Prospective evaluation of cardiac effects of first-time marathon training, running, and recovery in middle-aged men: cohort study rationale and design

Abstract

Background Several phenomena may point to potentially detrimental cardiac effects of endurance exercise, such as elevated circulating cardiac troponin levels and reductions in systolic and diastolic function directly after marathon completion. Furthermore, while myocardial abnormalities have been reported in patients who recovered from COVID-19, the cardiac impact of extensive endurance exercise in individuals who recovered from COVID-19 remains unknown. We therefore aim to investigate (potentially detrimental) cardiac effects of first-time marathon training and participation, including a subset of participants who recovered from COVID-19, in apparently healthy middle-aged men. Study design This exploratory prospective cohort study investigates cardiac effects of first-time marathon running in 24 middle-aged (35–50 years) healthy men. Primary outcomes are cardiac morphological changes from pre-training up to 1 month after marathon completion, measured with magnetic resonance imaging (MRI) at 4 time points: 1) baseline (4 months before the marathon), 2) pre-marathon (2 weeks before the marathon), 3) post-marathon (< 24 h post-marathon), and 4) recovery (4 weeks after the marathon). Secondary parameters include other cardiac or non-cardiac changes: 1) quantitative MRI myocardial mapping, including mean diffusivity and extracellular volume fraction, 2) echocardiographic morphology and function changes, 3) VO2max, 4) electrocardiogram changes, and 5) levels of cardiac biomarkers. Discussion This study will contribute to our understanding of cardiac adaptations and maladaptations to first-time marathon running in middle-aged men, and the interaction between extreme endurance exercise and potential detrimental cardiac effects, also in the context of COVID-19. Results will inform on future research directions while providing new clinical insights for health professionals involved in athlete care.

Pre-Participation Screenings Frequently Miss Occult Cardiovascular Conditions in Apparently Healthy Male Middle-Aged First-Time Marathon Runners

“…Our current analysis of pre-participation screening was conducted within the framework of a study that investigated the effects of first-time marathon running in men aged 35–50 years [ 13 ]. We recruited participants who responded to announcements made through the Amsterdam University Medical Centers’ newsletter, local newspapers, social media, and the Marathon organiser’s website.…”

“…We recruited participants who responded to announcements made through the Amsterdam University Medical Centers’ newsletter, local newspapers, social media, and the Marathon organiser’s website. After confirming eligibility, an online screening subsequently took place wherein potential participants could reconfirm their interest, and were given general information about the study and inclusion and exclusion criteria [ 13 ] and what informed consent would entail. After giving informed consent, participants in the 2021 Amsterdam Marathon study underwent extensive testing at baseline, pre-marathon (after 4 months of training), directly post-marathon, and after 1 month of recovery.…”

“…We applied the ACSM and ESC pre-participation screenings to the participants’ baseline data. As outlined in the study design [ 13 ], the ACSM algorithm was applied before inclusion, while the ESC algorithm score was calculated post hoc. In short, the ACSM pre-participation screening for individuals aged 18–65 is based on (1) exercise participation 3 months prior and (2) cardiovascular, metabolic, or renal disease history/symptoms [ 8 ].…”

“…We therefore pragmatically compared ACSM and ESC pre-participation screening outcomes against baseline findings from our 2021 Amsterdam Marathon study [ 13 ] comprising comprehensive cardiovascular evaluations and the consequent sports advice in a rigorously investigated cohort of middle-aged men participating in their first marathon. The current work reports findings from the baseline measurements of our study population and the clinical implications of our findings.…”