Canadian Journal of Cardiology

The Potential Cardiotoxic Effects of Exercise

  • André La Gerche
    Corresponding author: A/Prof André La Gerche, Sports Cardiology, Baker IDI Heart and Diabetes Institute, Level 4 Alfred Centre, 99 Commercial Rd, Melbourne 3004, Australia. Tel.: +1-9288-4423; fax: +61-39288-4422.
    Baker IDI Heart and Diabetes Institute, and Department of Cardiology, Alfred Hospital, Melbourne, Australia; and the Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
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Published:February 24, 2016DOI:


      The emerging controversy related to the potential cardiotoxic effects of high doses of intense exercise need to be considered among the much stronger evidence that supports the pleomorphic benefits of exercise as a whole. However, there is fairly compelling evidence to support the association between long-term sport practice and an increased prevalence of atrial fibrillation and the fact that this relates to a chronic altered atrial substrate. This article was designed to challenge the reader with speculative science that suggests that exercise might promote permanent structural changes in the myocardium which can, in some individuals, predispose to arrhythmias. In terms of long-term health outcomes, it would seem that these small risks are outweighed by the many other benefits of exercise, including a likely decrease in atherosclerotic vascular events, although some recent results have brought into question whether the protective benefits of exercise on vascular events also extends to high-intensity exercise training. Above all else, in this article we sought to highlight current controversies to stimulate research on the many unanswered questions. In particular, there is a lack of adequately powered prospective studies from which we can measure health outcomes and their relationship to exercise-induced cardiac remodelling.


      La nouvelle controverse relative aux possibles effets cardiotoxiques de l’exercice intensif pendant de longues périodes doit être revue à la lumière des preuves beaucoup plus probantes appuyant les nombreux bienfaits offerts par l’exercice physique en général. Il existe des preuves assez concluantes à l’effet que les sports intenses pratiqués à long terme augmentent la prévalence de la fibrillation auriculaire liée à une modification du substrat auriculaire et cet article a pour but de mettre le lecteur au défi en lui présentant l’hypothèse selon laquelle l’exercice serait susceptible d’entraîner des modifications structurelles permanentes du myocarde qui pourraient prédisposer certaines personnes à l’arythmie. Ces risques, somme toute limités, seraient toutefois amplement compensés par les bienfaits généraux de l’exercice physique, notamment la réduction des accidents vasculaires liés à l’athérosclérose, et ce, même si les résultats de certaines études récentes semblent remettre en question les bienfaits vasculaires de l’exercice intensif. Dans cet article, nous avons avant tout cherché à faire ressortir la controverse actuelle afin de stimuler l’amorce de travaux de recherche visant à fournir des réponses aux nombreuses questions qui demeurent toujours en suspens. Il y a notamment une pénurie d’études prospectives suffisamment importantes pour pouvoir mesurer les effets de l’exercice sur la santé et son association avec le remodelage cardiaque induit par l’exercice.
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