Can Intensive Exercise Harm the Heart?

Gerche, André La; Heidbüchel, Hein

doi:10.1161/circulationaha.114.008141

Cited by 113 publications

(24 citation statements)

References 88 publications

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“…Therefore, our observed association between pro-inflammatory cytokines and exercise-induced RV dysfunction may be of significance. Such changes could be consistent with the hypothesis of greater RV wall stress during exercise inducing RV dysfunction via an inflammatory process [6]. …”

Section: Discussionsupporting

confidence: 87%

“…Moderate exercise is associated with improved health outcomes and it has been argued that anti-inflammatory cytokines such as Interleukins 6, 8 and 10 (IL-6, IL-8 and IL-10) may potentiate some of these benefits [5]. The benefits of more extreme bouts of intense prolonged exercise are less established [6] and the inflammatory response may also differ from that of mild/ moderate exercise [1, 3, 7] In animal models, a single bout of extreme exercise was shown to elicit myocardial damage associated with acute inflammatory myocardial infiltrates [8]. More recently, Benito et al observed an increase in inflammatory and pro-fibrotic markers in the atria and right ventricle of rats following 16 weeks of intense physical training which was associated with a greater propensity to ventricular arrhythmias [9].…”

Section: Introductionmentioning

confidence: 99%

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Relationship between Inflammatory Cytokines and Indices of Cardiac Dysfunction following Intense Endurance Exercise

et al. 2015

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ObjectivesPro-inflammatory cytokines have been noted to increase following exercise but their relationship to exercise-induced cardiac dysfunction has not previously been investigated. We sought to evaluate whether exercise-induced cardiac dysfunction was associated with increases in cytokines, particularly the pro-inflammatory cytokines IL-1β, IL-12p70 and TNFα, which have been most implicated in cardiac pathology.Methods40 well-trained endurance athletes underwent evaluation prior to and immediately following one of four endurance sporting events ranging from 3 to 11 hours duration. Cytokines (IL-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were analyzed by flow cytometry from serum samples collected within 50 minutes of race completion. Cardiac troponin (cTnI) and B-type natriuretic peptide were combined with an echocardiographic assessment of cardiac function, and a composite of cTnI > 0.04 μg/L, BNP increase > 10 ng/L and a decrease in right ventricular ejection (RVEF) > 10% were prospectively defined as evidence of myocardial dysfunction.ResultsRelative to baseline, IL-6 IL-8 and IL-10 increased 8.5-, 2.9-, and 7.1-fold, respectively, P<0.0001. Thirty-one (78%), 19 (48%) and 18 (45%) of the athletes met the pre-specified criteria for significant cTnI, BNP and RVEF changes, respectively. TNFα, IL-12p70 were univariate predictors of ΔRVEF and ΔBNP whilst none of the anti-inflammatory cytokines were significantly associated with these measures. Ten athletes (25%, all athletes competing in the endurance event of longest duration) met criteria for exercise-induced myocardial dysfunction. In these 10 athletes with myocardial dysfunction, as compared to those without, there was significantly greater post-race expression of the pro-inflammatory cytokines IL-12p70 (8.1±3.8pg/ml vs. 2.5±2.6pg/ml, P<0.0001) and TNFα (6.5±3.1pg/ml vs. 2.0±2.5pg/ml, P<0.0001).ConclusionCardiac dysfunction following intense endurance exercise was associated with increased expression of pro-inflammatory cytokines. This does not prove a causal relationship but provides rationale for further investigations into whether inflammation mediates exercise-induced myocardial dysfunction.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Relationship between Inflammatory Cytokines and Indices of Cardiac Dysfunction following Intense Endurance Exercise

et al. 2015

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“…-remains a topic plagued by considerable uncertainty and thus fertile grounds for active debate. 4,5 Recently, the right ventricle (RV) has assumed a prominent place in this dialogue. Under resting conditions, the RV does less work than the left ventricle (LV) to generate matched stroke volumes because of the relatively low afterload imparted by the pulmonary vasculature.…”

