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... Evolving evidence suggests that the considerable benefits of ET may be attained at levels well below those suggested by national guidelines. Running, for example, is a popular and practical form of ET from which much of this evidence is based [16,17]. ...
... Recent running studies have demonstrated a U-shaped relationship between running doses and reduction in CVD and all-cause mortality. These prospective observational studies include the Copenhagen City Heart Study (CCHS) [18,19], the National Runners' and Walkers' Health Studies (NRWHS) [41], and the Aerobics Center Longitudinal Study (ACLS) [15][16][17]. ...
... Data from the ACLS of 13,016 runners and 42,121 nonrunners, with 3413 deaths, followed for an average of 15 years, have been reported recently [15][16][17]. The runners had a 30% reduction in all-cause mortality and 45% reduction in CVD mortality compared with nonrunners, with an average increase in life expectancy of 3 years [17]. ...
... [7][8][9] The current US guidelines for aerobic PA and ET suggest that all individuals should perform at least 150 min/wk of moderate PA, 75 min/wk of vigorous PA, or an equivalent of a combination of both. 2,10 Running is a particularly attractive form of aerobic PA and ET that is generally regarded as a popular and practical high-intensity form of vigorous ET. 11,12 Other evidence indicates that considerable benefits of aerobic PA and ET may be attained at levels well below those suggested by these national and international guidelines, [11][12][13][14][15] and, in fact, there may be cardiotoxicity of extreme exercise training (EET), such as prolonged, high-volume training and competing in marathons, ultramarathons, or full distance triathlons. [7][8][9]16 In this review, we examine the evidence for the benefits of vigorous aerobic PA and ET, specifically running, for protection against various chronic diseases, including CVD and all-cause mortality. ...
... [7][8][9] The current US guidelines for aerobic PA and ET suggest that all individuals should perform at least 150 min/wk of moderate PA, 75 min/wk of vigorous PA, or an equivalent of a combination of both. 2,10 Running is a particularly attractive form of aerobic PA and ET that is generally regarded as a popular and practical high-intensity form of vigorous ET. 11,12 Other evidence indicates that considerable benefits of aerobic PA and ET may be attained at levels well below those suggested by these national and international guidelines, [11][12][13][14][15] and, in fact, there may be cardiotoxicity of extreme exercise training (EET), such as prolonged, high-volume training and competing in marathons, ultramarathons, or full distance triathlons. [7][8][9]16 In this review, we examine the evidence for the benefits of vigorous aerobic PA and ET, specifically running, for protection against various chronic diseases, including CVD and all-cause mortality. ...
... 1,2,6 Patients with these disorders but with a favorable level of CRF generally have a considerably better prognosis than do unfit individuals without these disorders. 1,2,6 Although there is an inherited non-PA component of CRF, which may contribute approximately 15% to 30% to the overall CRF level, 12,22 the major determinant of CRF is the amount and intensity of aerobic PA and ET. Although high levels of both PA and CRF predict a better prognosis, most studies indicate that CRF levels are a considerably better predictor of prognosis than are PA levels. ...
Article
Considerable evidence has established the link between high levels of physical activity (PA) and all-cause and cardiovascular disease (CVD)-specific mortality. Running is a popular form of vigorous PA that has been associated with better overall survival, but there is debate about the dose-response relationship between running and CVD and all-cause survival. In this review, we specifically reviewed studies published in PubMed since 2000 that included at least 500 runners and 5-year follow-up so as to analyze the relationship between vigorous aerobic PA, specifically running, and major health consequences, especially CVD and all-cause mortality. We also made recommendations on the optimal dose of running associated with protection against CVD and premature mortality, as well as briefly discuss the potential cardiotoxicity of a high dose of aerobic exercise, including running (eg, marathons).
... Certainly, all types of PA are associated with benefits, but as reviewed above, HIPA is probably associated with more marked benefits, such as with many leisure time sporting activities and, especially, running. [16][17][18][19][20][62][63][64][65][66][67][68] Several years ago, we reviewed the effects of running on chronic diseases and CVD and all-cause mortality, 16 and updated this more recently. 17 Although, there are numerous studies on running and CVD in the literature, we especially reviewed the data from the National Runner's and Walker's Health Study, the Running Aging Study, the Copenhagen City Heart Study, 18,66 and especially the Aerobics Center Longitudinal Study (ACLS), 19,67 which are all reviewed in detail elsewhere. ...
... 16,17 However, in this report, we will mostly emphasize the data from the ACLS, which is perhaps the largest and most robust from a CVD -and all-cause mortality standpoint, including emphasis on dose-response relationship of running and mortality. 16,17,19,67,68 ...
