Myocardial Fibrosis in Athletes van de Schoor, Freek R; Aengevaeren, Vincent L; Hopman, Maria T E ...
Mayo Clinic proceedings,
11/2016, Volume:
91, Issue:
11
Journal Article
Peer reviewed
Open access
Myocardial fibrosis (MF) is a common phenomenon in the late stages of diverse cardiac diseases and is a predictive factor for sudden cardiac death. Myocardial fibrosis detected by magnetic resonance ...imaging has also been reported in athletes. Regular exercise improves cardiovascular health, but there may be a limit of benefit in the exercise dose-response relationship. Intense exercise training could induce pathologic cardiac remodeling, ultimately leading to MF, but the clinical implications of MF in athletes are unknown. For this comprehensive review, we performed a systematic search of the PubMed and MEDLINE databases up to June 2016. Key Medical Subject Headings terms and keywords pertaining to MF and exercise (training) were included. Articles were included if they represented primary MF data in athletes. We identified 65 athletes with MF from 19 case studies/series and 14 athletic population studies. Myocardial fibrosis in athletes was predominantly identified in the intraventricular septum and where the right ventricle joins the septum. Although the underlying mechanisms are unknown, we summarize the evidence for genetic predisposition, silent myocarditis, pulmonary artery pressure overload, and prolonged exercise-induced repetitive micro-injury as contributors to the development of MF in athletes. We also discuss the clinical implications and potential treatment strategies of MF in athletes.
To determine the relationship between lifelong exercise dose and the prevalence of cardiovascular morbidity.
From June 1, 2011, through December 31, 2014, 21,266 individuals completed an online ...questionnaire regarding their lifelong exercise patterns and cardiovascular health status. Cardiovascular disease (CVD) was defined as a diagnosis of myocardial infarction, stroke, or heart failure, and cardiovascular risk factors (CVRFs) were defined as hypertension, hypercholesterolemia, or type 2 diabetes. Lifelong exercise patterns were measured over a median of 32 years for 405 patients with CVD, 1379 patients with CVRFs, and 10,656 controls. Participants were categorized into nonexercisers and quintiles (Q1-Q5) of exercise dose (metabolic equivalent task MET minutes per week).
The CVD/CVRF prevalence was lower for each exercise quintile compared with nonexercisers (CVD: nonexercisers, 9.6% vs Q1: 4.4%, Q2: 2.8%, Q3: 2.4%, Q4: 3.6%, Q5: 3.9%; P<.001; CVRF: nonexercisers, 24.6% vs Q1: 13.8%, Q2: 10.2%, Q3: 9.0%, Q4: 9.4%, Q5: 12.0%; P<.001). The lowest exercise dose (Q1) significantly reduced CVD and CVRF prevalence, but the largest reductions were found at 764 to 1091 MET-min/wk for CVD (adjusted odds ratio=0.31; 95% CI, 0.20-0.48) and CVRFs (adjusted odds ratio=0.36; 95% CI, 0.28-0.47). The CVD/CVRF prevalence did not further decrease in higher exercise dose groups. Exercise intensity did not influence the relationship between exercise patterns and CVD or CVRFs.
These findings demonstrate a curvilinear relationship between lifelong exercise patterns and cardiovascular morbidity. Low exercise doses can effectively reduce CVD/CVRF prevalence, but engagement in exercise for 764 to 1091 MET-min/wk is associated with the lowest CVD/CVRF prevalence. Higher exercise doses do not yield additional benefits.
Purpose
Fat-free mass (FFM) loss is a concerning aspect of bariatric surgery, but little is known about its time-course and factors related with excessive FFM loss. This study examined (i) the ...progress of FFM loss up to 3 years post-bariatric surgery and (ii) the prevalence and determinants of excessive FFM loss.
