To the Editor:
La Gerche and Claessen raised concerns about the potential negative effects of exercise, especially strenuous endurance exercise (SEE) on right ventricular (RV) function in both healthy and ill populations.
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This is in line with a recent meta-analysis by Elliott and La Gerche reporting that this type of exercise is associated with acute depression of RV systolic function,2
thus suggesting that exposure to repeated bouts of SEE can have potential long-term consequences. La Gerche and Claessen argued that left atrial pressure is increased during SEE, thereby increasing pulmonary artery pressure.1
Thus, they stated that frequent episodes of increased RV work induced by long-term SEE can promote compensatory RV remodelling, increase myocardial damage biomarkers such as troponins and B-type natriuretic peptide, or even accelerate heart failure (HF). However, to the best of our knowledge, the bulk of available evidence supports the finding that the previously mentioned alterations are rather transient, with a dose-effect relationship existing for exercise intensity and duration.La Gerche and Claessen also state that SEE can promote acute and transient RV dysfunction, with repeated bouts leading to structural remodelling and arrhythmias of the right ventricle.
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In this regard, we recently reported that long-term participation in regular SEE, even at the professional level, does not seem to have negative consequences on RV systolic function, suggesting that, at least in healthy individuals, RV dysfunction induced by an acute bout of SEE is a reversible physiological phenomenon rather than a pathologic response.3
In fact, a recent meta-analysis from our group showed a standard mortality ratio resulting from cardiovascular disease (CVD)—including HF and coronary artery disease—of 0.73 (95% confidence interval, 0.65-0.82; P < 0.001) in those engaging in the highest exercise (including SEE) levels—ie, elite athletes in various sport disciplines (n = 12,119, mostly men), such as Tour de France finishers or Olympic marathoners—compared with the general population.4
Physicians and health professionals should be aware that healthy individuals who engage in SEE sport events could exhibit acute transient cardiologic features that are apparently compatible with cardiac diseases, yet these alterations are attributable in most cases to transient physiological responses rather than pathologic status. In fact, although preparticipation screening is recommended, especially for men aged 40+ years with CVD risk factors (notably, diabetes), long-term SEE practice should not be discouraged in the healthy population because it positively modulates the main risk factors for CVD, ie, obesity, diabetes, hypertension, and hypercholesterolemia.
Disclosures
The authors have no conflicts of interest to disclose.
References
- Is exercise good for the right ventricle? Concepts for health and disease.Can J Cardiol. 2015; 31: 502-508
Elliott 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 2015;49:724-9.
- Strenuous endurance exercise and right ventricular systolic function: no evidence of long-term sequelae.Int J Cardiol. 2015; 179: 297-298
- Elite athletes live longer than the general population: a meta-analysis.Mayo Clin Proc. 2014; 89: 1195-1200
Article info
Publication history
Published online: February 05, 2015
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© 2015 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
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- Is Exercise Good for the Right Ventricle? Concepts for Health and DiseaseCanadian Journal of CardiologyVol. 31Issue 4
- PreviewThere is substantial evidence supporting the prescription of exercise training in patients with left-sided heart disease, but data on the effects of exercise are far more limited for conditions that primarily affect the right ventricle. There is evolving evidence that right ventricular (RV) function is of critical importance to circulatory function during exercise. Even in healthy individuals with normal pulmonary vascular function, the hemodynamic load on the right ventricle increases relatively more during exercise than that of the left ventricle, and this disproportionate load is far greater in patients with pulmonary hypertension.
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- Reply to Sanchis-Gomar et al.—Undeniable Benefits of Exercise Should Not Preclude Inquiry Into the Mechanisms of Arrhythmias in AthletesCanadian Journal of CardiologyVol. 31Issue 10
- PreviewWe thank Sanchis-Gomar et al. for their interest in our review but regret their inference that our article raises concern about the potential negative effects of endurance exercise. We do not think that our position differs from that of our colleagues. In fact, the critique raised by our colleagues in this letter is almost an exact restatement of the words in our article. For example, we state unambiguously: “We do not believe that the small risks associated with disorders such as this are sufficient to discourage anyone from exercise practice and the many health benefits that it provides,” which seems virtually identical to the final comment in our colleagues' letter.
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