... In contrast to the results of the Copenhagen City Heart Study, 18,66 which would suggest the loss of benefit or even potentially harm of moderate-doses of running, our results from a larger sample with much better statistical power indicated that runners with Q5 still had significantly better CVD -and all-cause survival compared with nonrunners. 16,17,67,68 However, the higher doses of running were not necessary to achieve maximal CVD -and all-cause mortality reductions. Also, when we later divided the Q5 runners further into tertiles (T1-3), we found that the highest tertile (Q5,T3), or the top 7% of running doses, actually appear to lose the benefit, compared to the nonrunners, although there was no increase in mortality risk, suggesting "more was still not bad" (Fig. 6). ...
Article
A large body of evidence demonstrates positive, graded effects of PA on cardiovascular disease (CVD) morbidity and mortality with increasing intensity compared with lower PA intensity. Running is often designated as a high-intensity PA with substantial evidence supporting its health benefits. Cross-country skiing is among the most demanding aerobic endurance exercises and requires engaging the upper- and lower-body. Cross-country skiing is often regarded as high-intensity PA, which has been associated with significant health benefits. However, a robust body of evidence identifying the dose-response relation between cross-country skiing volume and health outcomes is sparse. Therefore, this review aims to summarize the available evidence linking cross-country skiing with CVD morbidity and all-cause mortality; postulated pathways that may elucidate the relation between these associations; outline areas of ongoing uncertainty; and the implications for primary and secondary CVD prevention. To put the findings into perspective, we also summarized the evidence linking running with CVD morbidity and all-cause mortality. Though a head-to-head comparison is not available, the evidence indicates that performing PA as cross-country skiing associates with lower mortality risk when compared with that observed in those undertaking their PA as running. Potential adverse effects of extreme high weekly doses of cross-country skiing over decades may be cardiac arrhythmias, such as atrial fibrillation. Evidence suggests that cross-country skiing may reduce the risk of CVD events and all-cause mortality via anti-inflammatory pathways, improvements in endothelial function and reduced levels of CVD risk factors, such as lipids, glucose, and blood pressure; and enhancement of cardiorespiratory fitness.
... [2] Running only 10 min/day at slow speed <6 miles/h, weekly running <51 min, <6 miles, 1-2 times, or <506 metabolic equivalents (METS)-min are sufficient to substantially reduce risk of mortality, compared with not running. [3,22] This amount of light exercise is easily achievable, can cause 30% and 45% reduction in all-cause and CV mortality, respectively, and add 3 years of gain in life expectancy. [3] Data extracted from 26 cohort studies show that increment of 1 MET h/week of energy expenditure, which is equivalent to 2-3 min of moderate to vigorous physical activity per day, results in a 0.8% reduction of the average relative risk (RR) of mortality from noncommunicable diseases. ...
... Young individuals with busy lifestyle and time crunch can achieve significant CV benefits by short bouts of running even 10 min a day 3-4 times, less than an hour per week. [22,24] The relation of CV mortality reduction and quantum of physical activity is not linear but curvilinear. [2,9] This observation suggests that at a higher level of exercise further gain in CV benefits is less or may plateau for every additional METS of exercise performed. ...
... [68,69] Cooper Clinic in Dallas, Texas, followed up of 55,137 adults for 15-year to examine associations of running with all-cause and CV mortality. [3,22] They used five quintiles of running so there would be an equal number of cases across different doses of running. CV mortality appeared to be relatively higher in those with higher doses of running compared with lower doses (reverse J-shaped association) and a slight nonsignificant trend of less benefit, for all-cause mortality, with higher doses of running compared with lower doses of running. ...
Article
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The habitual level of physical activity of the human race has significantly and abruptly declined in the last few generations due to technological developments. The professional societies and government health agencies have published minimum physical activity requirement guidelines to educate the masses about the importance of exercise and to reduce cardiovascular (CV) and all-cause mortality at the population level. There is growing participation in marathon running by amateur, middle-aged cases with a belief that more intense exercise will give incremental health benefits. Experts have cautioned the nonathlete amateurs about the "exercise paradox" and probable deleterious effects of high-intensity prolonged exercise on CV and musculoskeletal system. The epidemiological studies suggest a "reverse J shaped" relationship between running intensity and CV mortality. The highest benefits of reduction in CV and all-cause mortality are achieved at a lower intensity of running while the benefits tend to get blunted at a higher intensity of running. The physicians should have a balanced discussion with the amateur runners training for a marathon, about risks and benefits of high-intensity exercise, and should evaluate them to rule out the occult coronary disease.
