Strenuous Endurance Exercise and the Heart: Physiological versus Pathological Adaptations

Volume 12

Issue 4. October 2022

Pedro L. Valenzuela,

Pedro L. Valenzuela

orcid.org/0000-0003-1730-3369

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

Correspondence to [email protected]Search for more papers by this author

Aaron Baggish,

Aaron Baggish

Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA

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Adrián Castillo-García,

Adrián Castillo-García

Fissac – Physiology, Health and Physical Activity, Madrid, Spain

Biology Systems Department, University of Alcalá, Madrid, Spain

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Alejandro Santos-Lozano,

Alejandro Santos-Lozano

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain

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Araceli Boraita,

Araceli Boraita

Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain

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Alejandro Lucia,

Alejandro Lucia

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain

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Pedro L. Valenzuela,

Pedro L. Valenzuela

orcid.org/0000-0003-1730-3369

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

Correspondence to [email protected]Search for more papers by this author

Aaron Baggish,

Aaron Baggish

Cardiovascular Performance Program, Massachusetts General Hospital, Boston, Massachusetts, USA

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Adrián Castillo-García,

Adrián Castillo-García

Fissac – Physiology, Health and Physical Activity, Madrid, Spain

Biology Systems Department, University of Alcalá, Madrid, Spain

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Alejandro Santos-Lozano,

Alejandro Santos-Lozano

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

i+HeALTH, European University Miguel de Cervantes, Valladolid, Spain

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Araceli Boraita,

Araceli Boraita

Department of Cardiology, Sports Medicine Center, Spanish Agency for Health Protection in Sports, Madrid, Spain

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Alejandro Lucia,

Alejandro Lucia

Physical Activity and Health Research Group (‘PaHerg’), Research Institute of the Hospital 12 de Octubre (‘imas12’), Madrid, Spain

Faculty of Sport Sciences, Universidad Europea de Madrid, Madrid, Spain

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https://doi.org/10.1002/cphy.c210045

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Abstract

Although the benefits of regular physical activity on cardiovascular health are well established, the effects of strenuous endurance exercise (SEE) have been a matter of debate since ancient times. In this article, we aim to provide a balanced overview of what is known about SEE and the heart—from epidemiological evidence to recent cardiac imaging findings. Lifelong SEE is overall cardioprotective, with endurance master athletes showing in fact a youthful heart. Yet, some lines of research remain open, such as the need to elucidate the time-course and potential relevance of transient declines in heart function (or increases in biomarkers of cardiac injury) with SEE. The underlying mechanisms and clinical relevance of SEE-associated atrial fibrillation, myocardial fibrosis, or high coronary artery calcium scores also remain to be elucidated. © 2022 American Physiological Society. Compr Physiol 12: 4067–4085, 2022.

