Heart, Lung and Circulation

Exercise—Is it Possible to Have Too Much of a Good Thing?

      The graded benefit of exercise on cardiovascular risk is well established. Observational studies have, however, focused on mild to moderate levels of activity. In Australia, in excess of 30% of the adult population exercise in excess of the upper range as studied in the literature. There is limited evidence as to whether the risk/benefit ratio is maintained in those participating in regular intense exercise. Case reports and circumstantial evidence raise the possibility that more extreme exercise may have some detrimental effects. In effect, exercise may have a typical dose–response curve with a plateau or even toxicity at more extreme levels. Given the increasing popularity of endurance sporting pursuits, there is a need for further research into the cardiac adaptations and consequences of extreme habitual exercise.


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        • Williams P.T.
        High-density lipoprotein cholesterol and other risk factors for coronary heart disease in female runners.
        New Engl J Med. 1996; 334: 1298-1303
        • King A.C.
        • Haskell W.L.
        • Young D.R.
        • Oka R.K.
        • Stefanick M.L.
        Long-term effects of varying intensities and formats of physical activity on participation rates, fitness, and lipoproteins in men and women aged 50 to 65 years.
        Circulation. 1995; 91: 2596-2604
        • Fagard R.H.
        The role of exercise in blood pressure control: supportive evidence.
        J Hypertens. 1995; 13: 1223-1227
        • Mayer-Davis E.J.
        • D’Agostino Jr., R.
        • Karter A.J.
        • Haffner S.M.
        • Rewers M.J.
        • Saad M.
        • Bergman R.N.
        Intensity and amount of physical activity in relation to insulin sensitivity: the insulin resistance atherosclerosis study.
        JAMA. 1998; 279: 669-674
        • Hu F.B.
        • Sigal R.J.
        • Rich-Edwards J.W.
        • Colditz G.A.
        • Solomon C.G.
        • Willett W.C.
        • Speizer F.E.
        • Manson J.E.
        Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study.
        JAMA. 1999; 282: 1433-1439
        • Yusuf S.
        • Hawken S.
        • Ounpuu S.
        • Dans T.
        • Avezum A.
        • Lanas F.
        • McQueen M.
        • Budaj A.
        • Pais P.
        • Varigos J.
        • Lisheng L.
        Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study.
        Lancet. 2004; 364: 937-952
        • Tanasescu M.
        • Leitzmann M.F.
        • Rimm E.B.
        • Willett W.C.
        • Stampfer M.J.
        • Hu F.B.
        Exercise type and intensity in relation to coronary heart disease in men.
        JAMA. 2002; 288: 1994-2000
        • Sesso H.D.
        • Paffenbarger Jr., R.S.
        • Lee I.M.
        Physical activity and coronary heart disease in men: the Harvard alumni health study.
        Circulation. 2000; 102: 975-980
        • Marcus B.H.
        • Albrecht A.E.
        • King T.K.
        • Parisi A.F.
        • Pinto B.M.
        • Roberts M.
        • Niaura R.S.
        • Abrams D.B.
        The efficacy of exercise as an aid for smoking cessation in women: a randomized controlled trial.
        Arch Intern Med. 1999; 159: 1229-1234
        • Penninx B.W.
        • Messier S.P.
        • Rejeski W.J.
        • Williamson J.D.
        • DiBari M.
        • Cavazzini C.
        • Applegate W.B.
        • Pahor M.
        Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis.
        Arch Intern Med. 2001; 161: 2309-2316
        • McTiernan A.
        • Kooperberg C.
        • White E.
        • Wilcox S.
        • Coates R.
        • Adams-Campbell L.L.
        • Woods N.
        • Ockene J.
        Recreational physical activity and the risk of breast cancer in postmenopausal women: the women's health initiative cohort study.
        JAMA. 2003; 290: 1331-1336
        • Michaud D.S.
        • Giovannucci E.
        • Willett W.C.
        • Colditz G.A.
        • Stampfer M.J.
        • Fuchs C.S.
        Physical activity, obesity, height, and the risk of pancreatic cancer.
        JAMA. 2001; 286: 921-929
      1. Participation in exercise, recreation and sport survey 2004 annual report: Australian Sports Commission, Australian Government; 2005:1–64.