... [3][4][5][6]8,71 The data suggest that even at levels below the recommendation (150 min/week of moderate or 75 min/week of vigorous aerobic PA) significant health benefits are seen. 65,66,[72][73][74] In a 2014 study, Wen et al found that a 15-min walk produces the same benefits as a 5- min run, and a 105-min walk produces the same benefits as a 25-min run. 75 The maximal benefits of running appear to occur at low levels and at approximately 40 min/day or less. ...
... 75 The maximal benefits of running appear to occur at low levels and at approximately 40 min/day or less. 42,65,66,[72][73][74][75] Although marathons and triathlons are associated with some risk, that risk is not high, and athletes should be not discouraged from participating. 42 Of note, the typical sports that most individuals are involved in during adolescence, and some during adulthood (ie, football, soccer, basketball), do not involve sustained intense aerobic PA, the main pattern of concern for cardiac overuse injury. ...
Article
Background: Debatably, the most commonly prescribed lifestyle modification for cardiovascular health involves daily exercise training (ET) and physical activity. Exercise has numerous known health benefits on blood pressure, lipid profile, weight loss, and glucose metabolism. However, controversy exists regarding the link between excessive endurance ET and harmful cardiac effects. Methods: We review the current literature and discuss the numerous known adverse effects of endurance ET on cardiac function. Results: Excessive endurance ET may negatively affect cardiac anatomy, play a role in osteoarthritis and coronary artery disease development, and increase the risks of cardiac arrhythmia and sudden cardiac death. Conclusion: More ET may not always be better when it comes to endurance ET, and optimal ET dosing regimens are clearly needed.
... 2 Similarly, our recent analysis of running and causespecific mortality suggested a reverse J-shaped association, specifically on coronary heart disease mortality, unlike other causes of death. 3 Data from the National Runners' and Walkers' Health Studies (NRWHS) of 2377 heart attack survivors also indicated a reverse J-shaped association of running or walking with all-cause and cardiovascular disease (CVD) mortality, with loss of benefit at high exercise doses. 4 Both the CCHS and NRWHS have limitations. ...
... Las tasas de mortalidad se ajustaron según la edad de referencia, el sexo y el año de examen. Se evidenció que las personas con una vida sedentaria presentan una mortalidad estimada en 45 por 10.000 personas / año (46) , bajando a 33 por 10.000 si realizaban 60 minutos de ejercicio a la semana, y a unos 28 y 27 por 10000 cuando el ejercicio eran entre 60 y 90 minutos o entre 90 y 150 min. a la semana. ...
... Pheidippides was indeed a well-trained messenger runner who, like his peers in the Greek army, was able to run 100-200 km in 1 day with short pauses only. Although low-to moderate-intensity exercise has well-known cardiovascular benefits [2,3], it has been increasingly suggested that prolonged SEE could have some potential deleterious cardiac effects, and growing controversy exists on the topic [4][5][6][7][8][9][10][11][12][13][14]. Furthermore, the term 'cardiac overuse injury' (or 'over-exercise') has recently been reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise' [5]. ...
Article
Full-text available
Although low- to moderate-intensity exercise has well-known cardiovascular benefits, it has been increasingly suggested that prolonged strenuous endurance exercise (SEE) could have potential deleterious cardiac effects. In effect, the term 'cardiac overuse injury' (or 'over-exercise') has been recently reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise'. In this article, we provide a balanced overview of the current state of knowledge regarding the 'pros' and 'cons' of SEE from a cardiological point of view.
... Some suggested mechanisms to the adverse cardiac effects include increased vascular oxidative stress and inflammation, myocardial fibrosis, functional and structural remodelling of the heart [46]. A question currently debated is whether the excessive endurance training jeopardizes the overall benefits of physical activity [10,47,48]. Our findings, based on the far end of a dose-response relationship, show that even in the absence of long-term cardiovascular advantage, endurance athletes saved years of life. ...