References

1Abdullah SM, Barkley KW, Bhella PS, Hastings JL, Matulevicius S, Fujimoto N, Shibata S, Carrick-Ranson G, Palmer MD, Gandhi N, Defina LF, Levine BD. Lifelong physical activity regardless of dose is not associated with myocardial fibrosis. Circ Cardiovasc Imaging 9: 1-7, 2016.
10.1161/CIRCIMAGING.116.005511
CASWeb of Science®Google Scholar
2Aengevaeren VL, Hopman MTE, Thompson PD, Bakker EA, George KP, Thijssen DHJ, Eijsvogels TMH. Exercise-induced cardiac troponin I increase and incident mortality and cardiovascular events. Circulation 140: 804-814, 2019.
10.1161/CIRCULATIONAHA.119.041627
PubMedWeb of Science®Google Scholar
3Aengevaeren VL, Mosterd A, Braber TL, Prakken NHJ, Doevendans PA, Grobbee DE, Thompson PD, Eijsvogels TMH, Velthuis BK. Relationship between lifelong exercise volume and coronary atherosclerosis in athletes. Circulation 136: 138-148, 2017.
10.1161/CIRCULATIONAHA.117.027834
CASPubMedWeb of Science®Google Scholar
4Andersen K, Farahmand B, Ahlbom A, Held C, Ljunghall S, Michaëlsson K, Sundström J. Risk of arrhythmias in 52 755 long-distance cross-country skiers: A cohort study. Eur Heart J 34: 3624-3631, 2013.
10.1093/eurheartj/eht188
PubMedWeb of Science®Google Scholar
5Antero J, Tanaka H, De Larochelambert Q, Pohar-Perme M, Toussaint JF. Female and male US Olympic athletes live 5 years longer than their general population counterparts: A study of 8124 former US Olympians. Br J Sports Med 55 (4): 206-212, 2021.
10.1136/bjsports-2019-101696
PubMedWeb of Science®Google Scholar
6Antero-Jacquemin J, Desgorces FD, Dor F, Sedeaud A, Haïda A, LeVan P, Toussaint JF. Row for your life: A century of mortality follow-up of French olympic rowers. PLoS One 9: 1-5, 2014.
10.1371/journal.pone.0113362
Web of Science®Google Scholar
7Antero-Jacquemin J, Rey G, Marc A, Dor F, Haïda A, Marck A, Berthelot G, Calmat A, Latouche A, Toussaint JF. Mortality in female and male French olympians: A 1948-2013 cohort study. Am J Sports Med 43: 1505-1512, 2015.
10.1177/0363546515574691
PubMedWeb of Science®Google Scholar
8Arbab-Zadeh A, Dijk E, Prasad A, Fu Q, Torres P, Zhang R, Thomas JD, Palmer D, Levine BD. Effect of aging and physical activity on left ventricular compliance. Circulation 110: 1799-1805, 2004.
10.1161/01.CIR.0000142863.71285.74
PubMedWeb of Science®Google Scholar
9Arem H, Moore SC, Patel A, Hartge P, Berrington De Gonzalez A, Visvanathan K, Campbell PT, Freedman M, Weiderpass E, Adami HO, Linet MS, Lee IM, Matthews CE. Leisure time physical activity and mortality: A detailed pooled analysis of the dose-response relationship. JAMA Intern Med 175: 959-967, 2015.
10.1001/jamainternmed.2015.0533
PubMedWeb of Science®Google Scholar
10Armstrong MEG, Green J, Reeves GK, Beral V, Cairns BJ. Frequent physical activity may not reduce vascular disease risk as much as moderate activity: Large prospective study of women in the United Kingdom. Circulation 131: 721-729, 2015.
10.1161/CIRCULATIONAHA.114.010296
CASPubMedWeb of Science®Google Scholar
11Ashor AW, Lara J, Siervo M, Celis-Morales C, Oggioni C, Jakovljevic DG, Mathers JC. Exercise modalities and endothelial function: A systematic review and dose–response meta-analysis of randomized controlled trials. Sports Med 45: 279-296, 2015.
10.1007/s40279-014-0272-9
PubMedWeb of Science®Google Scholar
12Aune D, Schlesinger S, Hamer M, Norat T, Riboli E. Physical activity and the risk of sudden cardiac death: A systematic review and meta-analysis of prospective studies. BMC Cardiovasc Disord 20: 318, 2020.
10.1186/s12872-020-01531-z
PubMedWeb of Science®Google Scholar
13Baggish AL. Focal fibrosis in the endurance athlete's heart: Running scarred or running scared? JACC Cardiovasc Imaging 11: 1271-1273, 2018.
10.1016/j.jcmg.2017.09.015
PubMedWeb of Science®Google Scholar
14Baggish AL, Wood MJ. Athlete's heart and cardiovascular care of the athlete: Scientific and clinical update. Circulation 123: 2723-2735, 2011.
10.1161/CIRCULATIONAHA.110.981571
PubMedWeb of Science®Google Scholar
15Baldesberger S, Bauersfeld U, Candinas R, Seifert B, Zuber M, Ritter M, Jenni R, Oechslin E, Luthi P, Scharf C, Marti B, Attenhofer Jost CH. Sinus node disease and arrhythmias in the long-term follow-up of former professional cyclists. Eur Heart J 29: 71-78, 2008.
10.1093/eurheartj/ehm555
PubMedWeb of Science®Google Scholar
16Bamberg F, Sommer WH, Hoffmann V, Achenbach S, Nikolaou K, Conen D, Reiser MF, Hoffmann U, Becker CR. Meta-analysis and systematic review of the long-term predictive value of assessment of coronary atherosclerosis by contrast-enhanced coronary computed tomography angiography. J Am Coll Cardiol 57: 2426-2436, 2011.
10.1016/j.jacc.2010.12.043
PubMedWeb of Science®Google Scholar
17Benito B, Gay-Jordi G, Serrano-Mollar A, Guasch E, Shi Y, Tardif JC, Brugada J, Nattel S, Mont L. Cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training. Circulation 123: 13-22, 2011.
10.1161/CIRCULATIONAHA.110.938282
PubMedWeb of Science®Google Scholar
18Bhella PS, Hastings JL, Fujimoto N, Shibata S, Carrick-Ranson G, Palmer MD, Boyd KN, Adams-Huet B, Levine BD. Impact of lifelong exercise “dose” on left ventricular compliance and distensibility. J Am Coll Cardiol 64: 1257-1266, 2014.
10.1016/j.jacc.2014.03.062
PubMedWeb of Science®Google Scholar
19Biffi A, Maron BJ, Verdile L, Fernando F, Spataro A, Marcello G, Ciardo R, Ammirati F, Colivicchi F, Pelliccia A. Impact of physical deconditioning on ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 44: 1053-1058, 2004.
10.1016/j.jacc.2004.05.065
PubMedWeb of Science®Google Scholar
20Biffi A, Pelliccia A, Verdile L, Fernando F, Spataro A, Caselli S, Santini M, Maron BJ. Long-term clinical significance of frequent and complex ventricular tachyarrhythmias in trained athletes. J Am Coll Cardiol 40: 446-452, 2002.
10.1016/S0735-1097(02)01977-0
PubMedWeb of Science®Google Scholar
21Billman GE. Cardiac autonomic neural remodeling and susceptibility to sudden cardiac death: Effect of endurance exercise training. Am J Physiol Heart Circ Physiol 297: H1171-H1193, 2009.
10.1152/ajpheart.00534.2009
CASPubMedWeb of Science®Google Scholar
22Bohm P, Schneider G, Linneweber L, Rentzsch A, Krämer N, Abdul-Khaliq H, Kindermann W, Meyer T, Scharhag J. Right and left ventricular function and mass in male elite master athletes: A controlled contrast-enhanced cardiovascular magnetic resonance study. Circulation 133: 1927-1935, 2016.
10.1161/CIRCULATIONAHA.115.020975
PubMedWeb of Science®Google Scholar
23Boraita A, Heras ME, Morales F, Marina-Breysse M, Canda A, Rabadan M, Barriopedro MI, Varela A, De La Rosa A, Tuñón J. Reference values of aortic root in male and female white elite athletes according to sport. Circ Cardiovasc Imaging 9: 1-10, 2016.
10.1161/CIRCIMAGING.116.005292
Web of Science®Google Scholar
24Boraita A, Sánchez-Testal MV, Diaz-Gonzalez L, Heras ME, Alcocer-Ayuga M, de la Rosa A, Rabadán M, Abdul-Jalbar B, Pérez de Isla L, Santos-Lozano A, Lucia A. Apparent ventricular dysfunction in elite young athletes: Another form of cardiac adaptation of the athlete's heart. J Am Soc Echocardiogr 32: 987-996, 2019.
10.1016/j.echo.2019.03.017
PubMedWeb of Science®Google Scholar
25Boraita A, Santos-Lozano A, Heras ME, González-Amigo F, López-Ortiz S, Villacastín JP, Lucia A. Incidence of atrial fibrillation in elite athletes. JAMA Cardiol 3: 1200-1205, 2018.
10.1001/jamacardio.2018.3482
PubMedWeb of Science®Google Scholar
26Braber TL, Mosterd A, Prakken NH, Rienks R, Nathoe HM, Mali WP, Doevendans PA, Backx FJ, Bots ML, Grobbee DE, Velthuis BK. Occult coronary artery disease in middle-aged sportsmen with a low cardiovascular risk score: The Measuring Athlete's Risk of Cardiovascular Events (MARC) study. Eur J Prev Cardiol 23: 1677-1684, 2016.
10.1177/2047487316651825
PubMedWeb of Science®Google Scholar
27Bramble DM, Lieberman DE. Endurance running and the evolution of Homo. Nature 432: 345-352, 2004.
10.1038/nature03052
CASPubMedWeb of Science®Google Scholar
28Breuckmann F, Möhlenkamp S, Nassenstein K, Lehmann N, Ladd S, Schmermund A, Sievers B, Schlosser T, Jöckel KH, Heusch G, Erbel R, Barkhausen J. Myocardial late gadolinium enhancement: Prevalence, pattern, and prognostic relevance in marathon runners. Radiology 251: 50-57, 2009.
10.1148/radiol.2511081118
PubMedWeb of Science®Google Scholar
29Carrick-Ranson G, Hastings JL, Bhella PS, Fujimoto N, Shibata S, Palmer MD, Boyd K, Livingston S, Dijk E, Levine BD. The effect of lifelong exercise dose on cardiovascular function during exercise. J Appl Physiol 116: 736-745, 2014.
10.1152/japplphysiol.00342.2013
CASPubMedWeb of Science®Google Scholar
30Caselli S, Maron MS, Urbano-Moral JA, Pandian NG, Maron BJ, Pelliccia A. Differentiating left ventricular hypertrophy in athletes from that in patients with hypertrophic cardiomyopathy. Am J Cardiol 114: 1383-1389, 2014.
10.1016/j.amjcard.2014.07.070
PubMedWeb of Science®Google Scholar
31Churchill TW, Groezinger E, Kim JH, Loomer G, Guseh JS, Wasfy MM, Isselbacher EM, Lewis GD, Weiner RB, Schmied C, Baggish AL. Association of ascending aortic dilatation and long-term endurance exercise among older masters-level athletes. JAMA Cardiol 5: 522-531, 2020.
10.1001/jamacardio.2020.0054
PubMedWeb of Science®Google Scholar
32Claessen G, Claus P, Ghysels S, Vermeersch P, Dymarkowski S, La Gerche A, Heidbuchel H. Right ventricular fatigue developing during endurance exercise: An exercise cardiac magnetic resonance study. Med Sci Sports Exerc 46: 1717-1726, 2014.
10.1249/MSS.0000000000000282
PubMedWeb of Science®Google Scholar
33Coates AM, King TJ, Currie KD, Tremblay JC, Petrick HL, Slysz JT, Pignanelli C, Berard JA, Millar PJ, Burr JF. Alterations in cardiac function following endurance exercise are not duration dependent. Front Physiol 11: 581797, 2020.
10.3389/fphys.2020.581797
PubMedWeb of Science®Google Scholar
34Cordain L, Gotshall RW, Eaton SB, Eaton SB. Physical activity, energy expenditure and fitness: An evolutionary perspective. Int J Sports Med 19: 328-335, 1998.
10.1055/s-2007-971926
CASPubMedWeb of Science®Google Scholar
35Corrado D, Basso C, Pavei A, Michieli P, Schiavon MTG. Trends in sudden cardiovascular death in young competitive athletes. JAMA 296: 1593-1601, 2006.
10.1001/jama.296.13.1593
CASPubMedWeb of Science®Google Scholar
36Corrado 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 42: 1959-1963, 2003.
10.1016/j.jacc.2003.03.002
PubMedWeb of Science®Google Scholar
37Currens JH, White PD. Half a century of running. Clinical, physiologic and autopsy findings in the case of Clarence DeMar (“Mr. Marathon”). N Engl J Med 265: 988-993, 1961.
10.1056/NEJM196111162652006
CASPubMedWeb of Science®Google Scholar
38D'Andrea A, Cocchia R, Riegler L, Salerno G, Scarafile R, Citro R, Vriz O, Limongelli G, Di Salvo G, Caso P, Bossone E, Calabr R, Russo MG. Aortic stiffness and distensibility in top-level athletes. J Am Soc Echocardiogr 25: 561-567, 2012.
10.1016/j.echo.2011.12.021
PubMedWeb of Science®Google Scholar
39D'Andrea A, Limongelli G, Caso P, Sarubbi B, Della Pietra A, Brancaccio P, Cice G, Scherillo M, Limongelli F, Calabrò R. Association between left ventricular structure and cardiac performance during effort in two morphological forms of athlete's heart. Int J Cardiol 86: 177-184, 2002.
10.1016/S0167-5273(02)00194-8
PubMedWeb of Science®Google Scholar
40D'Andrea A, Riegler L, Golia E, Cocchia R, Scarafile R, Salerno G, Pezzullo E, Nunziata L, Citro R, Cuomo S, Caso P, Di Salvo G, Cittadini A, Russo MG, Calabrò R, Bossone E. Range of right heart measurements in top-level athletes: The training impact. Int J Cardiol 164: 48-57, 2013.
10.1016/j.ijcard.2011.06.058
PubMedWeb of Science®Google Scholar
41D'Andrea A, Riegler L, Morra S, Scarafile R, Salerno G, Cocchia R, Golia E, Martone F, Di Salvo G, Limongelli G, Pacileo G, Bossone E, Calabró R, Russo MG. Right ventricular morphology and function in top-level athletes: A three-dimensional echocardiographic study. J Am Soc Echocardiogr 25: 1268-1276, 2012.
10.1016/j.echo.2012.07.020
PubMedWeb of Science®Google Scholar
42D'Souza A, Sharma S, Boyett MR. CrossTalk opposing view: Bradycardia in the trained athlete is attributable to a downregulation of a pacemaker channel in the sinus node. J Physiol 593: 1749-1751, 2015.
10.1113/jphysiol.2014.284356
CASPubMedWeb of Science®Google Scholar
43Darling E. The effects of training: A study of the Harvard University Crews. Bost Med Surg J 141: 205-209, 1899.
10.1056/NEJM189908311410901
Google Scholar
44Defina LF, Radford NB, Barlow CE, Willis BL, Leonard D, Haskell WL, Farrell SW, Pavlovic A, Abel K, Berry JD, Khera A, Levine BD. Association of all-cause and cardiovascular mortality with high levels of physical activity and concurrent coronary artery calcification. JAMA Cardiol 4: 174-181, 2019.
10.1001/jamacardio.2018.4628
PubMedWeb of Science®Google Scholar
45Douglas PS, O'Toole ML, Hiller WD, Hackney K, Reichek N. Cardiac fatigue after prolonged exercise. Circulation 76: 1206-1213, 1987.
10.1161/01.CIR.76.6.1206
CASPubMedWeb of Science®Google Scholar
46Douglas PS, O'Toole ML, Katz SE. Prolonged exercise alters cardiac chronotropic responsiveness in endurance athletes. J Sports Med Phys Fitness 38: 158-163, 1998.

CASPubMedWeb of Science®Google Scholar
47Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Atrial fibrillation is associated with different levels of physical activity levels at different ages in men. Heart 100: 1037-1042, 2014.
10.1136/heartjnl-2013-305304
PubMedWeb of Science®Google Scholar
48Drca N, Wolk A, Jensen-Urstad M, Larsson SC. Physical activity is associated with a reduced risk of atrial fibrillation in middle-aged and elderly women. Heart 101: 1627-1630, 2015.
10.1136/heartjnl-2014-307145
CASPubMedWeb of Science®Google Scholar
49Ector J, Ganame J, Van Der Merwe N, Adriaenssens B, Pison L, Willems R, Gewillig M, Heidbüchel H. Reduced right ventricular ejection fraction in endurance athletes presenting with ventricular arrhythmias: A quantitative angiographic assessment. Eur Heart J 28: 345-353, 2007.
10.1093/eurheartj/ehl468
PubMedWeb of Science®Google Scholar
50Ekelund U, Tarp J, Steene-Johannessen J, Hansen BH, Jefferis B, Fagerland MW, Whincup P, Diaz KM, Hooker SP, Chernofsky A, Larson MG, Spartano N, Vasan RS, Dohrn IM, Hagströmer M, Edwardson C, Yates T, Shiroma E, Anderssen SA, Lee IM. Dose-response associations between accelerometry measured physical activity and sedentary time and all cause mortality: Systematic review and harmonised meta-analysis. BMJ 366: 1-10, 2019.

