Intense Endurance Exercise: A Potential Risk Factor in the Development of Heart Disease

Exercise is known to improve cardiac health; however, the upper limit of exercise is not as clear. High-intensity endurance exercise and its association with cardiac dysfunction are becoming more important as more people in the USA participate in endurance activity. Intensive endurance exercise is associated with heart disease. Peer-reviewed primary literature related to endurance exercise, cardiac remodelling, myocardial fibrosis, and arrhythmia was searched and selected from the PubMed Database to be reviewed. Increased cardiac remodelling, myocardial fibrosis, and arrhythmias were associated with increased endurance exercise in most instances. Clinically significant dysfunction from endurance exercise-induced cardiac remodelling and myocardial fibrosis is not certain. However, increased incidence of sinus node disease (SND) and atrial flutter in endurance athletes, even after deconditioning, seems to be most associated with endurance exercise. Cardiac remodelling, fibrosis, and arrhythmia were associated with cardiac dysfunction. All review articles in this study were limited by a low sample size since it was difficult to obtain a full record of previous endurance activity. The reversibility of cardiac changes needs to be further investigated and can be applied in the differential diagnosis of other cardiomyopathies. The interaction between performance-enhancing drugs and endurance exercise needs to be further studied to determine its action on cardiac health. Findings from these studies could contribute to exercise recommendations.