Article
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To quantify the years of life saved from cardiovascular (CVD), cancer and overall deaths among elite athletes according to their main type of physiological effort performed in the Olympic Games. All French athletes participating in the Games from 1912 to 2012, with vital status validated and cause of death (if concerned) identified by the national registries were included (n = 2814, 455 died) and classified according to 6 groups of effort: POWER (continuous effort < 45 s); INTERMEDIATE (45 s ≤ continuous effort < 600 s); ENDURANCE (continuous effort ≥ 600 s); POLYVALENT (participating in different events entering different classifications), INTERMITTENT (intermittent effort, i.e. team sports); PRECISION (targeting events). The theoretical years-lost method was adapted to calculate gains in longevity (years-saved) according to specific-risks under the competing risks model and was implemented in R software. Considering overall-deaths, all groups significantly saved, on average, 6.5 years of life (95% CI 5.8–7.2) compared to the general population. This longevity advantage is mainly driven by a lower risk of cancer which, isolated, contributed to significantly save 2.3 years of life (95% CI 1.2–1.9) on average in each group. The risk of CVD-related mortality in the ENDURANCE and PRECISION groups is not significantly different from the general population. The other groups significantly saved, on average, 1.6 years of life (95% CI 1.2–1.9) from CVD death. The longevity benefits in elite athletes are associated with the type of effort performed during their career, mainly due to differences on the CVD-risk of death.
... 19 Notwithstanding, the hypothesis of a reverse J-shaped association curve between exercise intensity and mortality is controversial. 14,20 It still needs to be explored if there is an optimum upper limit of exercise intensity for different exercise modalities, such as running, beyond which further exercise produces adverse health effects. ...
... Although the current PA guidelines suggest that more exercise and PA generally provide greater health benefits, the doseresponse relationships of different types and intensities of exercise with different health outcomes are still unclear and controversial. 22,23 Therefore, we investigated the dose-response relationship between resistance exercise and the risk of hypercholesterolemia in this study. ...
Article
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Objective: To examine the associations of resistance exercise, independent of and combined with aerobic exercise, with the risk of development of hypercholesterolemia in men. Patients and methods: This study used data from the Aerobics Center Longitudinal Study, which is a cohort examining the associations of clinical and lifestyle factors with the development of chronic diseases and mortality. Participants received extensive preventive medical examinations at the Cooper Clinic in Dallas, Texas, between January 1, 1987, and December 31, 2006. A total of 7317 men aged 18 to 83 years (mean age, 46 years) without hypercholesterolemia at baseline were included. Frequency (times per week) and total amount (min/wk) of resistance and aerobic exercise were determined by self-report. Hypercholesterolemia was defined as a total cholesterol level of 240 mg/dL or higher or physician diagnosis. Results: During a median (interquartile range) follow-up of 4 (2 to 7) years, hypercholesterolemia developed in 1430 of the 7317 men (20%). Individuals meeting the resistance exercise guidelines (≥2 d/wk) had a 13% lower risk of development of hypercholesterolemia (hazard ratio [HR], 0.87; 95% CI, 0.76-0.99; P=.04) after adjustment for general characteristics, lifestyle factors, and aerobic exercise. In addition, less than 1 h/wk and 2 sessions per week of resistance exercise were associated with 32% and 31% lower risks of hypercholesterolemia (HR, 0.68; 95% CI, 0.54-0.86; P=.001; and HR, 0.69; 95% CI, 0.54-0.88; P=.003), respectively, compared with no resistance exercise. Higher levels of resistance exercise did not provide benefits. Meeting both resistance and aerobic exercise guidelines (≥500 metabolic equivalent task min/wk) lowered the risk of development of hypercholesterolemia by 21% (HR, 0.79; 95% CI, 0.68-0.91; P=.002). compared with meeting none of the guidelines. Conclusion: Compared with no resistance exercise, less than 1 h/wk of resistance exercise, independent of aerobic exercise, is associated with a significantly lower risk of development of hypercholesterolemia in men (P=.001). However, the lowest risk of hypercholesterolemia was found at 58 min/wk of resistance exercise. This finding suggests that resistance exercise should be encouraged to prevent hypercholesterolemia in men. However, future studies with a more rigorous analysis including major potential confounders (eg, diet, medications) are warranted.
... Pheidippides was indeed a well-trained messenger runner who, like his peers in the Greek army, was able to run 100-200 km in 1 day with short pauses only. Although low-to moderate-intensity exercise has well-known cardiovascular benefits [2,3], it has been increasingly suggested that prolonged SEE could have some potential deleterious cardiac effects, and growing controversy exists on the topic [4][5][6][7][8][9][10][11][12][13][14]. Furthermore, the term 'cardiac overuse injury' (or 'over-exercise') has recently been reported to group all the possible deleterious cardiac consequences of repeated exposure to SEE or 'over-exercise' [5]. ...
Article
Full-text available
In den letzten Jahren wurde das Mantra: „Sport schützt vor Herzkrankheiten“ durch Studien relativiert, die zu zeigen scheinen, dass zu viel Sport dem Herzen schadet. Zu unrecht, so der Kardiologe und Sportmediziner Prof. Herbert Löllgen. Er befasste sich umfassend mit der Studienlage und beleuchtet Ergebnisse und Methoden kritisch.