Google Scholar
51Elliott AD, La Gerche A. The right ventricle following prolonged endurance exercise: Are we overlooking the more important side of the heart? A meta-analysis. Br J Sports Med 49: 724-729, 2015.
10.1136/bjsports-2014-093895
PubMedWeb of Science®Google Scholar
52Fagard R, Van Den Broeke C, Amery A. Left ventricular dynamics during exercise in elite marathon runners. J Am Coll Cardiol 14: 112-118, 1989.
10.1016/0735-1097(89)90060-0
CASPubMedWeb of Science®Google Scholar
53Farahmand BY, Ahlbom A, Ekblom Ö, Ekblom B, Hållmarker U, Aronson D, Persson Brobert G. Mortality amongst participants in Vasaloppet: A classical long-distance ski race in Sweden. J Intern Med 253: 276-283, 2003.
10.1046/j.1365-2796.2003.01122.x
CASPubMedWeb of Science®Google Scholar
54Farrell J, Langan P, Gordon B. Roentgen ray study of group of long-distance runners, with special reference to effects of exercise on size of heart. Am J Med Sci 177: 394, 1929.
10.1097/00000441-192903000-00011
Google Scholar
55Fiuza-Luces C, Garatachea N, Berger NA, Lucia A. Exercise is the real polypill. Physiology 28: 330-358, 2013.
10.1152/physiol.00019.2013
CASPubMedWeb of Science®Google Scholar
56Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza J, Izquierdo M, Ruilope L, Lucia A. Exercise benefits in cardiovascular disease: Beyond attenuating traditional risk factors. Nat Rev Cardiol 15: 731-743, 2018.
10.1038/s41569-018-0065-1
CASPubMedWeb of Science®Google Scholar
57Fiuza-Luces C, Santos-Lozano A, Joyner M, Carrera-Bastos P, Picazo O, Zugaza JL, Izquierdo M, Ruilope LM, Lucia A. Exercise benefits in cardiovascular disease: Beyond attenuation of traditional risk factors. Nat Rev Cardiol 15: 731-743, 2018.
10.1038/s41569-018-0065-1
CASPubMedWeb of Science®Google Scholar
58Fragakis N, Pagourelias ED, Koskinas KC, Vassilikos V. Arrhythmias in athletes: Evidence-based strategies and challenges for diagnosis, management, and sports eligibility. Cardiol Rev 21: 229-238, 2013.
10.1097/CRD.0b013e31827fd9ab
PubMedWeb of Science®Google Scholar
59Franzen E, Mangold S, Erz G, Claussen CD, Niess AM, Kramer U, Burgstahler C. Comparison of morphological and functional adaptations of the heart in highly trained triathletes and long-distance runners using cardiac magnetic resonance imaging. Heart Vessel 28: 626-631, 2013.
10.1007/s00380-012-0289-7
PubMedWeb of Science®Google Scholar
60Franzoni F, Ghiadoni L, Galetta F, Plantinga Y, Lubrano V, Huang Y, Salvetti G, Regoli F, Taddei S, Santoro G, Salvetti A. Physical activity, plasma antioxidant capacity, and endothelium-dependent vasodilation in young and older men. Am J Hypertens 18: 510-516, 2005.
10.1016/j.amjhyper.2004.11.006
CASPubMedWeb of Science®Google Scholar
61Galderisi M, Cardim N, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Edvardsen T, Freitas A, Habib G, Kitsiou A, Plein S, Petersen SE, Popescu BA, Schroeder S, Burgstahler C, Lancellotti P. The multi-modality cardiac imaging approach to the athletés heart: An expert consensus of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16: 353, 2015.
10.1093/ehjci/jeu323
PubMedWeb of Science®Google Scholar
62Gao J, Hao Q, Lu L, Han J, Huang F, Vuitton D, Wang J, Zhang S, Liu P. Associations of long-term physical activity trajectories with coronary artery calcium progression and cardiovascular disease events: Results from the CARDIA study. Br J Sports Med, 2022. DOI: 10.1136/bjsports-2021-105092.
10.1136/bjsports-2021-105092
PubMedWeb of Science®Google Scholar
63Garatachea N, Santos-Lozano A, Sanchis-Gomar F, Pareja-Galeano H, Emanuele E, Lucia A. Elite athletes live longer than the general population: A meta-analysis. Mayo Clin Proc 89: 1195-1200, 2014.
10.1016/j.mayocp.2014.06.004
PubMedWeb of Science®Google Scholar
64Gati S, Malhotra A, Sedgwick C, Papamichael N, Dhutia H, Sharma R, Child AH, Papadakis M, Sharma S. Prevalence and progression of aortic root dilatation in highly trained young athletes. Heart 105: 920-925, 2019.

PubMedWeb of Science®Google Scholar
65Gentry JL, Carruthers D, Joshi PH, Maroules CD, Ayers CR, de Lemos JA, Aagaard P, Hachamovitch R, Desai MY, Roselli EE, Dunn RE, Alexander K, Lincoln AE, Tucker AM, Phelan DM. Ascending aortic dimensions in former national football league athletes. Circ Cardiovasc Imaging 10: 1-7, 2017.
10.1161/CIRCIMAGING.117.006852
Web of Science®Google Scholar
66Gilbert CA, Nutter DO, Felner JM, Perkins JV, Heymsfield SB, Schlant RC. Echocardiographic study of cardiac dimensions and function in the endurance-trained athlete. Am J Cardiol 40: 528-533, 1977.
10.1016/0002-9149(77)90067-4
CASPubMedWeb of Science®Google Scholar
67Green DJ, O'Driscoll G, Joyner MJ, Cable NT. Exercise and cardiovascular risk reduction: Time to update the rationale for exercise? J Appl Physiol 105: 766-768, 2008.
10.1152/japplphysiol.01028.2007
PubMedWeb of Science®Google Scholar
68Gries KJ, Raue U, Perkins RK, Lavin KM, Overstreet BS, D'Acquisto LJ, Graham B, Finch WH, Kaminsky LA, Trappe TA, Trappe S. Cardiovascular and skeletal muscle health with lifelong exercise. J Appl Physiol 125: 1636-1645, 2018.
10.1152/japplphysiol.00174.2018
PubMedWeb of Science®Google Scholar
69Groot H, Rossman M, Garten R, Wang E, Hoff J, Helgerud J, Richadson R. The effect of physical activity on passive leg movement-induced vasodilation with age. Med Sci Sports Exerc 48: 1548-1557, 2016.
10.1249/MSS.0000000000000936
PubMedWeb of Science®Google Scholar
70Gulati A, Jabbour A, Ismail TF, Guha K, Khwaja J, Raza S, Morarji K, Brown TDH, Ismail NA, Dweck MR, Di Pietro E, Roughton M, Wage R, Daryani Y, O'Hanlon R, Sheppard MN, Alpendurada F, Lyon AR, Cook SA, Cowie MR, Assomull RG, Pennell DJ, Prasad SK. Association of fibrosis with mortality and sudden cardiac death in patients with nonischemic dilated cardiomyopathy. JAMA - J Am Med Assoc 309: 896-908, 2013.
10.1001/jama.2013.1363
CASPubMedWeb of Science®Google Scholar
71Gurven M, Jaeggi AV, Kaplan H, Cummings D. Physical activity and modernization among Bolivian Amerindians. PLoS One 8: e55679, 2013.
10.1371/journal.pone.0055679
CASPubMedWeb of Science®Google Scholar
72Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: A pooled analysis of 358 population-based surveys with 1.9 million participants. Lancet Glob Health 6: E1077-E1086, 2018.
10.1016/S2214-109X(18)30357-7
PubMedWeb of Science®Google Scholar
73Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health 4: 23-35, 2020.
10.1016/S2352-4642(19)30323-2
PubMedWeb of Science®Google Scholar
74Hanne-Paparo N, Kellermann J. Long-term Holter ECG monitoring of athletes. Med Sci Sports Exerc 13: 294-298, 1981.
10.1249/00005768-198105000-00004
CASPubMedWeb of Science®Google Scholar
75Harmon KG, Asif IM, Maleszewski JJ, Owens DS, Prutkin JM, Salerno JC, Zigman ML, Ellenbogen R, Rao AL, Ackerman MJ, Drezner JA. Incidence and etiology of sudden cardiac arrest and death in high school athletes in the United States. Mayo Clin Proc 91: 1493-1502, 2016.
10.1016/j.mayocp.2016.07.021
PubMedWeb of Science®Google Scholar
76Haskell WL, Sims C, Myll J, Bortz WM, St. Goar FG, Alderman EL. Coronary artery size and dilating capacity in ultradistance runners. Circulation 87: 1076-1082, 1993.
10.1161/01.CIR.87.4.1076
CASPubMedWeb of Science®Google Scholar
77Haykowsky MJ, Samuel TJ, Nelson MD, La Gerche A. Athlete's heart: Is the morganroth hypothesis obsolete? Heart Lung Circ 27: 1037-1041, 2018.
10.1016/j.hlc.2018.04.289
PubMedWeb of Science®Google Scholar
78Heidbuchel 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 24: 1473-1480, 2003.
10.1016/S0195-668X(03)00282-3
PubMedWeb of Science®Google Scholar
79Heidbuchel H, Prior DL, La Gerche A. Ventricular arrhythmias associated with long-term endurance sports: What is the evidence? Br J Sports Med 46: i44-i50, 2012.
10.1136/bjsports-2012-091162
PubMedWeb of Science®Google Scholar
80Henschen S. Skidlauf und Skidwettlauf. Eine medizinische Sportstudie. Mitt Med Klin Upsala. Fischer, vol. 2, 1899, p. 74.