Materials and Methods
A total of 3596 patients (20% males, 43.5 ± 11.1 years old, BMI = 44.2 ± 5.5 kg/m
2
) underwent sleeve gastrectomy (SG) or Roux-en-Y gastric bypass (RYGB) surgery. Bioelectrical impedance analysis was performed preoperatively and 3, 6, 9, 12, 18, 24 and 36 months post-surgery. Changes in body composition were assessed by mixed model analysis. Prevalence of excessive FFM loss (based on three different cutoff values: ≥ 25%, ≥ 30% and ≥ 35% FFM loss/weight loss (= %FFML/WL)) was estimated and its determinants were assessed by linear regression analysis.
Results
Highest rates of FFM loss were found at 3 and 6 months post-surgery, reflecting 57% and 73% of peak FFM loss, respectively. Prevalence of excessive FFM loss ranged from 14 to 46% at 36 months post-surgery, with an older age (
β
= 0.14, 95%CI = 0.10–0.18,
P
< .001), being male (
β
= 3.99, 95%CI = 2.86–5.12,
P
< .001), higher BMI (
β
= 0.13, 95%CI = 0.05–0.20,
P
= .002) and SG (
β
= 2.56, 95%CI = 1.36–3.76,
P
< .001) as determinants for a greater %FFML/WL.
Conclusion
Patients lost most FFM within 3 to 6 months post-surgery. Prevalence of excessive FFM loss was high, emphasizing the need for more vigorous approaches to counteract FFM loss. Furthermore, future studies should assess habitual physical activity and dietary intake shortly after surgery in relation to FFM loss.
Exercise increases core body temperature (Tc), which is necessary to optimise physiological processes. However, excessive increase in Tc may impair performance and places participants at risk for the ...development of heat-related illnesses. Cooling is an effective strategy to attenuate the increase in Tc. This meta-analysis compares the effects of cooling before (precooling) and during exercise (percooling) on performance and physiological outcomes.
A computerised literature search, citation tracking and hand search were performed up to May 2013. 28 studies met the inclusion criteria, which were trials that examined the effects of cooling strategies on exercise performance in men, while exercise was performed in the heat (>30°C). 20 studies used precooling, while 8 studies used percooling.
The overall effect of precooling and percooling interventions on exercise performance was +6.7±0.9% (effect size (ES)=0.43). We found a comparable effect (p=0.82) of precooling (+5.7±1.0% (ES=0.44)) and percooling (+9.9±1.9% (ES=0.40)) to improve exercise performance. A lower finishing Tc was found in precooling (38.9°C) compared with control condition (39.1°C, p=0.03), while Tc was comparable between conditions in percooling studies. No correlation between Tc and performance was found. We found significant differences between cooling strategies, with a combination of multiple techniques being most effective for precooling (p<0.01) and ice vest for percooling (p=0.02).
Cooling can significantly improve exercise performance in the heat. We found a comparable ES for precooling and percooling on exercise performance, while the type of cooling technique importantly impacts the effects. Precooling lowered the finishing core temperature, while there was no correlation between Tc and performance.
Summary
Postbariatric loss of muscle tissue could negatively affect long‐term health due to its role in various bodily processes, such as metabolism and functional capacity. This meta‐analysis aimed ...to unravel time‐dependent changes in the magnitude and progress of lean body mass (LBM), fat‐free mass (FFM), and skeletal muscle mass (SMM) loss following bariatric surgery. A systematic literature search was conducted in Pubmed, Embase, and Web of Science. Fifty‐nine studies assessed LBM (n = 37), FFM (n = 20), or SMM (n = 3) preoperatively and ≥1 time points postsurgery. Random‐effects meta‐analyses were performed to determine pooled loss per outcome parameter and follow‐up time point. At 12‐month postsurgery, pooled LBM loss was −8.13 kg 95%CI −9.01; −7.26. FFM loss and SMM loss were −8.23 kg 95%CI −10.74; −5.73 and −3.18 kg 95%CI −5.64; −0.71, respectively. About 55% of 12‐month LBM loss occurred within 3‐month postsurgery, followed by a more gradual decrease up to 12 months. Similar patterns were seen for FFM and SMM. In conclusion, >8 kg of LBM and FFM loss was observed within 1‐year postsurgery. LBM, FFM, and SMM were predominantly lost within 3‐month postsurgery, highlighting that interventions to mitigate such losses should be implemented perioperatively.