... Although all of these 2017 Issues were excellent, I believe that our July/August 2017 Physical Activity/Exercise/ Fitness Issue may become one of the top Issues ever, with many very top level papers, [15][16][17][18][19][20][21][22][23][24][25] including several already in the media, 26-28 that will make this Issue on par along with the January 2014 Obesity and 2015 Physical Activity ones. In fact, P R O G R E S S I N C A R D I O V A S C U L A R D I S E A S E S X X ( 2 0 1 7 ) X X X -X X X 26 which reviewed several of his very major papers on running, [29][30][31][32][33] won the Elsevier Atlas Award. Each month, several articles are nominated from over 1800 Elsevier Journals, and only one is picked by an external advisory board based on showcasing the research that can (or already has) significantly impact people's lives around the world with the hope of bringing greater attention to this research to help ensure its successful implementation. ...
... Indeed, positive effects of regularly performed exercise on cardiorespiratory fitness and metabolic control are without dispute. In most of the well-known diabetes prevention studies as DPS, DDP, HERITAGE, LookAHEAD, STRRIDE, Da Qing Diabetes Study, TULIP, and others, the risk reduction for diabetes, the metabolic syndrome or cardiovascular events ranges around 35 % [4,[21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]. Despite this knowledge, less than 40 % of European countries developed national recommendations for physical activity [36]. ...
Article
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Exercise as a key prevention strategy for diabetes and obesity is commonly accepted and recommended throughout the world. Unfortunately, not all individuals profit to the same extent, some exhibit exercise resistance. This phenomenon of non-response to exercise is found for several endpoints, including glucose tolerance and insulin sensitivity. Since these non-responders are of notable quantity, there is the need to understand the underlying mechanisms and to identify predictors of response. This displays the basis to develop personalized training intervention regimes. In this review, we summarize the current knowledge on response variability, with focus on human studies and improvement of glucose homeostasis as outcome.
... Low to moderate intensity aerobic or endurance exercise (e.g., brisk walking daily for 30-60 min) has well-documented beneficial effects on cardiovascular morbidity and mortality [1,2]. However, the impact of much higher exercise loads (e.g., training for and competing in marathon running events) on a previously healthy heart remain controversial [2][3][4][5], and some authors warn of the potentially deleterious cardiac effects of long-term strenuous endurance exercise [6][7][8]. The concept of 'cardiac overuse injury' (or 'over exercise') has been recently reported to group the potential negative effects of strenuous endurance exercise [9]. ...
Thesis
Type 2 diabetes mellitus (T2DM) represents 90 – 95 % of all diabetes cases and is characterized by β-cell dysfunction and insulin resistance leading to hyperglycemia. Hyperglycemia increases oxidative stress, inflammation, and orthosympatic activity and limits bioavailability of nitric oxide (NO), resulting in micro- (nephropathy, neuropathy, retinopathy) and macrovascular (cerebrovascular, cardiovascular, and peripheral artery disease) complications. These complications result in higher morbidity and mortality rates, decrease quality of life, and increase health economic burden. Increasing physical activity and a more balanced, healthy food intake are the first-line management. Herein, the promising vascular health benefits of nutraceuticals, like flavonoids and more specifically flavanols, have gained interest.Flavanols are natural substances present in several fruits, teas, red wines, beans, and predominantly in cocoa and are believed to beneficially affect human health. Based on epidemiological, in vitro-, animal-, and human studies, cocoa flavanols (CF) would have antioxidant properties, improve endothelial function, lower blood pressure (BP), and reduce inflammation. The mechanisms of action of CF are not yet completely understood, but it is believed that increasing NO bioavailability and –activity and antioxidative actions like inhibiting lipid peroxidation and nicotinamide adenine dinucleotide phosphate oxidase and scavenging free radicals play a key role.So far, research into the potential beneficial vascular health properties of CF in patients with diabetes mellitus (DM) is limited and demonstrated inconsistent results. However, based on the pathophysiology of diabetic vascular complications and the believed mechanisms of action of CF, one could assume that CF would exert vascular protection in T2DM subjects. Therefore, this doctoral research investigated whether CF exert vascular health benefits in patients with T2DM through the following 3 aims: (1) examine the evidence for CF-induced vascular health properties in patients with DM, (2) setup of a robust, standardized, clearly described trial protocol, and (3) investigate the acute effects of CF on peripheral vascular reactivity in patients with T2DM via execution of the described acute, randomized, double-blinded, placebo-controlled cross-over trial.First, we published a systematic review and meta-analysis on the vascular health effects of CF in patients with DM. We highlighted the need for more, robust, standardized research because of the high heterogeneity in administered intervention (dose, duration and frequency, nature of intervention), the studied population (age, sex, BMI, medical therapy, stage of disease), and measurement methods. Because of paucity of reports, we could only perform the meta-analysis on the mid/long-term effects of CF on blood pressure (BP) in patients with DM and mixed populations with increased cardiovascular risk. This meta-analysis indicated weak evidence for a reduction in diastolic BP (DBP) of, at best, 1 – 2 mmHg. No effect on systolic BP (SBP) was detected. Furthermore, CF effects on BP would be stronger in female, hypertensive, younger adults, providing a CF dose comprising at least 90 mg epicatechine (EC), and when ingested in 1 daily batch.Second, the protocol paper illustrating our setup acute, randomized, double-blinded, placebo-controlled cross-over trial was published. Here we thoroughly described our protocol trial in which we take into account the limitations in previous studies. We believe that acute studies in which subjects ingest a pure cocoa extract are the first step to gain insight in CF actions as possible confounding impact of additional fat, sugars, milk or other substances could mask/ counteract/ strengthen the effects of CF [...]