Google Scholar
81Hieda M, Howden E, Sarma S, Tarumi T, Palmer D, Lawley J, Hearon C, Hardin A, Fu Q, Zhang R, Levine BD. Impact of lifelong exercise training “dose” on ventricular-arterial coupling. Circulation 138: 2638-2647, 2018.
10.1161/CIRCULATIONAHA.118.035116
PubMedWeb of Science®Google Scholar
82Houweling PJ, Papadimitriou ID, Seto JT, Pérez LM, Del CJ, North KN, Lucia A, Eynon N. Is evolutionary loss our gain? The role of ACTN3 p.Arg577Ter (R577X) genotype in athletic performance, ageing, and disease. Hum Mutat 39: 1774-1787, 2018.
10.1002/humu.23663
CASPubMedWeb of Science®Google Scholar
83Howden EJ, Carrick-Ranson G, Sarma S, Hieda M, Fujimoto N, Levine BD. Effects of sedentary aging and lifelong exercise on left ventricular systolic function. Med Sci Sports Exerc 50: 494-501, 2018.
10.1249/MSS.0000000000001464
PubMedWeb of Science®Google Scholar
84Iskandar A, Thompson PD. A meta-analysis of aortic root size in elite athletes. Circulation 127: 791-798, 2013.
10.1161/CIRCULATIONAHA.112.000974
PubMedWeb of Science®Google Scholar
85Jensen-Urstad K, Bouvier F, Saltin B, Jensen-Urstad M. High prevalence of arrhythmias in elderly male athletes with a lifelong history of regular strenuous exercise. Heart 79: 161-164, 1998.
10.1136/hrt.79.2.161
CASPubMedWeb of Science®Google Scholar
86Jouffroy R, Caille V, Perrot S, Vieillard-Baron A, Dubourg O, Mansencal N. Changes of cardiac function during ultradistance trail running. Am J Cardiol 116: 1284-1289, 2015.
10.1016/j.amjcard.2015.07.045
PubMedWeb of Science®Google Scholar
87Joyner MJ, Coyle EF. Endurance exercise performance: The physiology of champions. J Physiol 586: 35-44, 2008.
10.1113/jphysiol.2007.143834
CASPubMedWeb of Science®Google Scholar
88Kania G, Blyszczuk P, Eriksson U. Mechanisms of cardiac fibrosis in inflammatory heart disease. Trends Cardiovasc Med 19: 247-252, 2009.
10.1016/j.tcm.2010.02.005
CASPubMedWeb of Science®Google Scholar
89Kaplan H, Thompson RC, Trumble BC, Wann LS, Allam AH, Beheim B, Frohlich B, Sutherland ML, Sutherland JD, Stieglitz J, Rodriguez DE, Michalik DE, Rowan CJ, Lombardi GP, Bedi R, Garcia AR, Min JK, Narula J, Finch CE, Gurven M, Thomas GS. Coronary atherosclerosis in indigenous South American Tsimane: A cross-sectional cohort study. Lancet 389: 1730-1739, 2017.
10.1016/S0140-6736(17)30752-3
PubMedWeb of Science®Google Scholar
90Karjalainen J, Kujala UM, Kaprio J, Sarna S, Viitasalo M. Lone atrial fibrillation in vigorously exercising middle aged men: Case-control study. BMJ 316: 1784-1785, 1998.
10.1136/bmj.316.7147.1784
CASPubMedWeb of Science®Google Scholar
91Karlsen S, Dahlslett T, Grenne B, Sjøli B, Smiseth O, Edvardsen T, Brunvand H. Global longitudinal strain is a more reproducible measure of left ventricular function than ejection fraction regardless of echocardiographic training. Cardiovasc Ultrasound 17: 1-12, 2019.
10.1186/s12947-019-0168-9
PubMedWeb of Science®Google Scholar
92Karlstedt E, Chelvanathan A, Da Silva M, Cleverley K, Kumar K, Bhullar N, Lytwyn M, Bohonis S, Oomah S, Nepomuceno R, Du X, Melnyk S, Zeglinski M, Ducas R, Sefidgar M, MacKenzie S, Sharma S, Kirkpatrick ID, Jassal DS. The impact of repeated marathon running on cardiovascular function in the aging population. J Cardiovasc Magn Reson 14: 1-7, 2012.
10.1186/1532-429X-14-58
PubMedWeb of Science®Google Scholar
93Kemal Erol M, Yilmaz M, Oztasyonar Y, Sevimli S, Senocak H. Aortic distensibility is increasing in elite athletes. Am J Cardiol 89: 1002-1004, 2002.
10.1016/S0002-9149(02)02260-9
PubMedWeb of Science®Google Scholar
94Kettunen JA, Kujala UM, Kaprio J, Bäckmand H, Peltonen M, Eriksson JG, Sarna S. All-cause and disease-specific mortality among male, former elite athletes: An average 50-year follow-up. Br J Sports Med 49: 893-897, 2015.
10.1136/bjsports-2013-093347
PubMedWeb of Science®Google Scholar
95Kim JH, Malhotra R, Chiampas G, D'Hemecourt P, Troyanos C, Cianca J, Smith RN, Wang TJ, Roberts WO, Thompson PD, Baggish AL, RACAER Study Group. Cardiac arrest during long-distance running races. N Engl J Med 366: 130-140, 2012.
10.1056/NEJMoa1106468
CASPubMedWeb of Science®Google Scholar
96Kindermann W, Scharhag J. High-level endurance exercise: Are all potential ‘cons’ justified? Sports Med 46: 1191-1192, 2016.
10.1007/s40279-016-0568-z
PubMedWeb of Science®Google Scholar
97Kleinnibbelink G, van Dijk APJ, Fornasiero A, Speretta GF, Johnson C, Hopman MTE, Sculthorpe N, George KP, Somauroo JD, Thijssen DHJ, Oxborough DL. Exercise-induced cardiac fatigue after a 45-min bout of high-intensity running exercise is not altered under hypoxia. J Am Soc Echocardiogr 34 (5): 511-521, 2021. DOI: 10.1016/j.echo.2020.12.003.
10.1016/j.echo.2020.12.003
PubMedWeb of Science®Google Scholar
98Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, Sugawara A, Totsuka K, Shimano H, Ohashi Y, Yamada N, Sone H. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events. J Am Med Assoc 301: 2024-2035, 2009.
10.1001/jama.2009.681
CASPubMedWeb of Science®Google Scholar
99Kovacs R, Baggish AL. Cardiovascular adaptation in athletes. Trends Cardiovasc Med 26: 46-52, 2016.
10.1016/j.tcm.2015.04.003
PubMedWeb of Science®Google Scholar
100Kraus WE, Powell KE, Haskell WL, Janz KF, Campbell WW, Jakicic JM, Troiano RP, Sprow K, Torres A, Piercy KL. Physical activity, all-cause and cardiovascular mortality, and cardiovascular disease. Med Sci Sports Exerc 51: 1270-1281, 2019.
10.1249/MSS.0000000000001939
PubMedWeb of Science®Google Scholar
101Kwong RY, Chan AK, Brown KA, Chan CW, Reynolds HG, Tsang S, Davis RB. Impact of unrecognized myocardial scar detected by cardiac magnetic resonance imaging on event-free survival in patients presenting with signs or symptoms of coronary artery disease. Circulation 113: 2733-2743, 2006.
10.1161/CIRCULATIONAHA.105.570648
PubMedWeb of Science®Google Scholar
102La Gerche A, Burns AT, D'Hooge J, MacIsaac AI, Heidbüchel H, Prior DL. Exercise strain rate imaging demonstrates normal right ventricular contractile reserve and clarifies ambiguous resting measures in endurance athletes. J Am Soc Echocardiogr 25: 253-262.e1, 2012.
10.1016/j.echo.2011.11.023
PubMedWeb of Science®Google Scholar
103La Gerche A, Burns AT, Mooney DJ, Inder WJ, Taylor AJ, Bogaert J, MacIsaac AI, Heidbüchel H, Prior DL. Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes. Eur Heart J 33: 998-1006, 2012.
10.1093/eurheartj/ehr397
CASPubMedWeb of Science®Google Scholar
104La Gerche A, Claessen G. Is exercise good for the right ventricle? Concepts for health and disease. Can J Cardiol 31: 502-508, 2015.
10.1016/j.cjca.2015.01.022
PubMedWeb of Science®Google Scholar
105La Gerche A, Claessen G, Dymarkowski S, Voigt JU, De Buck F, Vanhees L, Droogne W, Van Cleemput J, Claus P, Heidbuchel H. Exercise-induced right ventricular dysfunction is associated with ventricular arrhythmias in endurance athletes. Eur Heart J 36: 1998-2010, 2015.
10.1093/eurheartj/ehv202
PubMedWeb of Science®Google Scholar
106La Gerche A, Connelly KA, Mooney DJ, MacIsaac AI, Prior DL. Biochemical and functional abnormalities of left and right ventricular function after ultra-endurance exercise. Heart 94: 860-866, 2008.
10.1136/hrt.2006.101063
CASPubMedWeb of Science®Google Scholar
107La Gerche A, Heidbuchel H, Burns A, Mooney DJ, Taylor AJ, Pluger HB, Inder WJ, Macisaac AI, Prior DL. Disproportionate exercise load and remodeling of the athlete's right ventricle. Med Sci Sports Exerc 43: 974-981, 2011.
10.1249/MSS.0b013e31820607a3
PubMedWeb of Science®Google Scholar
108La Gerche A, Robberecht C, Kuiperi C, Nuyens D, Willems R, de Ravel T, Matthijs G, Heidbüchel H. Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin. Heart 16: 1268-1274, 2010.
10.1136/hrt.2009.189621
Web of Science®Google Scholar
109Lau DH, Nattel S, Kalman JM, Sanders P. Modifiable risk factors and atrial fibrillation. Circulation 136: 583-596, 2017.
10.1161/CIRCULATIONAHA.116.023163
PubMedWeb of Science®Google Scholar
110Lazarus NR, Harridge SDR. Declining performance of master athletes: Silhouettes of the trajectory of healthy human ageing? J Physiol 595: 2941-2948, 2017.
10.1113/JP272443
CASPubMedWeb of Science®Google Scholar
111Lear A, Patel N, Mullen C, Simonson M, Leone V. Incidence of sudden cardiac arrest and death in young athletes and military members: A systematic review and meta-analysis. J Athl Train 57: 431-443, 2021.
10.4085/1062-6050-0748.20
Web of Science®Google Scholar
112Leckie T, Richardson A, Watkins E, Fitzpatrick D, Galloway R, Grimaldi R, Roberts A, Baker P. High-sensitivity troponin T in marathon runners, marathon runners with heart disease and collapsed marathon runners. Scand J Med Sci Sports 29: 663-668, 2019.
10.1111/sms.13392
PubMedWeb of Science®Google Scholar
113Lee SE, Chang HJ, Sung JM, Park HB, Heo R, Rizvi A, Lin FY, Kumar A, Hadamitzky M, Kim YJ, Conte E, Andreini D, Pontone G, Budoff MJ, Gottlieb I, Lee BK, Chun EJ, Cademartiri F, Maffei E, Marques H, Leipsic JA, Shin S, Choi JH, Chinnaiyan K, Raff G, Virmani R, Samady H, Stone PH, Berman DS, Narula J, Shaw LJ, Bax JJ, Min JK. Effects of statins on coronary atherosclerotic plaques: The PARADIGM study. JACC Cardiovasc Imaging 11: 1475-1484, 2018.
10.1016/j.jcmg.2018.04.015
PubMedWeb of Science®Google Scholar
114Lepers R, Stapley PJ. Master athletes are extending the limits of human endurance. Front Physiol 7: 1-8, 2016.
10.3389/fphys.2016.00613
PubMedWeb of Science®Google Scholar
115Levine B. Can intensive exercise harm the heart?: The benefits of competitive endurance training for cardiovascular structure and function. Circulation 130: 987-991, 2014.
10.1161/CIRCULATIONAHA.114.008142
PubMedWeb of Science®Google Scholar
116Li F, Hopkins WG, Wang X, Baker JS, Nie J, Qiu J, Quach B, Wang K, Yi L. Kinetics, moderators and reference limits of exercise-induced elevation of cardiac troponin T in athletes: A systematic review and meta-analysis. Front Physiol 12: 651851, 2021.
10.3389/fphys.2021.651851
PubMedWeb of Science®Google Scholar
117López-Valenciano A, Mayo X, Liguori G, Copeland RJ, Lamb M, Jimenez A. Changes in sedentary behaviour in European Union adults between 2002 and 2017. BMC Public Health 20: 1-10, 2020.
10.1186/s12889-020-09293-1
PubMedWeb of Science®Google Scholar
118Lucia A, Earnest C, Arribas C. The Tour de France: A physiological review. Scand J Med Sci Sports 13: 275-283, 2003.
10.1034/j.1600-0838.2003.00345.x
CASPubMedWeb of Science®Google Scholar
119Lucia A, Foster C, Pérez M, Arenas J. What isn't taught in medical schools: The William Wordsworth lesson. Nat Clin Pract Cardiovasc Med 5: 372-374, 2008.
10.1038/ncpcardio1241
PubMedGoogle Scholar
120Lucía A, Hoyos J, Santalla A, Earnest C, Chicharro JL. Tour de France versus Vuelta a España: Which is harder? Med Sci Sports Exerc 35: 872-878, 2003.
10.1249/01.MSS.0000064999.82036.B4
PubMedWeb of Science®Google Scholar
121Lucía A, Morán M, Pérez M, Saborido A, Días E, Megías A, Chicharro JL. Short-term effects of marathon running in master runners: No evidence of myocardial injurt. Int J Sports Med 20: 482-486, 1999.
10.1055/s-1999-8824
CASPubMedWeb of Science®Google Scholar
122Lucia A, Serratosa L, Saborido A, Pardo J, Boraita A, Morán M, Bandrés F, Megías A, Chicharro J. Short-term effects of marathon running: No evidence of cardiac dysfunction. Med Sci Sports Exerc 31: 1414-1421, 1999.
10.1097/00005768-199910000-00009
CASPubMedWeb of Science®Google Scholar
123Lye M, Donnellan C. Heart disease in the elderly. Heart 84: 560-566, 2000. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1017783/.
10.1136/heart.84.5.560
CASPubMedWeb of Science®Google Scholar
124MacDougall JD, Tuxen D, Sale DG, Moroz JR, Sutton JR. Arterial blood pressure response to heavy resistance exercise. J Appl Physiol 58: 785-790, 1985.
10.1152/jappl.1985.58.3.785
CASPubMedWeb of Science®Google Scholar
125Malhotra A, Dhutia H, Finocchiaro G, Gati S, Beasley I, Clift P, Cowie C, Kenny A, Mayet J, Oxborough D, Patel K, Pieles G, Rakhit D, Ramsdale D, Shapiro L, Somauroo J, Stuart G, Varnava A, Walsh J, Yousef Z, Tome M, Papadakis M, Sharma S. Outcomes of cardiac screening in adolescent soccer players. N Engl J Med 379: 524-534, 2018.
10.1056/NEJMoa1714719
PubMedWeb of Science®Google Scholar
126Mandsager K, Harb S, Cremer P, Phelan D, Nissen SE, Jaber W. Association of cardiorespiratory fitness with long-term mortality among adults undergoing exercise treadmill testing. JAMA Netw Open 1: e183605, 2018.
10.1001/jamanetworkopen.2018.3605
PubMedWeb of Science®Google Scholar
127Marijon E, Tafflet M, Antero-Jacquemin J, El Helou N, Berthelot G, Celermajer DS, Bougouin W, Combes N, Hermine O, Empana JP, Rey G, Toussaint JF, Jouven X. Mortality of French participants in the Tour de France (1947-2012). Eur Heart J 34: 3145-3150, 2013.
10.1093/eurheartj/eht347
PubMedWeb of Science®Google Scholar
128Maron B. Sudden death in young athletes. N Engl J Med 349: 1064-1075, 2003.
10.1056/NEJMra022783
CASPubMedWeb of Science®Google Scholar
129Maron BJ, Doerer JJ, Haas TS, Tierney DM, Mueller FO. Sudden deaths in young competitive athletes analysis of 1866 deaths in the united states, 1980-2006. Circulation 119: 1085-1092, 2009.
10.1161/CIRCULATIONAHA.108.804617
PubMedWeb of Science®Google Scholar
130Maron BJ, Poliac L, Roberts W. Risk for sudden cardiac death associated with marathon running. J Am Coll Cardiol 28: 428-431, 1996.
10.1016/0735-1097(96)00137-4
CASPubMedWeb of Science®Google Scholar
131Martínez-Navarro I, Sánchez-Gómez J, Sanmiguel D, Collado E, Hernando B, Panizo N, Hernando C. Immediate and 24-h post-marathon cardiac troponin T is associated with relative exercise intensity. Eur J Appl Physiol 120: 1723-1731, 2020.
10.1007/s00421-020-04403-8
CASPubMedWeb of Science®Google Scholar
132McDougall J, Michaels L. Cardiovascular causes of sudden death in “De Subitaneis Mortibus” by Giovanni Maria Lancisi: A translation from the original Latin. Bull Hist Med 46: 486-494, 1972.