      2. La Gerche A, Connelly KA, Mooney DJ, MacIsaac AI, Prior DL. Biochemical and functional abnormalities of left and right ventricular function following ultra-endurance exercise. Heart; in press.

        • Gyimes Z.
        • Pavlik G.
        • Simor T.
        Morphological and functional differences in cardiac parameters between power and endurance athletes: a magnetic resonance imaging study.
        Acta Physiol Hung. 2004; 91: 49-57
        • Pluim B.M.
        • Lamb H.J.
        • Kayser H.W.
        • Leujes F.
        • Beyerbacht H.P.
        • Zwinderman A.H.
        • van der Laarse A.
        • Vliegen H.W.
        • de Roos A.
        • van der Wall E.E.
        Functional and metabolic evaluation of the athlete's heart by magnetic resonance imaging and dobutamine stress magnetic resonance spectroscopy.
        Circulation. 1998; 97: 666-672
        • Pluim B.M.
        • Zwinderman A.H.
        • van der Laarse A.
        • van der Wall E.E.
        The athlete's heart. A meta-analysis of cardiac structure and function.
        Circulation. 2000; 101: 336-344
        • Pelliccia A.
        • Maron B.J.
        • Di Paolo F.M.
        • Biffi A.
        • Quattrini F.M.
        • Pisicchio C.
        • Roselli A.
        • Caselli S.
        • Culasso F.
        Prevalence and clinical significance of left atrial remodeling in competitive athletes.
        J Am Coll Cardiol. 2005; 46: 690-696
        • Yakovlev N.N.
        • Kaledin S.V.
        • Krasnova A.F.
        • Leshkevich L.G.
        • Popova N.K.
        • Rogozkin V.A.
        • Chagovets N.R.
        • Kostygova L.A.
        Physiological and chemical adaptation to muscular activity in relation to length of rest periods between exertions during training.
        Fiziol Zh SSSR Im I M Sechenova. 1961; 47: 56-59
        • Yakovlev N.N.
        Biochemistry of sport in the Soviet Union: beginning, development, and present status.
        Med Sci Sports. 1975; 7: 237-247
        • Chen Y.
        • Serfass R.C.
        • Mackey-Bojack S.M.
        • Kelly K.L.
        • Titus J.L.
        • Apple F.S.
        Cardiac troponin T alterations in myocardium and serum of rats after stressful, prolonged intense exercise.
        J Appl Physiol. 2000; 88: 1749-1755
        • Kiryu K.
        • Machida N.
        • Kashida Y.
        • Yoshihara T.
        • Amada A.
        • Yamamoto T.
        Pathologic and electrocardiographic findings in sudden cardiac death in racehorses.
        J Vet Med Sci. 1999; 61: 921-928
        • Ludmerer K.M.
        • Kissane G.M.
        Clinico-pathologic conference: sudden death in 47 year old marathon runner.
        Am J Med. 1984; 76: 517-526
        • Elosua R.
        • Arquer A.
        • Mont L.
        • Sambola A.
        • Molina L.
        • Garcia-Moran E.
        • Brugada J.
        • Marrugat J.
        Sport practice and the risk of lone atrial fibrillation: a case-control study.
        Int J Cardiol. 2006; 108: 332-337
        • Karjalainen J.
        • Kujala U.M.
        • Kaprio J.
        • Sarna S.
        • Viitasalo M.
        Lone atrial fibrillation in vigorously exercising middle aged men: case-control study.
        BMJ. 1998; 316: 1784-1785
        • Corrado D.
        • Basso C.
        • Rizzoli G.
        • Schiavon M.
        • Thiene G.
        Does sports activity enhance the risk of sudden death in adolescents and young adults?.
        J Am Coll Cardiol. 2003; 42: 1959-1963
        • Heidbuchel H.
        • Hoogsteen J.
        • Fagard R.
        • Vanhees L.
        • Ector H.
        • Willems R.
        • Van Lierde J.
        High prevalence of right ventricular involvement in endurance athletes with ventricular arrhythmias. Role of an electrophysiologic study in risk stratification.
        Eur Heart J. 2003; 24: 1473-1480