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Background The current guideline recommends moderate‐ to vigorous‐intensity physical activity (PA) at least 40 min/day for 3 to 4 days/week. Although recent evidence has demonstrated that low‐dose PA could reduce cardiovascular mortality, the relationship between low‐dose PA and the risk of stroke remains uncertain. Methods and Results Using data from a nation‐wide sample cohort in Korea, we examined 336 326 individuals who received a general health examination between 2009 and 2010. Level of PA was assessed using a questionnaire for weekly PA frequencies regarding 3 intensity categories: light, moderate, and vigorous. Moderate‐ to vigorous‐intensity PA (MVPA) was classified into 4 frequency categories: none, 1 to 2, 3 to 4, or ≥5 times/week. Cox proportional hazard models were constructed to estimate the risk of stroke. During the average follow‐up of 3.6 years, 2213 stroke cases occurred. MVPA was none in 50%, 1 to 2 times/week in 20%, 3 to 4 times/week in 13%, and ≥5 times/week in 18% of the cohort. Individuals with MVPA 1 to 2 times/week had a 16% reduced risk of stroke (adjusted hazard ratio, 0.84; 95% confidence interval, 0.73–0.96) compared with those with no MVPA. The population attributable fraction of no MVPA was 12%, which was the second most important risk factor for a stroke after hypertension. Conclusions Even 1 to 2 times a week of MVPA might be beneficial to prevent a first‐ever stroke in the general population, although a quantitative validation of the questionnaire is needed. From a public health perspective, we need to encourage inactive people to start exercising with more‐achievable goals.
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Cette thèse visait à explorer trois limites des adaptations cardiovasculaires des sportifs endurants. Les athlètes endurants bradycardes ont-ils un risque augmenté de présenter des syncopes réflexes et des particularités électrocardiographiques par rapport à leurs homologues non bradycardes ? Commencer un entraînement après 40 ans est-il trop tard pour espérer améliorer sa santé cardiovasculaire ? La fatigue cardiaque retrouvée à l’issue d’efforts longs et intenses chez les coureurs à pied est-elle également induite par des efforts pratiqués essentiellement avec les bras comme le canoë-kayak ou par les efforts pratiqués par les militaires durant leurs stages intensifs ? Tout d’abord, l’étude BRADY suggère que chez des athlètes endurants de même niveau qui diffèrent uniquement par leur FC de repos (44 vs 61 batt.min-1) les bradycardes ne sont pas plus à risque de syncopes réflexes ni de particularités électrocardiographiques que les non bradycardes. L’hypertrophie cardiaque, plus importante chez les bradycardes, pourrait jouer un rôle central dans le développement de la bradycardie du sportif. Deuxièmement, l’étude COSS suggère que commencer un entraînement en endurance après 40 ans n’est pas trop tard pour être en meilleure santé cardiovasculaire à 60 ans. En effet le VO2max, la FC de repos ainsi que la balance sympathovagal ne diffèrent pas chez des seniors de 60 ans ayant commencé à s’entraîner avant 30 ans de chez ceux ayant commencé après 40 ans. Ces indices de la santé cardiovasculaire étaient meilleurs dans ces deux groupes par rapport aux personnes n’ayant jamais suivi un entraînement en endurance. Seul un entraînement initié avant 30 ans semble cependant apporter certains bénéfices vasculaires à l’effort, non retrouvés chez les seniors ayant commencé après 40 ans. Enfin, l’étude FACEFI visait à évaluer les conséquences cardiaques de 3 types d’efforts : 3 semaines d’entraînements intenses en canoë-kayak au pôle France de Cesson-Sévigné, 24h d’un stage d’aguerrissement chez des élèves des Écoles de Saint-Cyr Coëtquidan, et 4 jours d’un stage chez les Commandos de Marine. Seule une partie des résultats obtenus chez les Commandos de Marine a été analysée. Ils indiquent que 3 jours et 3 nuits d’un stage commando, finalisés par une marche forcée de 20 km en portant une charge de 20 kg, ne semblent pas altérer ni les dimensions ni les fonctions cardiaques. La durée relativement faible de l’effort (< 2h45), le très bon niveau d’entraînement des sujets, ainsi que la composante en résistance importante des efforts réalisés, peuvent expliquer ce résultat.