CASPubMedGoogle Scholar
133Mckendry J, Breen L, Shad BJ, Greig CA. Muscle morphology and performance in master athletes: A systematic review and meta-analyses. Ageing Res Rev 45: 62-82, 2018.
10.1016/j.arr.2018.04.007
PubMedWeb of Science®Google Scholar
134Mehta R, Gaze D, Mohan S, Williams KL, Sprung V, George K, Jeffries R, Hudson Z, Perry M, Shave R. Post-exercise cardiac troponin release is related to exercise training history. Int J Sports Med 33: 333-337, 2012.
10.1055/s-0031-1301322
CASPubMedWeb of Science®Google Scholar
135Merghani A, Maestrini V, Rosmini S, Cox AT, Dhutia H, Bastiaenan R, David S, Yeo TJ, Narain R, Malhotra A, Papadakis M, Wilson MG, Tome M, Alfakih K, Moon JC, Sharma S. Prevalence of subclinical coronary artery disease in masters endurance athletes with a low atherosclerotic risk profile. Circulation 136: 126-137, 2017.
10.1161/CIRCULATIONAHA.116.026964
CASPubMedWeb of Science®Google Scholar
136Middleton N, Shave R, George K, Whyte G, Hart E, Atkinson G. Left ventricular function immediately following prolonged exercise. Med Sci Sports Exerc 38: 681-687, 2006.
10.1249/01.mss.0000210203.10200.12
PubMedWeb of Science®Google Scholar
137Miyasaka Y, Barnes ME, Gersh BJ, Cha SS, Bailey KR, Abhayaratna W, Seward JB, Iwasaka T, Tsang TSM. Incidence and mortality risk of congestive heart failure in atrial fibrillation patients: A community-based study over two decades. Eur Heart J 27: 936-941, 2006.
10.1093/eurheartj/ehi694
PubMedWeb of Science®Google Scholar
138Mohananey D, Masri A, Desai RM, Dalal S, Phelan D, Kanj M, Wazni O, Griffin BP, Desai MY. Global incidence of sports-related sudden cardiac death. J Am Coll Cardiol 69: 2672-2673, 2017.
10.1016/j.jacc.2017.03.564
PubMedWeb of Science®Google Scholar
139Mohanty S, Mohanty P, Tamaki M, Natale V, Gianni C, Trivedi C, Gokoglan Y, Di Biase L, Natale A. Differential association of exercise intensity with risk of atrial fibrillation in men and women: Evidence from a meta-analysis. J Cardiovasc Electrophysiol 27: 1021-1029, 2016.
10.1111/jce.13023
PubMedWeb of Science®Google Scholar
140Möhlenkamp S, Lehmann N, Breuckmann F, Bröcker-Preuss M, Nassenstein K, Halle M, Budde T, Mann K, Barkhausen J, Heusch G, Jöckel KH, Erbel R. Running: The risk of coronary events - prevalence and prognostic relevance of coronary atherosclerosis in marathon runners. Eur Heart J 29: 1903-1910, 2008.
10.1093/eurheartj/ehn163
PubMedWeb of Science®Google Scholar
141Möhlenkamp S, Leineweber K, Lehmann N, Braun S, Roggenbuck U, Perrey M, Broecker-Preuss M, Budde T, Halle M, Mann K, Jöckel KH, Erbel R, Heusch G. Coronary atherosclerosis burden, but not transient troponin elevation, predicts long-term outcome in recreational marathon runners. Basic Res Cardiol 109: 391, 2014.
10.1007/s00395-013-0391-8
CASPubMedWeb of Science®Google Scholar
142Montero D, Díaz-Cañestro C. Maximal cardiac output in athletes: Influence of age. Eur J Prev Cardiol 22: 1588-1600, 2015.
10.1177/2047487314566759
PubMedWeb of Science®Google Scholar
143Montero D, Padilla J, Diaz-Cañestro C, Muris DMJ, Pyke KE, Obert P, Walther G. Flow-mediated dilation in athletes: Influence of aging. Med Sci Sports Exerc 46: 2148-2158, 2014.
10.1249/MSS.0000000000000341
PubMedWeb of Science®Google Scholar
144Morganroth J, Maron BJ, Henry WL, Epstein SE. Comparative left ventricular dimensions in trained athletes. Ann Intern Med 82: 521-524, 1975.
10.7326/0003-4819-82-4-521
CASPubMedWeb of Science®Google Scholar
145Mortensen SP, Nyberg M, Winding K, Saltin B. Lifelong physical activity preserves functional sympatholysis and purinergic signalling in the ageing human leg. J Physiol 590: 6227-6236, 2012.
10.1113/jphysiol.2012.240093
CASPubMedWeb of Science®Google Scholar
146Mousavi N, Czarnecki A, Kumar K, Fallah-Rad N, Lytwyn M, Han SY, Francis A, Walker JR, Kirkpatrick IDC, Neilan TG, Sharma S, Jassal DS. Relation of biomarkers and cardiac magnetic resonance imaging after marathon running. Am J Cardiol 103: 1467-1472, 2009.
10.1016/j.amjcard.2009.01.294
PubMedWeb of Science®Google Scholar
147Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood J. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346: 793-801, 2002.
10.1056/NEJMoa011858
PubMedWeb of Science®Google Scholar
148Naeije R, Chesler N. Pulmonary circulation at exercise. Compr Physiol 2: 711-741, 2012.
10.1002/cphy.c100091
PubMedWeb of Science®Google Scholar
149Naylor LH, George K, O'Driscol G, Green DJ. The athlete's heart: A contemporary appraisal of the “Morganroth hypothesis”. Sports Med 38: 69-90, 2008.
10.2165/00007256-200838010-00006
PubMedWeb of Science®Google Scholar
150Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ. Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston Marathon. Circulation 114: 2325-2333, 2006.
10.1161/CIRCULATIONAHA.106.647461
PubMedWeb of Science®Google Scholar
151Neilan TG, Yoerger DM, Douglas PS, Marshall JE, Halpern EF, Lawlor D, Picard MH, Wood MJ. Persistent and reversible cardiac dysfunction among amateur marathon runners. Eur Heart J 27: 1079-1084, 2006.
10.1093/eurheartj/ehi813
PubMedWeb of Science®Google Scholar
152Nyberg M, Blackwell JR, Damsgaard R, Jones AM, Hellsten Y, Mortensen SP. Lifelong physical activity prevents an age-related reduction in arterial and skeletal muscle nitric oxide bioavailability in humans. J Physiol 590: 5361-5370, 2012.
10.1113/jphysiol.2012.239053
CASPubMedWeb of Science®Google Scholar
153O'Hanlon R, Wilson M, Wage R, Smith G, Alpendurada F, Wong J, Dahl A, Oxborough D, Godfrey R, Sharma S, Roughton M, George K, Pennell D, Whyte G, Prasad S. Troponin release following endurance exercise: Is inflammation the cause? A cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 12: 1-7, 2010.
10.1186/1532-429X-12-38
PubMedWeb of Science®Google Scholar
154Oxborough D, Sharma S, Shave R, Whyte G, Birch K, Artis N, Batterham AM, George K. The right ventricle of the endurance athlete: The relationship between morphology and deformation. J Am Soc Echocardiogr 25: 263-271, 2012.
10.1016/j.echo.2011.11.017
PubMedWeb of Science®Google Scholar
155Parry-Williams G, Gati S, Sharma S. The heart of the ageing endurance athlete: The role of chronic coronary stress. Eur Heart J 42: 2737-2744, 2021.
10.1093/eurheartj/ehab095
CASPubMedWeb of Science®Google Scholar
156Parry-Williams G, Sharma S. The effects of endurance exercise on the heart: Panacea or poison? Nat Rev Cardiol 17: 402-412, 2020.
10.1038/s41569-020-0354-3
CASPubMedWeb of Science®Google Scholar
157Parsonage WA, Ruane L. Cardiac troponin and exercise; still much to learn. Hear Lung Circ 26: 645-647, 2017.
10.1016/j.hlc.2017.05.112
CASPubMedWeb of Science®Google Scholar
158Pelliccia A, Adami PE, Quattrini F, Squeo MR, Caselli S, Verdile L, Maestrini V, Di Paolo F, Pisicchio C, Ciardo R, Spataro A. Are Olympic athletes free from cardiovascular diseases? Systematic investigation in 2352 participants from Athens 2004 to Sochi 2014. Br J Sports Med 51: 238-243, 2017.
10.1136/bjsports-2016-096961
PubMedWeb of Science®Google Scholar
159Pelliccia A, Culasso F, Di Paolo FM, Maron BJ. Physiologic left ventricular cavity dilatation in elite athletes. Ann Intern Med 130: 23-31, 1999.
10.7326/0003-4819-130-1-199901050-00005
CASPubMedWeb of Science®Google Scholar
160Pelliccia A, Di Paolo FM, De Blasiis E, Quattrini FM, Pisicchio C, Guerra E, Culasso F, Maron BJ. Prevalence and clinical significance of aortic root dilation in highly trained competitive athletes. Circulation 122: 698-706, 2010.
10.1161/CIRCULATIONAHA.109.901074
PubMedWeb of Science®Google Scholar
161Pelliccia A, Maron BJ, De Luca R, Di Paolo FM, Spataro A, Culasso F. Remodeling of left ventricular hypertrophy in elite athletes after long-term deconditioning. Circulation 105: 944-949, 2002.
10.1161/hc0802.104534
PubMedWeb of Science®Google Scholar
162Pelliccia A, Maron BJ, Di Paolo FM, Biffi A, Quattrini FM, Pisicchio C, Roselli A, Caselli S, Culasso F. Prevalence and clinical significance of left atrial remodeling in competitive athletes. J Am Coll Cardiol 46: 690-696, 2005.
10.1016/j.jacc.2005.04.052
PubMedWeb of Science®Google Scholar
163Peterson DF, Kucera K, Thomas LC, Maleszewski J, Siebert D, Lopez-Anderson M, Zigman M, Schattenkerk J, Harmon KG, Drezner JA. Aetiology and incidence of sudden cardiac arrest and death in young competitive athletes in the USA: A 4-year prospective study. Br J Sports Med 55 (21): 1196-1203, 2021.
10.1136/bjsports-2020-102666
PubMedWeb of Science®Google Scholar
164Pluim BM, Zwinderman AH, Van Der Laarse A, Van Der Wall EE. The athlete's heart: A meta-analysis of cardiac structure and function. Circulation 101: 336-344, 2000.
10.1161/01.CIR.101.3.336
CASPubMedWeb of Science®Google Scholar
165Potter E, Marwick TH. Assessment of left ventricular function by echocardiography: The case for routinely adding global longitudinal strain to ejection fraction. JACC Cardiovasc Imaging 11: 260-274, 2018.
10.1016/j.jcmg.2017.11.017
PubMedWeb of Science®Google Scholar
166Prasad A, Popovic ZB, Arbab-Zadeh A, Fu Q, Palmer D, Dijk E, Greenberg NL, Garcia MJ, Thomas JD, Levine BD. The effects of aging and physical activity on Doppler measures of diastolic function. Am J Cardiol 99: 1629-1636, 2007.
10.1016/j.amjcard.2007.01.050
PubMedWeb of Science®Google Scholar
167Radford NB, DeFina LF, Leonard D, Barlow CE, Willis BL, Gibbons LW, Gilchrist SC, Khera A, Levine BD. Cardiorespiratory fitness, coronary artery calcium, and cardiovascular disease events in a cohort of generally healthy middle-age men: Results from the cooper center longitudinal study. Circulation 137: 1888-1895, 2018.
10.1161/CIRCULATIONAHA.117.032708
CASPubMedWeb of Science®Google Scholar
168Raichlen DA, Pontzer H, Harris JA, Mabulla AZP, Marlowe FW, Josh Snodgrass J, Eick G, Colette Berbesque J, Sancilio A, Wood BM. Physical activity patterns and biomarkers of cardiovascular disease risk in hunter-gatherers. Am J Hum Biol 29: 1-13, 2017.
10.1002/ajhb.22919
Web of Science®Google Scholar
169Ramakrishnan R, Doherty A, Smith-Byrne K, Rahimi K, Bennett D, Woodward M, Walmsley R, Dwyer T. Accelerometer measured physical activity and the incidence of cardiovascular disease: Evidence from the UK Biobank Cohort study. PLoS Med 18: 1-16, 2021.

