: An Analysis of Recent Contributions on the Journal of Cardiovascular Disease and Development

“…Several basic-science studies have investigated the micro-structural LA reproductions and the applicability of the new modality of catheter ablation in respect of such LA alterations [ 27 , 28 , 29 , 30 ]. The fetal AF theory was highlighted in some valuable papers enforcing the concept of the influence in AF predisposition both from the ambient, behaviour and lifestyle [ 31 , 32 , 33 ] and from the embryogenesis [ 34 , 35 , 36 ]/genetic pabulum [ 37 ].…”