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Ausdauersport und kardiale Schädigung – eine kritische Analyse

Endurance sports and cardiac injury: a critical analysis

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Zusammenfassung

Hintergrund

Seit Jahren gibt es immer wieder Berichte über eine mögliche links- oder rechtsventrikuläre Schädigung des Herzens durch intensive Sportaktivität. Auch die Todesfälle während des Marathons, beim Fußball wie auch neuerdings in der Modedisziplin Triathlon scheinen diesen Berichten Recht zu geben. Artikel über das sog. Sportlerherz und Komplikationen im Alter beunruhigen Ausdauersportler, deren Betreuer und viele, die sich durch Sport eine Gewichtsabnahme, eine Verbesserung des Diabetes mellitus oder auch die Verbesserung der allgemeinen Fitness versprechen.

Methoden

Es wird ein Überblick über Physiologie des Sportlerherzens gegeben. Der sportbedingte plötzliche Herztod (PHT) wird besprochen und es werden Studien zum Thema der Schädigung des rechten und des linken Ventrikels diskutiert. Anschließend werden die sportbedingten Herzerkrankungen im Alter und die Prognose des Sportlers im Alter analysiert.

Ergebnisse

Die jungen Sportler sterben 5-mal häufiger als Nichtsportler beim Sport. Kardiale Schädigungen im Alter (v. a. Herzrhythmusstörungen) sind beim Sportler möglich, auch wenn (nur) Ausdauersportler im Durchschnitt länger zu leben scheinen.

Schlussfolgerungen

Die lebensverlängernde und positive Wirkung des moderaten Sports steht nicht zur Diskussion, der Wettkampfsport kann jedoch negative Auswirkungen haben. Das Ausmaß der „negativen Sportsdosis“ ist unbekannt, aber der tägliche Verbrauch von ca. 490 kcal/Tag durch Bewegung im aeroben Bereich und adäquates Screening der persönlichen Disposition/Risiken stellen klare Empfehlungen dar, um den PHT und sonstige negative Auswirkungen des Sports zu vermeiden.

Abstract

Background

The potential for left- or right-ventricular injury induced by intensive sporting activities has been continually reported for years. The spectacular sudden deaths that occur during marathons, football, soccer, and, more recently, in the trend discipline triathlons seem to support that view. In addition, reports about the “athlete’s heart” and complications in the elderly causes uncertainty among endurance athletes and their coaches as well as those, hoping that sporting activity will lead to weight reduction or will improve diabetes or general fitness.

Methods

This article provides an overview of the physiology of the athlete’s heart. Sudden cardiac death (SCD) caused by sporting activity and studies on the topic of left- and right-ventricular injury are discussed. This is followed by an analysis of sports-related heart diseases in the elderly and of the prognosis of the older athletes.

Results

Young athletes die during sporting activity five times more often compared with non-athletes. Cardiac injuries in the elderly (primarily cardiac arrhythmias) may occur in athletes, even if (only) endurance athletes seem to live longer on average.

Conclusion

The life prolonging and positive effect of moderate sporting activity is not up for discussion, but competitive sports may have negative effects. The extent of the “negative dosage of sport” is unknown; however, a daily expenditure of 490 kcal by physical activity in the aerobic zone and adequate screening of the personal disposition/risks are clear recommendations for avoiding SCD and other negative effects of sporting activity.

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  1. Dept. für Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Elberfelder Str.1, 58095, Hagen, Deutschland

    Roman Leischik

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Leischik, R. Ausdauersport und kardiale Schädigung – eine kritische Analyse. Präv Gesundheitsf 10, 79–87 (2015). https://doi.org/10.1007/s11553-014-0476-8

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