Web of Science®Google Scholar
170Regwan S, Hulten EA, Martinho S, Slim J, Villines TC, Mitchell J, Slim AM. Marathon running as a cause of troponin elevation: A systematic review and meta-analysis. J Interv Cardiol 23: 443-450, 2010.
10.1111/j.1540-8183.2010.00575.x
CASPubMedWeb of Science®Google Scholar
171Richardson AJ, Leckie T, Watkins ER, Fitzpatrick D, Galloway R, Grimaldi R, Baker P. Post marathon cardiac troponin T is associated with relative exercise intensity. J Sci Med Sport 21: 880-884, 2018.
10.1016/j.jsams.2018.02.005
CASPubMedWeb of Science®Google Scholar
172Rifai N, Douglas PS, O'Toole M, Rimm E, Ginsburg GS. Cardiac troponin T and I, electrocardiographic wall motion analyses, and ejection fractions in athletes participating in the Hawaii Ironman Triathlon. Am J Cardiol 83: 1085-1089, 1999.
10.1016/S0002-9149(99)00020-X
CASPubMedWeb of Science®Google Scholar
173Roberts WO, Schwartz RS, Kraus SM, Schwartz JG, Peichel G, Garberich RF, Lesser JR, Oesterle SN, Wickstrom KK, Knickelbine T, Harris KM. Long-term marathon running is associated with low coronary plaque formation in women. Med Sci Sports Exerc 49: 641-645, 2017.
10.1249/MSS.0000000000001154
PubMedWeb of Science®Google Scholar
174Ross R, Blair SN, Arena R, Church TS, Després JP, Franklin BA, Haskell WL, Kaminsky LA, Levine BD, Lavie CJ, Myers J, Niebauer J, Sallis R, Sawada SS, Sui X, Wisløff U. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation 134: e653-e699, 2016.
10.1161/CIR.0000000000000461
PubMedWeb of Science®Google Scholar
175Ruiz JR, Joyner M, Lucia A. CrossTalk opposing view: Prolonged intense exercise does not lead to cardiac damage. J Physiol 591: 4943-4945, 2013.
10.1113/jphysiol.2013.257147
CASPubMedWeb of Science®Google Scholar
176Ruiz JR, Joyner MJ, Lucia A. Letter by Ruiz et al regarding article, “cardiac arrhythmogenic remodeling in a rat model of long-term intensive exercise training”. Circulation 124: e250, 2011.
10.1161/CIRCULATIONAHA.111.022228
PubMedWeb of Science®Google Scholar
177Saltin B, Stenberg J. Circulatory response to prolonged severe exercise. J Appl Physiol 19: 833-838, 1964.
10.1152/jappl.1964.19.5.833
CASPubMedWeb of Science®Google Scholar
178Sanchis-Gomar F, Joyner MJ, Löllgen H, Lucia A. Confounders in the evaluation of cardiac fibrosis by late gadolinium enhancement. Sports Med 46: 1193-1194, 2016.
10.1007/s40279-016-0569-y
PubMedWeb of Science®Google Scholar
179Sanchis-Gomar F, López-Ramón M, Alis R, Garatachea N, Pareja-Galeano H, Santos-Lozano A, Catalán P, Sansoni V, Perego S, Lombardi G, Löllgen H, Bueno H, Serrano-Ostáriz E, Lucia A. No evidence of adverse cardiac remodeling in former elite endurance athletes. Int J Cardiol 222: 171-177, 2016.
10.1016/j.ijcard.2016.07.197
PubMedWeb of Science®Google Scholar
180Sanchis-Gomar F, Olaso-Gonzalez G, Corella D, Gomez-Cabrera MC, Vina J. Increased average longevity among the Tour de France cyclists. Int J Sports Med 32: 644-647, 2011.
10.1055/s-0031-1271711
CASPubMedWeb of Science®Google Scholar
181Sanchis-Gomar F, Pérez LM, Joyner MJ, Löllgen H, Lucia A. Endurance exercise and the heart: Friend or foe? Sports Med 46: 459-466, 2016.
10.1007/s40279-015-0434-4
PubMedWeb of Science®Google Scholar
182Sanchis-Gomar F, Perez-Quilis C, Lippi G, Cervellin G, Leischik R, Löllgen H, Serrano-Ostáriz E, Lucia A. Atrial fibrillation in highly trained endurance athletes — description of a syndrome. Int J Cardiol 226: 11-20, 2017.
10.1016/j.ijcard.2016.10.047
PubMedWeb of Science®Google Scholar
183Santos-Lozano A, Martín-Hernández J, Baladrón C, Turrado-Sevilla MÁ, Arrarás-Flores Á, Villacastín JP, Boraita A, Bueno H, Lucia A. Sudden cardiac death in professional soccer players. J Am Coll Cardiol 70: 1420-1421, 2017.
10.1016/j.jacc.2017.07.738
PubMedWeb of Science®Google Scholar
184Santos-Lozano A, Sanchis-Gomar F, Garatachea N, Arrarás-Flores Á, Pareja-Galeano H, Fiuza-Luces C, Joyner MJ, Lucia A. Incidence of sudden cardiac death in professional cycling: Sudden cardiac death and exercise. Int J Cardiol 223: 222-223, 2016.
10.1016/j.ijcard.2016.08.155
PubMedWeb of Science®Google Scholar
185Sanz de la Garza M, Grazioli G, Bijnens BH, Pajuelo C, Brotons D, Subirats E, Brugada R, Roca E, Sitges M. Inter-individual variability in right ventricle adaptation after an endurance race. Eur J Prev Cardiol 23: 1114-1124, 2016.
10.1177/2047487315622298
PubMedWeb of Science®Google Scholar
186Sattelmair J, Pertman J, Ding EL, Kohl HW, Haskell W, Lee IM. Dose response between physical activity and risk of coronary heart disease: A meta-analysis. Circulation 124: 789-795, 2011.
10.1161/CIRCULATIONAHA.110.010710
PubMedWeb of Science®Google Scholar
187Scharhag J, Schneider G, Urhausen A, Rochette V, Kramann B, Kindermann W. Athlete's heart: Right and left ventricular mass and function in male endurance athletes and untrained individuals determined by magnetic resonance imaging. J Am Coll Cardiol 40: 1856-1863, 2002.
10.1016/S0735-1097(02)02478-6
PubMedWeb of Science®Google Scholar
188Schmid J, Liesinger L, Birner-Gruenberger R, Stojakovic T, Scharnagl H, Dieplinger B, Asslaber M, Radl R, Beer M, Polacin M, Mair J, Szolar D, Berghold A, Quasthoff S, Binder JS, Rainer PP. Elevated cardiac troponin T in patients with skeletal myopathies. J Am Coll Cardiol 71: 1540-1549, 2018.
10.1016/j.jacc.2018.01.070
CASPubMedWeb of Science®Google Scholar
189Scott JM, Warburton DER. Mechanisms underpinning exercise-induced changes in left ventricular function. Med Sci Sports Exerc 40: 1400-1407, 2008.
10.1249/MSS.0b013e318172cf10
PubMedWeb of Science®Google Scholar
190Senturk T, Xu H, Puppala K, Krishnan B, Sakaguchi S, Chen LY, Karim R, Dickinson O, Benditt DG. Cardiac pauses in competitive athletes: A systematic review examining the basis of current practice recommendations. Europace 18: 1873-1879, 2016.