Article
Physical inactivity is one of the leading modifiable risk factors for global mortality, with an estimated 20% to 30% increased risk of death compared with those who are physically active. The “behavior” of physical activity (PA) is multifactorial, including social, environmental, psychological, and genetic factors. Abundant scientific evidence has demonstrated that physically active people of all age groups and ethnicities have higher levels of cardiorespiratory fitness, health, and wellness, and a lower risk for developing several chronic medical illnesses, including cardiovascular disease, compared with those who are physically inactive. Although more intense and longer durations of PA correlate directly with improved outcomes, even small amounts of PA provide protective health benefits. In this state-of-the-art review, the authors focus on “healthy PA” with the emphasis on the pathophysiological effects of physical inactivity and PA on the cardiovascular system, mechanistic/triggering factors, the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion regarding PA. Sustainable and comprehensive programs to increase PA among all individuals need to be developed and implemented at local, regional, national, and international levels to effect positive changes and improve global health, especially the reduction of cardiovascular disease.
Article
Physical inactivity is one of the leading modifiable risk factors for global mortality, with an estimated 20% to 30% increased risk of death compared with those who are physically active. The “behavior” of physical activity (PA) is multifactorial, including social, environmental, psychological, and genetic factors. Abundant scientific evidence has demonstrated that physically active people of all age groups and ethnicities have higher levels of cardiorespiratory fitness, health, and wellness, and a lower risk for developing several chronic medical illnesses, including cardiovascular disease, compared with those who are physically inactive. Although more intense and longer durations of PA correlate directly with improved outcomes, even small amounts of PA provide protective health benefits. In this state-of-the-art review, the authors focus on “healthy PA” with the emphasis on the pathophysiological effects of physical inactivity and PA on the cardiovascular system, mechanistic/triggering factors, the role of preventive actions through personal, education/environment, and societal/authoritative factors, as well as factors to provide guidance for caregivers of health promotion regarding PA. Sustainable and comprehensive programs to increase PA among all individuals need to be developed and implemented at local, regional, national, and international levels to effect positive changes and improve global health, especially the reduction of cardiovascular disease.
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Substantial evidence has established the value of high levels of physical activity, exercise training (ET), and overall cardiorespiratory fitness in the prevention and treatment of cardiovascular diseases. This article reviews some basics of exercise physiology and the acute and chronic responses of ET, as well as the effect of physical activity and cardiorespiratory fitness on cardiovascular diseases. This review also surveys data from epidemiological and ET studies in the primary and secondary prevention of cardiovascular diseases, particularly coronary heart disease and heart failure. These data strongly support the routine prescription of ET to all patients and referrals for patients with cardiovascular diseases, especially coronary heart disease and heart failure, to specific cardiac rehabilitation and ET programs. © 2015 American Heart Association, Inc.