Multiple epidemiological studies document that habitual physical activity reduces the risk of atherosclerotic cardiovascular disease (ASCVD), and most demonstrate progressively lower rates of ASCVD ...with progressively more physical activity. Few studies have included individuals performing high-intensity, lifelong endurance exercise, however, and recent reports suggest that prodigious amounts of exercise may increase markers for, and even the incidence of, cardiovascular disease. This review examines the evidence that extremes of endurance exercise may increase cardiovascular disease risk by reviewing the causes and incidence of exercise-related cardiac events, and the acute effects of exercise on cardiovascular function, the effect of exercise on cardiac biomarkers, including "myocardial" creatine kinase, cardiac troponins, and cardiac natriuretic peptides. This review also examines the effect of exercise on coronary atherosclerosis and calcification, the frequency of atrial fibrillation in aging athletes, and the possibility that exercise may be deleterious in individuals genetically predisposed to such cardiac abnormalities as long QT syndrome, right ventricular cardiomyopathy, and hypertrophic cardiomyopathy. This review is to our knowledge unique because it addresses all known potentially adverse cardiovascular effects of endurance exercise. The best evidence remains that physical activity and exercise training benefit the population, but it is possible that prolonged exercise and exercise training can adversely affect cardiac function in some individuals. This hypothesis warrants further examination.
Physical activity and exercise training are associated with a lower risk for coronary events. However, cross-sectional studies in middle-aged and older male athletes revealed increased coronary ...artery calcification (CAC) and atherosclerotic plaques, which were related to the amount and intensity of lifelong exercise. We examined the longitudinal relationship between exercise training characteristics and coronary atherosclerosis.
Middle-aged and older men from the MARC-1 (Measuring Athlete's Risk of Cardiovascular Events 1) study were invited for follow-up in MARC-2 (Measuring Athlete's Risk of Cardiovascular Events 2) study. The prevalence and severity of CAC and plaques were determined by coronary computed tomography angiography. The volume (metabolic equivalent of task MET hours/week) and intensity (moderate 3 to 6 MET hours/week; vigorous 6 to 9 MET hours/week; and very vigorous ≥9 MET hours/week) of exercise training were quantified during follow-up. Linear and logistic regression analyses were performed to determine the association between exercise volume/intensity and markers of coronary atherosclerosis.
We included 289 (age, 54 50 to 60 years median (Q1 to Q3)) of the original 318 MARC-1 participants with a follow-up of 6.3±0.5 years (mean±SD). Participants exercised for 41 (25 to 57) MET hours/week during follow-up, of which 0% (0 to 19%) was at moderate intensity, 44% (0 to 84%) was at vigorous intensity, and 34% (0 to 80%) was at very vigorous intensity. Prevalence of CAC and the median CAC score increased from 52% to 71% and 1 (0 to 32) to 31 (0 to 132), respectively. Exercise volume during follow-up was not associated with changes in CAC or plaque. Vigorous intensity exercise (per 10% increase) was associated with a lesser increase in CAC score (β, -0.05 -0.09 to -0.01;
=0.02), whereas very vigorous intensity exercise was associated with a greater increase in CAC score (β, 0.05 0.01 to 0.09 per 10%;
=0.01). Very vigorous exercise was also associated with increased odds of dichotomized plaque progression (adjusted odds ratio aOR, 1.09 1.01 to 1.18 per 10%; aOR, 2.04 0.93 to 4.15 for highest versus lowest very vigorous intensity tertiles, respectively), and specifically with increased calcified plaques (aOR, 1.07 1.00 to 1.15 per 10%; aOR, 2.09 1.09 to 4.00 for highest versus lowest tertile, respectively).