PubMedWeb of Science®Google Scholar
191Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International recommendations for electrocardiographic interpretation in athletes. J Am Coll Cardiol 69: 1057-1075, 2017.
10.1016/j.jacc.2017.01.015
PubMedWeb of Science®Google Scholar
192Sharma S, Drezner JA, Baggish A, Papadakis M, Wilson MG, Prutkin JM, La Gerche A, Ackerman MJ, Borjesson M, Salerno JC, Asif IM, Owens DS, Chung EH, Emery MS, Froelicher VF, Heidbuchel H, Adamuz C, Asplund CA, Cohen G, Harmon KG, Marek JC, Molossi S, Niebauer J, Pelto HF, Perez MV, Riding NR, Saarel T, Schmied CM, Shipon DM, Stein R, Vetter VL, Pelliccia A, Corrado D. International recommendations for electrocardiographic interpretation in athletes. Eur Heart J 39: 1466-1480, 2018.
10.1093/eurheartj/ehw631
PubMedWeb of Science®Google Scholar
193Shave RE, Lieberman DE, Drane AL, Brown MG, Batterham AM, Worthington S, Atencia R, Feltrer Y, Neary J, Weiner RB, Wasfy MM, Baggish AL. Selection of endurance capabilities and the trade-off between pressure and volume in the evolution of the human heart. Proc Natl Acad Sci U S A 116: 19905-19910, 2019.
10.1073/pnas.1906902116
CASPubMedWeb of Science®Google Scholar
194Shibata S, Fujimoto N, Hastings JL, Carrick-Ranson G, Bhella PS, Hearon CM, Levine BD. The effect of lifelong exercise frequency on arterial stiffness. J Physiol 596: 2783-2795, 2018.
10.1113/JP275301
CASPubMedWeb of Science®Google Scholar
195Siegel AJ. Elevated skeletal muscle creatine kinase MB isoenzyme levels in marathon runners. JAMA J Am Med Assoc 250: 2835-2837, 1983.
10.1001/jama.1983.03340200069032
CASPubMedWeb of Science®Google Scholar
196Siegel AJ, Lewandrowski KB, Strauss HW, Fischman AJ, Yasuda T. Normal post-race antimyosin myocardial scintigraphy in asymptomatic marathon runners with elevated serum creatine kinase MB isoenzyme and troponin T levels. Evidence against silent myocardial cell necrosis. Cardiology 86: 451-456, 1995.
10.1159/000176922
CASPubMedWeb of Science®Google Scholar
197Starnberg K, Jeppsson A, Lindahl B, Hammarsten O. Revision of the troponin T release mechanism from damaged human myocardium. Clin Chem 60: 1098-1104, 2014.
10.1373/clinchem.2013.217943
CASPubMedWeb of Science®Google Scholar
198Stavroulakis GA, George KP. Exercise-induced release of troponin. Clin Cardiol 43: 872-881, 2020.
10.1002/clc.23337
PubMedWeb of Science®Google Scholar
199Stewart GM, Yamada A, Haseler LJ, Kavanagh JJ, Chan J, Koerbin G, Wood C, Sabapathy S. Influence of exercise intensity and duration on functional and biochemical perturbations in the human heart. J Physiol 594: 3031-3044, 2016.
10.1113/JP271889
CASPubMedWeb of Science®Google Scholar
200Stewart S, Hart CL, Hole DJ, McMurray JJV. A population-based study of the long-term risks associated with atrial fibrillation: 20-year follow-up of the Renfrew/Paisley study. Am J Med 113: 359-364, 2002.
10.1016/S0002-9343(02)01236-6
CASPubMedWeb of Science®Google Scholar
201Sung K-C, Hong Y, Lee J-Y, Lee S-J, Chang Y, Ryu S, Zhao D, Cho J, Guallar E, Lima JA. Physical activity and the progression of coronary artery calcification. Heart 107, 2021. DOI: 10.1136/heartjnl-2021-319346.
10.1136/heartjnl-2021-319346
Web of Science®Google Scholar
202Svedberg N, Sundström J, James S, Hållmarker U, Hambraeus K, Andersen K. Long-term incidence of atrial fibrillation and stroke among cross-country skiers. Circulation 140: 910-920, 2019.