Section: Article See P 1927mentioning

confidence: 99%

Endurance Exercise and the Right Ventricle

Wasfy

Baggish

2016

Circulation

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“…1 Drs Scott and Haykowsky argue that we did not adequately address exercise dose as defined by both duration and intensity. We believe that this critique may be reasonably leveled at the entire field of exercise cardiology in which there is no standard definition of what constitutes an athlete, intense exercise, or endurance exercise.…”

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confidence: 99%

“…We thank them for highlighting the fact that intense exercise can serve as a trigger of cardiac events in persons with underlying atherosclerotic coronary disease. In our article, 1 we discussed the controversial and unproven causal relationship between exercise-induced cardiac remodeling and predisposition to arrhythmias such as atrial fibrillation and ventricular arrhythmias. As a very important but different clinical question, Möhlenkamp et al investigated subclinical coronary vessel disease in middle-aged exercise enthusiasts who had relatively recently taken up marathon running.…”

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confidence: 99%

Response to Letters Regarding Article, “Can Intensive Exercise Harm the Heart? You Can Get Too Much of a Good Thing”

Gerche

Heidbüchel

2015

Circulation

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We thank our colleagues for their interest in our article pertaining to the controversial topic of whether intense exercise can cause cardiac injury.1 Drs Scott and Haykowsky argue that we did not adequately address exercise dose as defined by both duration and intensity. We believe that this critique may be reasonably leveled at the entire field of exercise cardiology in which there is no standard definition of what constitutes an athlete, intense exercise, or endurance exercise. For example, we have previously noted that the definition of intense exercise used in the cardiology literature (10 metabolic equivalents or 35 mL·min −1 ·kg −1 oxygen utilization) would be regarded as a warm-up for many competitive athletes.2 This has led to considerable confusion in discussions of the health benefits of high-level exercise. Until we devise some standard reference of exercise quantification, we will continue to lump recreational exercise enthusiasts and professional athletes under nonspecific umbrella terms when the amount of exercise, extent of cardiac remodeling, and related health consequences may be quite different. In the words of Paracelsus referred to by Scott and Haykowsky, we cannot attempt to discriminate between the "the right dose [which] differentiates a poison and a remedy" if we do not even know how to measure the dose. We would support a peer group discussion aimed at establishing clearer definitions of exercise quantification so that we can approach this expanding field of scientific discovery with greater clarity.Dr Möhlenkamp and colleagues highlight another interaction between intense exercise and cardiac health that we did not address. We thank them for highlighting the fact that intense exercise can serve as a trigger of cardiac events in persons with underlying atherosclerotic coronary disease. In our article, 1 we discussed the controversial and unproven causal relationship between exercise-induced cardiac remodeling and predisposition to arrhythmias such as atrial fibrillation and ventricular arrhythmias. As a very important but different clinical question, Möhlenkamp et al investigated subclinical coronary vessel disease in middle-aged exercise enthusiasts who had relatively recently taken up marathon running. They studied 108 subjects who were >50 years of age (mean age, 57 years) and had started marathon training within the preceding decade.3 More than half of the subjects were previous smokers, their body mass indexes were in the upper end of the healthy range, and their exercise training volume was relatively modest compared with that proposed to cause cardiac remodeling. Therefore, it was perhaps not surprising that Möhlenkamp et al identified an incidence of coronary vessel disease approximating that of the general population. For reasons that remain unexplained, they also found more prevalent myocardial fibrosis. Their study design does not address the causal question, that is, whether intense exercise prevents or promotes atherosclerotic heart disease. This would require a study of in...

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Can Intensive Exercise Harm the Heart?

Cited by 113 publications

References 88 publications

Relationship between Inflammatory Cytokines and Indices of Cardiac Dysfunction following Intense Endurance Exercise

Relationship between Inflammatory Cytokines and Indices of Cardiac Dysfunction following Intense Endurance Exercise

Endurance Exercise and the Right Ventricle

Response to Letters Regarding Article, “Can Intensive Exercise Harm the Heart? You Can Get Too Much of a Good Thing”

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