Cardiovascular Adaptation and Side Effects in Middle-Aged Marathoners

Young-Joo Kim

doi:10.5763/kjsm.2016.34.1.10

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Kim: Cardiovascular Adaptation and Side Effects in Middle-Aged Marathoners

Review Article

Korean J Sports Med 2016;34(1):10-18.

Published online: 19 January 2016

DOI: https://doi.org/10.5763/kjsm.2016.34.1.10

Cardiovascular Adaptation and Side Effects in Middle-Aged Marathoners

Young-Joo Kim

Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence: Young-Joo Kim Department of Rehabilitation Medicine, Sanggye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-1383, Fax: +82-2-938-4109 E-mail: rladudwn1383@naver.com

Received 2 May 2016 Revised 20 May 2016 Accepted 24 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Regular exercise brings about various positive effects on cardiovascular, oncological, psychiatric, neurological, and endocrinological systems of human body. According to exercise types with cardiovascular adaptation, endurance exercise is characterized by eccentric hypertrophy; resistance exercise is characterized by concentric hypertrophy; and the combination of the eccentric hypertrophy and concentric hypertrophy is seen in cycling and rowing. Although the cardiac functions of athletes are not different from those in general population, athletes show higher exercise capacities because of the increased diameter of ventricle. Atrial fibrillation which is the most common in middle-aged marathoners shows 5.3 times higher prevalence compared to that in general population. In addition, higher arterial stiffness is shown in marathoners, and higher resting blood pressure is shown in sub-3 hours-marathoners. Especially the runners with higher resting blood pressure or severe arrhythmia showed superior cardiopulmonary functions and excessive exercise habits when compared to the normal runners. The runners with exercise-induced hypertension are prone to show increased levels of cardiac markers by increasing cardiac muscle burden in exercise, and then be taken with resting hypertension in the future. The major cause of sudden deaths in marathon race of middle-aged marathoners is coronary artery disease (CAD), and the higher prevalence of CAD is shown in middle-aged marathoners being manifested by the exercise stress test or cardiac computed tomography. Therefore, middle-aged marathoners who regularly participate in marathon race are required to undergo annual exercise stress test, and their additional checkups for cardiovascular system should be supervised by specialized medical doctors.

Keywords: Marathon, Cardiac hypertrophy, Arrhythmia, Hypertension, Sudden death

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Fig. 1.

Left ventricle adaptation according to exercise types.

Fig. 2.

(A) Changes in cardiac troponin I (cTnI) in exercise-induced hypertension (EIH) and control (CON) groups before and after the marathon. (B) Changes in N-terminal pro B-type natriuretic peptide (NT-proBNP) in EIH and CON before and after the marathon (C) Changes in endothelin-1 in EIH and CON groups before and after the marathon. ∗Significantly different from CON at p＜0.05; ^§Significantly different from baseline (Pre) at p＜0.05.

Fig. 3.

(A) Creatinine Kinase's response to the 100 km ultramarthon between exercise-induced hypertension group and normal group. (B) C-reactive protein's response to the 100 km ultramarthon between exercise-induced hypertension group and normal group. (C) N-terminal pro-brain natriutretic peptide's response to the 100 km ultramarthon between exercise-induced hypertension group and normal group. CK: creatine kinase, EIH: exercise-induced hypertension, NOR: normal group, Pre: pre-race, hsCRP: high sensitive C-reactive protein, NT-proBNP: N-terminal pro B-type natriuretic peptide. ∗Significantly different from the previous distance at p＜0.05; ^§Significantly different from NOR at p＜0.05.

Fig. 4.

(A) Changes in the creatinine kinase (CK) levels by each check point. (B) Changes in the cardiac troponin I (cTnI) levels by each check point. (C) Changes in the N-terminal pro-brain natriutretic peptide (NT-proBNP) levels by each check point. CK: creatine kinase, Pre: pre-race, cTnI: cardiac troponin I, NS: no significant, NT-proBNP: N-terminal pro B-type natriuretic peptide. ^aSignificant difference compared to the pre-race value; ^bSignificant difference compared to the 100 km check ^cSignificant difference compared to the 200 km point; check point; ∗p＜0.001; ∗∗p＜0.05.

Table 1.

Exercise times, number of finished races, finishing time, exercise habits, and VO_2max in ARG

Factor	NRG (n=538)	ARG (n=14)	Total (n=552)	p-value
Training history (mo)	83.9±43.8	128.5±73.4∗	85.0±45.2	0.041
Marathons completed (n)	42.2±41.5	37.2±21.0	42.1±41.1	0.652
Marathon time (min)	219.7±30.6	206.3±29.2	219.4±30.6	0.106
Exercise intensity (Borg's RPE scale)	12.9±1.5	14.3±0.9^§	13.0±1.5	0.002
Exercise time (min/day)	96.1±37.3	87.9±22.0	95.9±37.0	0.410
Exercise frequency (time/wk)	3.7±1.2	4.0±1.1	3.7±1.3	0.391
VO_2max (mL/kg/min)	49.2±6.5	53.1±6.8∗	49.3±6.5	0.030

Values are presented as the mean±standard deviation. ARG: arrhythmia runners group, NRG: normal runners group, RPE: rating of perceived exertion. ∗Significantly different from NRG at p＜0.05;

^§ Significantly different from NRG at p＜0.01.

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