PubMedWeb of Science®Google Scholar
203Tahir E, Starekova J, Muellerleile K, von Stritzky A, Münch J, Avanesov M, Weinrich JM, Stehning C, Bohnen S, Radunski UK, Freiwald E, Blankenberg S, Adam G, Pressler A, Patten M, Lund GK. Myocardial fibrosis in competitive triathletes detected by contrast-enhanced CMR correlates with exercise-induced hypertension and competition history. JACC Cardiovasc Imaging 11: 1260-1270, 2018.
10.1016/j.jcmg.2017.09.016
PubMedWeb of Science®Google Scholar
204Tanaka H, Seals DR. Dynamic exercise performance in Masters athletes: Insight into the effects of primary human aging on physiological functional capacity. J Appl Physiol 95: 2152-2162, 2003.
10.1152/japplphysiol.00320.2003
PubMedWeb of Science®Google Scholar
205Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, White HD, Mickley H, Crea F, Van De Werf F, Bucciarelli-Ducci C, Katus HA, Pinto FJ, Antman EM, Hamm CW, De Caterina R, Januzzi JL, Apple FS, Garcia MAA, Underwood SR, Canty JM, Lyon AR, Devereaux PJ, Zamorano JL, Lindahl B, Weintraub WS, Newby LK, Virmani R, Vranckx P, Cutlip D, Gibbons RJ, Smith SC, Atar D, Luepker RV, Robertson RM, Bonow RO, Steg PG, O'Gara PT, Fox KAA, Hasdai D, Aboyans V, Achenbach S, Agewall S, Alexander T, Avezum A, Barbato E, Bassand JP, Bates E, Bittl JA, Breithardt G, Bueno H, Bugiardini R, Cohen MG, Dangas G, De Lemos JA, Delgado V, Filippatos G, Fry E, Granger CB, Halvorsen S, Hlatky MA, Ibanez B, James S, Kastrati A, Leclercq C, Mahaffey KW, Mehta L, Müller C, Patrono C, Piepoli MF, Piñeiro D, Roffi M, Rubboli A, Sharma S, Simpson IA, Tendera M, Valgimigli M, Van Der Wal AC, Windecker S. Fourth universal definition of myocardial infarction (2018). Eur Heart J 40: 237-269, 2019.
10.1093/eurheartj/ehy462
PubMedWeb of Science®Google Scholar
206Trappe S, Hayes E, Galpin A, Jemiolo B, Fink W, Trappe T, Kaminsky L, Jansson A, Gustafsson T, Tesch P. New records in aerobic power among octogenarian lifelong endurance athletes. J Appl Physiol 114: 3-10, 2013.
10.1152/japplphysiol.01107.2012
PubMedWeb of Science®Google Scholar
207Trivax JE, Franklin BA, Goldstein JA, Chinnaiyan KM, Gallagher MJ, Dejong AT, Colar JM, Haines DE, McCullough PA. Acute cardiac effects of marathon running. J Appl Physiol 108: 1148-1153, 2010.
10.1152/japplphysiol.01151.2009
CASPubMedWeb of Science®Google Scholar
208Trivax JE, McCullough PA. Phidippides cardiomyopathy: A review and case illustration. Clin Cardiol 35: 69-73, 2012.
10.1002/clc.20994
PubMedWeb of Science®Google Scholar
209Vaitkevicius PV, Fleg JL, Engel JH, O'Connor FC, Wright JG, Lakatta LE, Yin FC, Lakatta EG. Effects of age and aerobic capacity on arterial stiffness in healthy adults. Circulation 88: 1456-1462, 1993. http://www.ncbi.nlm.nih.gov/pubmed/8403292.
10.1161/01.CIR.88.4.1456
CASPubMedWeb of Science®Google Scholar
210Valenzuela P, Morales J, Santos-Lozano A, Saco-Ledo G, Díaz-González L, Boraita A, Lavie C, Lucia A. What do we really know about the association between physical activity, sports, and atrial fibrillation? A systematic review and meta-analysis from unbiased studies. Eur J Prev Cardiol 29 (4): e143-e148, 2022.
10.1093/eurjpc/zwab073
PubMedWeb of Science®Google Scholar
211Valenzuela PL, Maffiuletti NA, Joyner MJ, Lucia A, Lepers R. Lifelong endurance exercise as a countermeasure against age-related VO_2max decline: Physiological overview and insights from masters athletes. Sports Med 50: 703-716, 2020.
10.1007/s40279-019-01252-0
PubMedWeb of Science®Google Scholar
212Valenzuela PL, Santos-Lozano A, Morales JS, López-Ortiz S, Pinto-Fraga J, Castillo-García A, Martín-Hernández J, Villacastín JP, Boraita A, Lucia A. Physical activity, sports and risk of atrial fibrillation: Umbrella review of meta-analyses. Eur J Prev Cardiol In press: 1-7, 2020.

Google Scholar
213van de Schoor FR, Aengevaeren VL, Hopman MTE, Oxborough DL, George KP, Thompson PD, Eijsvogels TMH. Myocardial fibrosis in athletes. Mayo Clin Proc 91: 1617-1631, 2016.
10.1016/j.mayocp.2016.07.012
PubMedWeb of Science®Google Scholar
214Viitasalo MT, Kala R, Eisalo A. Ambulatory electrocardiographic findings in young athletes between 14 and 16 years of age. Eur Heart J 5: 2-6, 1984.
10.1093/oxfordjournals.eurheartj.a061546
CASPubMedWeb of Science®Google Scholar
215Voight BF, Kudaravalli S, Wen X, Pritchard JK. A map of recent positive selection in the human genome. PLoS Biol 4: 0446-0458, 2006.
10.1073/pnas.0401566101
CASPubMedWeb of Science®Google Scholar
216Walker J, Calkins H, Nazarian S. Evaluation of cardiac arrhythmia among athletes. Am J Med 123: 1075-1081, 2010.
10.1016/j.amjmed.2010.05.008
PubMedWeb of Science®Google Scholar
217Waterhouse DF, Ismail TF, Prasad SK, Wilson MG, O'Hanlon R. Imaging focal and interstitial fibrosis with cardiovascular magnetic resonance in athletes with left ventricular hypertrophy: Implications for sporting participation. Br J Sports Med 46: 69-78, 2012.
10.1136/bjsports-2012-091482
PubMedWeb of Science®Google Scholar
218Wilson M, O'Hanlon R, Prasad S, Deighan A, MacMillan P, Oxborough D, Godfrey R, Smith G, Maceira A, Sharma S, George K, Whyte G. Diverse patterns of myocardial fibrosis in lifelong, veteran endurance athletes. J Appl Physiol 110: 1622-1626, 2011.
10.1152/japplphysiol.01280.2010
CASPubMedWeb of Science®Google Scholar
219Wilson M, O'Hanlon R, Prasad S, Oxborough D, Godfrey R, Alpendurada F, Smith G, Wong J, Basavarajaiah S, Sharma S, Nevill A, Gaze D, George K, Whyte G. Biological markers of cardiac damage are not related to measures of cardiac systolic and diastolic function using cardiovascular magnetic resonance and echocardiography after an acute bout of prolonged endurance exercise. Br J Sports Med 45: 780-784, 2011.
10.1136/bjsm.2009.064089
CASPubMedWeb of Science®Google Scholar
220Wolff S, Picco J, Díaz-González L, Valenzuela P, González-Dávila E, Matilde P, Wolff D, Lucia A, Boraita A. Exercise-induced cardiac fatigue in recreational ultra-marathon runners at moderate altitude: Insights from myocardial deformation analysis. Front Cardiovasc Med 8: 744393, 2022.
10.3389/fcvm.2021.744393
PubMedWeb of Science®Google Scholar
221Zehender M, Meinertz T, Keul J, Just H. ECG variants and cardiac arrhythmias in athletes: Clinical relevance and prognostic importance. Am Heart J 119: 1378-1391, 1990.
10.1016/S0002-8703(05)80189-9
CASPubMedWeb of Science®Google Scholar
222Zhang C-D, Xu S-L, Wang X-Y, Tao L-Y, Zhao W, Gao W. Prevalence of myocardial fibrosis in intensive endurance training athletes: A systematic review and meta-analysis. Front Cardiovasc Med 7: 585692, 2020.
10.3389/fcvm.2020.585692
PubMedWeb of Science®Google Scholar

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