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Review
. 2018 Aug 28;20(10):84.
doi: 10.1007/s11936-018-0674-3.

The "Extreme Exercise Hypothesis": Recent Findings and Cardiovascular Health Implications

Thijs M H Eijsvogels  1 , Paul D Thompson  2 , Barry A Franklin  3
Affiliations
Review

The "Extreme Exercise Hypothesis": Recent Findings and Cardiovascular Health Implications

Thijs M H Eijsvogels et al. Curr Treat Options Cardiovasc Med. .

Abstract

Purpose of review: The "Extreme Exercise Hypothesis" is characterized by a U-shaped or reverse J-shaped, dose-response curve between physical activity volumes and cardiovascular health outcomes. In this review, we summarize recent findings that may support or refute the "Extreme Exercise Hypothesis." Furthermore, we discuss potential cardiovascular health implications of the cardiac anatomical, structural, contractility, and biomarker abnormalities that have been reported in some veteran endurance athletes.

Recent findings: Emerging evidence from epidemiological studies and observations in cohorts of endurance athletes suggest that potentially adverse cardiovascular manifestations may occur following high-volume and/or high-intensity long-term exercise training, which may attenuate the health benefits of a physically active lifestyle. Accelerated coronary artery calcification, exercise-induced cardiac biomarker release, myocardial fibrosis, atrial fibrillation, and even higher risk of sudden cardiac death have been reported in athletes. There is primarily circumstantial evidence that supports the "Extreme Exercise Hypothesis." Subclinical and atherosclerotic coronary artery disease (CAD) as well as structural cardiovascular abnormalities and arrhythmias are present in some of the most active veteran endurance athletes and need appropriate clinical follow-up to reduce the risk for adverse cardiovascular outcomes. Future studies are warranted to establish the long-term cardiovascular health effects of these findings in veteran endurance athletes.

Keywords: Atherosclerosis; Athletes; Endurance exercise; Myocardial fibrosis; Physical activity; Sudden cardiac death.

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Conflict of interest statement

Conflict of Interest

Thijs M.H. Eijsvogels and Barry A. Franklin each declare no potential conflicts of interest.

Paul D. Thompson reports being a member of the Speakers’ Bureau for Regeneron, Sanofi, Amgen and Amarin; serving as a consultant for Amgen, Regeneron, Esperion and Sanolfi; receiving research support from Sanofi, Regeneron, Esperion, Amgen, and Amarin; owning stock in Abbvie, Abbott, CVS, General Electric, Johnson & Johnson, Medtronic, and Sarepta; and providing legal consultation on exercise-related cardiac events and statin myopathy.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Figures

Fig. 1
Fig. 1
Conceptual overview of the “Extreme Exercise Hypothesis.” Increasing volumes of exercise lead to a curvilinear decrease in health risks, but these health benefits may be partially lost once an individual performs exercise training beyond the optimal exercise dose.
Fig. 2
Fig. 2
Potential mechanisms and associated sequelae for atrial fibrillation induced by strenuous endurance exercise. The combination of autonomic, structural, and hemodynamic effects of high-volume, high-intensity aerobic exercise, repeated over time, likely impart some of the increased risk for arrhythmias (Adapted from [, –48]).
See this image and copyright information in PMC

References

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
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