Exercise intensity but not volume was associated with progression of coronary atherosclerosis during 6-year follow-up. It is intriguing that very vigorous intensity exercise was associated with greater CAC and calcified plaque progression, whereas vigorous intensity exercise was associated with less CAC progression.
Purpose
The magnitude of heat acclimation (HA) adaptations varies largely among individuals, but it remains unclear what factors influence this variability. This study compared individual ...characteristics related to fitness status and body dimensions of low-, medium-, and high responders to HA.
Methods
Twenty-four participants (9 female, 15 male; maximum oxygen uptake
V
˙
O
2peak,kg
52 ± 9 mL kg
−1
min
−1
) completed 10 daily controlled-hyperthermia HA sessions. Adaptations were evaluated by heat stress tests (HST; 35 min cycling 1.5 W kg
−1
; 33 °C, 65% relative humidity) pre- and post-HA. Low-, medium-, and high responder groups were determined based on tertiles (
n
= 8) of individual adaptations for resting rectal temperature (
T
re
), exercise-induced
T
re
rise (Δ
T
re
), whole-body sweat rate (WBSR), and heart rate (HR).
Results
Body dimensions (
p
> 0.3) and
V
˙
O
2peak,kg
(
p
> 0.052) did not differentiate low-, medium-, and high responders for resting
T
re
or Δ
T
re
. High WBSR responders had a larger body mass and lower body surface area-to-mass ratio than low responders (83.0 ± 9.3 vs 67.5 ± 7.3 kg; 249 ± 12 vs 274 ± 15 cm
2
kg
−1
, respectively;
p
< 0.005). Conversely, high HR responders had a smaller body mass than low responders (69.2 ± 6.8 vs 83.4 ± 9.4 kg;
p
= 0.02).
V
˙
O
2peak,kg
did not differ among levels of responsiveness for WBSR and HR (
p
> 0.3).
Conclusion
Individual body dimensions influenced the magnitude of sudomotor and cardiovascular adaptive responses, but did not differentiate
T
re
adaptations to HA. The influence of
V
˙
O
2peak,kg
on the magnitude of adaptations was limited.
Subjective measures of sedentary behaviour (SB) (i.e. questionnaires and diaries/logs) are widely implemented, and can be useful for capturing type and context of SBs. However, little is known about ...comparative validity and reliability. The aim of this systematic review and meta-analysis was to: 1) identify subjective methods to assess overall, domain- and behaviour-specific SB, and 2) examine the validity and reliability of these methods.
The databases MEDLINE, EMBASE and SPORTDiscus were searched up to March 2020. Inclusion criteria were: 1) assessment of SB, 2) evaluation of subjective measurement tools, 3) being performed in healthy adults, 4) manuscript written in English, and 5) paper was peer-reviewed. Data of validity and/or reliability measurements was extracted from included studies and a meta-analysis using random effects was performed to assess the pooled correlation coefficients of the validity.
The systematic search resulted in 2423 hits. After excluding duplicates and screening on title and abstract, 82 studies were included with 75 self-reported measurement tools. There was wide variability in the measurement properties and quality of the studies. The criterion validity varied between poor-to-excellent (correlation coefficient R range - 0.01- 0.90) with logs/diaries (R = 0.63 95%CI 0.48-0.78) showing higher criterion validity compared to questionnaires (R = 0.35 95%CI 0.32-0.39). Furthermore, correlation coefficients of single- and multiple-item questionnaires were comparable (1-item R = 0.34; 2-to-9-items R = 0.35; ≥10-items R = 0.37). The reliability of SB measures was moderate-to-good, with the quality of these studies being mostly fair-to-good.
Logs and diaries are recommended to validly and reliably assess self-reported SB. However, due to time and resources constraints, 1-item questionnaires may be preferred to subjectively assess SB in large-scale observations when showing similar validity and reliability compared to longer questionnaires.
CRD42018105994.
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