Complex association between physical activity and atrial fibrillation, with nuanced outcomes based on exercise intensity and individual risk factors.
Deep dives
Myocardial Fibrosis in Athletes
Athletes, especially those engaging in high volumes of exercise, show a higher prevalence of myocardial fibrosis than non-exercising controls. Studies reveal that the number of years spent training, competitive marathons, and ultra-endurance marathons completed are correlated with myocardial fibrosis. The location, pattern, and extent of fibrosis differ in athletes compared to non-athletes. While the data suggests a link between exercise volume and myocardial fibrosis, further research is needed to ascertain the clinical significance, especially in the absence of negative health outcomes.
Coronary Artery Calcification and Exercise
Endurance athletes exhibit higher coronary artery calcification scores compared to less active controls, indicating a relationship between exercise volume and calcification. Studies show that athletes with elevated calcification tend to have more stable, calcified plaques rather than soft ones, potentially lowering the risk of plaque rupture. The impact of exercise on calcification is intricate, with varying interpretations based on individual risk factors and history.
Atrial Fibrillation in Athletes
Recent studies indicate a complex association between physical activity, cardiorespiratory fitness, and atrial fibrillation (AFib). Higher cardiorespiratory fitness in the general population is linked to a reduced risk of AFib. Contrastingly, studies in endurance athletes, especially in cross-country skiers, demonstrate an increased risk of AFib with higher exercise volumes. AFib risk is influenced by autonomic changes, structural heart alterations, and hemodynamic shifts related to exercise intensity and duration.
Risk-Benefit Ratio of AFib and Exercise Volume
While high exercise volumes in athletes may correlate with myocardial fibrosis, coronary artery calcification, and atrial fibrillation, the complete risk-benefit ratio remains unclear. Current evidence suggests nuanced outcomes, with higher cardiorespiratory fitness potentially reducing AFib risk in the general population. The relationship between AFib and resistance training remains underexplored, and caution is advised in interpreting the impact of exercise on atrial fibrillation without substantial long-term follow-up data.
The Importance of Monitoring AFib Symptoms and Stroke Risk in Patients
The presence of AFib can impact patients differently, affecting not only symptoms but also the risk of stroke. For older patients with AFib and additional risk factors, the concern heightens, often leading to recommendations for lifelong blood thinner use to minimize stroke risk. Understanding the stroke risk associated with AFib, especially in individuals with exercise-induced AFib, remains a critical aspect of patient care.
Understanding Athlete's Heart and Left Ventricular Hypertrophy
The podcast delves into the concept of athlete's heart, where the heart adapts to exercise demands to support increased performance. Specific studies show that endurance and resistance training lead to different adaptations in heart chambers, with endurance training causing growth in size and thickness of all heart chambers, notably the left ventricle. On the other hand, resistance training mainly increases the thickness of the left ventricle's muscle. The discussion highlights the importance of accurately interpreting cardiac imaging results in athletes to differentiate between physiological adaptations and potential risks like left ventricular hypertrophy.
On this week's podcast, Drs. Baraki and Feigenbaum discuss the extreme exercise hypothesis.
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References:
The “Extreme Exercise Hypothesis”: Recent Findings and Cardiovascular Health Implications
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132728/
Effect of Sex and Sporting Discipline on LV Adaptation to Exercise
https://pubmed.ncbi.nlm.nih.gov/27865722/
Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete's heart
https://pubmed.ncbi.nlm.nih.gov/23474689/
The athlete's heart: a contemporary appraisal of the 'Morganroth hypothesis'
https://pubmed.ncbi.nlm.nih.gov/18081368/
A comparison of cardiac structure and function between female powerlifters, fitness-oriented athletes, and sedentary controls
https://pubmed.ncbi.nlm.nih.gov/32892422/
Physical activity, cardiorespiratory fitness, and cardiovascular health: A clinical practice statement of the ASPC Part I: Bioenergetics, contemporary physical activity recommendations, benefits, risks, extreme exercise regimens, potential maladaptations
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9586848/
Dose-response association between moderate to vigorous physical activity and incident morbidity and mortality for individuals with a different cardiovascular health status: A cohort study among 142,493 adults from the Netherlands
https://pubmed.ncbi.nlm.nih.gov/34855764/
Association of All-Cause and Cardiovascular Mortality With High Levels of Physical Activity and Concurrent Coronary Artery Calcification
https://jamanetwork.com/journals/jamacardiology/fullarticle/2722746
A prospective randomised longitudinal MRI study of left ventricular adaptation to endurance and resistance exercise training in humans
https://pubmed.ncbi.nlm.nih.gov/21969450/
Anabolic Androgenic Steroids Induce Reversible Left Ventricular Hypertrophy and Cardiac Dysfunction. Echocardiography Results of the HAARLEM Study
https://pubmed.ncbi.nlm.nih.gov/36304014/
Myocardial Fibrosis in Athletes
https://pubmed.ncbi.nlm.nih.gov/27720455/
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