Part 1: potential dangers of extreme endurance exercise: how much is too much? Part 2: screening of school-age athletes

The question is not whether exercise is or isn’t one of the very best strategies for improving quality of life, cardiovascular (CV) health and longevity—it is. And there is no debate as to whether or not strenuous high-intensity endurance training produces an amazingly efficient, compliant, and powerful pump—it does. The essence of the controversy centers on what exactly is the ideal pattern of long-term physical activity (PA) for conferring robust and enduring CV health, while also optimizing life expectancy. With that goal in mind, this review will focus on the question: “Is more always better when it comes to exercise?” And if a dose–response curve exists for the therapeutic effects of PA, where is the upper threshold at which point further training begins to detract from the health and longevity benefits noted with moderate exercise? The emerging picture from the cumulative data on this hotly debated topic is that moderate exercise appears to be the sweet spot for bestowing lasting CV health and longevity. However, the specific definition of moderate in this context is not clear yet

The relationship between obesity and coronary artery disease

Obesity continues to be a growing issue in the United States, with an estimated prevalence of 72 million people. There are major health implications associated with obesity, including its relationship with hypertension, diabetes mellitus type 2, metabolic syndrome, and dyslipidemia, all independent risk factors for coronary artery disease (CAD). Despite the increased risk of developing CAD, in recent years an "obesity paradox" has been described in which moderately obese individuals with established cardiovascular disease, including CAD, appear to have mortality similar to their normal-weight counterparts. This review examines the relationship between obesity and CAD, including the increased risk of hypertension, diabetes mellitus, metabolic syndrome, and dyslipidemia, along with a discussion of the obesity paradox and the benefits of weight reduction

Healthy Weight and Obesity Prevention

Overweight and obesity have reached epidemic levels in the United States and worldwide, and this has contributed to substantial cardiovascular and other health risks. However, controversy exists concerning the causes of obesity and effective modalities for its prevention and treatment. There is also controversy related to the concept of metabolically healthy obesity phenotype, the “obesity paradox,” and on the importance of fitness to protect individuals who are overweight or obese from cardiovascular diseases. In this state-of-the-art review, the authors focus on “healthy weight” with the emphasis on the pathophysiologic effects of weight gain on the cardiovascular system; mechanistic/triggering factors; and 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. Additionally, the authors briefly review metabolically healthy obesity, the obesity paradox, and issues beyond lifestyle consideration for weight loss with medications and bariatric surgery.From the John Ochsner Heart and Vascular Institute, Ochsner Clinical School—The University of Queensland School of Medicine, New Orleans, Louisiana; Department of Physical Therapy, College of Applied Health Science, University of Illinois at Chicago, Chicago, Illinois; PROFITH “PROmoting FITness and Health through Physical Activity” Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain; Division of Cardiovascular Medicine, University of Missouri School of Medicine, Columbia, Missouri; and the Northwestern University, Feinberg School of Medicine, Chicago, Illinois. Dr. Ortega receives support for research activity from the Spanish Ministry of Economy and Competitiveness and FEDER (DEP2016-79512-R); additional funding from the University of Granada, Plan Propio de Investigación 2016, Excellence actions: Unit of Excellence on Exercise and Health (UCEES); and the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 667302. Dr. Kushner has served on the advisory board for Novo Nordisk, Weight Watchers, and Retrofit. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose

The role of cardiorespiratory fitness on the risk of sudden cardiac death at the population level: A systematic review and meta-analysis of the available evidence

Cardiorespiratory fitness (CRF) has been widely studied as a powerful and independent predictor of all-cause and disease-specific mortality. Sudden cardiac death (SCD) is recognized as a significant cause of mortality among the general population, including the general population without previous symptoms of any coronary heart disease (CHD). Consequently, SCD is an important public health problem, which constitutes a clinical challenge. Thus, prevention of SCD by detecting early risk factors could be a useful tool, contributing to the American Heart Association‘s goal of decreasing the incidence of SCD at the population level. The identification of these risk factors for CVD would facilitate the large-scale screening of those participants at higher risk of SCD. This systematic review collects information about the role of CRF on the risk of SCD at the available evidence, and analyzes the long-term influence of CRF as a risk factor and independent predictor of SCD