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People who are physically active have at least a 30% lower risk of death during follow-up compared with those who are inactive. However, the ideal dose of exercise for improving longevity is uncertain. The aim of this study was to investigate the association between jogging and long-term, all-cause mortality by focusing specifically on the effects of pace, quantity, and frequency of jogging. As part of the Copenhagen City Heart Study, 1,098 healthy joggers and 3,950 healthy nonjoggers have been prospectively followed up since 2001. Cox proportional hazards regression analysis was performed with age as the underlying time scale and delayed entry. Compared with sedentary nonjoggers, 1 to 2.4 h of jogging per week was associated with the lowest mortality (multivariable hazard ratio [HR]: 0.29; 95% confidence interval [CI]: 0.11 to 0.80). The optimal frequency of jogging was 2 to 3 times per week (HR: 0.32; 95% CI: 0.15 to 0.69) or ≤1 time per week (HR: 0.29; 95% CI: 0.12 to 0.72). The optimal pace was slow (HR: 0.51; 95% CI: 0.24 to 1.10) or average (HR: 0.38; 95% CI: 0.22 to 0.66). The joggers were divided into light, moderate, and strenuous joggers. The lowest HR for mortality was found in light joggers (HR: 0.22; 95% CI: 0.10 to 0.47), followed by moderate joggers (HR: 0.66; 95% CI: 0.32 to 1.38) and strenuous joggers (HR: 1.97; 95% CI: 0.48 to 8.14). The findings suggest a U-shaped association between all-cause mortality and dose of jogging as calibrated by pace, quantity, and frequency of jogging. Light and moderate joggers have lower mortality than sedentary nonjoggers, whereas strenuous joggers have a mortality rate not statistically different from that of the sedentary group. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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AimsWe aimed to investigate the association of number of completed races and finishing time with risk of arrhythmias among participants of Vasaloppet, a 90 km cross-country skiing event.Methods and resultsAll the participants without cardiovascular disease who completed Vasaloppet during 1989-98 were followed through national registries until December 2005. Primary outcome was hospitalization for any arrhythmia and secondary outcomes were atrial fibrillation/flutter (AF), bradyarrhythmias, other supraventricular tachycardias (SVT), and ventricular tachycardia/ventricular fibrillation/cardiac arrest (VT/VF/CA). Among 52 755 participants, 919 experienced arrhythmia during follow-up. Adjusting for age, education, and occupational status, those who completed the highest number of races during the period had higher risk of any arrhythmias [hazard ratio (HR)1.30; 95% CI 1.08-1.58; for ≥5 vs. 1 completed race], AF (HR 1.29; 95% CI 1.04-1.61), and bradyarrhythmias (HR 2.10; 95% CI 1.28-3.47). Those who had the fastest relative finishing time also had higher risk of any arrhythmias (HR 1.30; 95% CI 1.04-1.62; for 100-160% vs. >240% of winning time), AF (1.20; 95% CI 0.93-1.55), and bradyarrhythmias (HR 1.85; 95% CI 0.97-3.54). SVT or VT/VF/CA was not associated with finishing time or number of completed races.Conclusions Among male participants of a 90 km cross-country skiing event, a faster finishing time and a high number of completed races were associated with higher risk of arrhythmias. This was mainly driven by a higher incidence of AF and bradyarrhythmias. No association with SVT or VT/VF/CA was found.
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Multiple studies have individually documented cardiac dysfunction and biochemical evidence of cardiac injury after endurance sports; however, convincing associations between the two are lacking. We aimed to determine the associations between the observed transient cardiac dysfunction and biochemical evidence of cardiac injury in amateur participants in endurance sports and to elicit the risk factors for the observed injury and dysfunction. We screened 60 nonelite participants, before and after the 2004 and 2005 Boston Marathons, with echocardiography and serum biomarkers. Echocardiography included conventional measures as well as tissue Doppler-derived strain and strain rate imaging. Biomarkers included cardiac troponin T (cTnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All subjects completed the race. Echocardiographic abnormalities after the race included altered diastolic filling, increased pulmonary pressures and right ventricular dimensions, and decreased right ventricular systolic function. At baseline, all had unmeasurable troponin. After the race, > 60% of participants had increased cTnT > 99th percentile of normal (> 0.01 ng/mL), whereas 40% had a cTnT level at or above the decision limit for acute myocardial necrosis (> or = 0.03 ng/mL). After the race, NT-proBNP concentrations increased from 63 (interquartile range [IQR] 21 to 81) pg/mL to 131 (IQR 82 to 193) pg/mL (P<0.001). The increase in biomarkers correlated with post-race diastolic dysfunction, increased pulmonary pressures, and right ventricular dysfunction (right ventricular mid strain, r=-0.70, P<0.001) and inversely with training mileage (r=-0.71, P<0.001). Compared with athletes training > 45 miles/wk, athletes who trained < or = 35 miles/wk demonstrated increased pulmonary pressures, right ventricular dysfunction (mid strain 16+/-5% versus 25+/-4%, P<0.001), myocyte injury (cTnT 0.09 versus < 0.01 ng/mL, P<0.001), and stress (NT-proBNP 182 versus 106 pg/mL, P<0.001). Completion of a marathon is associated with correlative biochemical and echocardiographic evidence of cardiac dysfunction and injury, and this risk is increased in those participants with less training.