Are There Clinical Cardiac Complications From Too Much Exercise?

The dose-response association between physical activity and cardiovascular outcomes is well described (10). As little as 15 min·d−1 of moderate-intensity exercise significantly lowers the risk for cardiovascular morbidity and mortality. Greater volumes yield greater cardiovascular benefit. However, the impact of extreme volumes of exercise on cardiovascular health is under debate (9), because some studies present evidence of adverse clinical outcomes in endurance athletes who perform exercise volumes at the extreme upper end of the physical activity continuum. These observations raise the possibility that high doses of exercise have deleterious cardiac effects

Using an Ingestible Telemetric Temperature Pill to Assess Gastrointestinal Temperature During Exercise.

Exercise results in an increase in core body temperature (Tc), which may reduce exercise performance and eventually can lead to the development of heat-related disorders. Therefore, accurate measurement of Tc during exercise is of great importance, especially in athletes who have to perform in challenging ambient conditions. In the current literature a number of methods have been described to measure the Tc (esophageal, external tympanic membrane, mouth or rectum). However, these methods are suboptimal to measure Tc during exercise since they are invasive, have a slow response or are influenced by environmental conditions. Studies described the use of an ingestible telemetric temperature pill as a reliable and valid method to assess gastrointestinal temperature (Tgi), which is a representative measurement of Tc. Therefore, the goal of this study was to provide a detailed description of the measurement of Tgi using an ingestible telemetric temperature pill. This study addresses important methodological factors that must be taken into account for an accurate measurement. It is recommended to read the instructions carefully in order to ensure that the ingestible telemetric temperature pill is a reliable method to assess Tgi at rest and during exercise

Incidence and predictors of exertional hyperthermia after a 15-km road race in cool environmental conditions

Objectives Current knowledge about the incidence and risk factors for exertional hyperthermia (core body temperature ≥40 °C) is predominantly based on military populations or small-sized studies in athletes. We assessed the incidence of exertional hyperthermia in 227 participants of a 15-km running race, and identified predictors for exertional hyperthermia. Design Observational study. Methods We measured intestinal core body temperature before and immediately after the race. To identify predictive factors of maximum core body temperature, we entered sex, age, BMI, post-finish dehydration, number of training weeks, fluid intake before and during the race, finish time, and core body temperature change during warming-up into a backward linear regression analysis. Additionally, two subgroups of hyperthermic and non-hyperthermic participants were compared. Results In a WBGT of 11 °C, core body temperature increased from 37.6 ± 0.4 °C at baseline to 37.8 ± 0.4 °C after warming-up, and 39.2 ± 0.7 °C at the finish. A total of 15% of all participants had exertional hyperthermia at the finish. Age, BMI, fluid intake before the race and the core body temperature change during warming-up significantly predicted maximal core body temperature (p < 0.001). Participants with hyperthermia at the finish line had a significantly greater core body temperature rise (p < 0.01) during the warming-up compared to non-hyperthermic peers, but similar race times (p = 0.46). Conclusions 15% of the recreational runners developed exertional hyperthermia, whilst core body temperature change during the warming-up was identified as strongest predictor for core body temperature at the finish. This study emphasizes that exertional hyperthermia is a common phenomenon in recreational athletes, and can be partially predicted

Within-subject Variation of Thermoregulatory Responses during Repeated Exercise Bouts

Aim: To assess the within-subject variation of thermoregulatory responses during 2 consecutive 15-km road races. Secondly, we explored whether gastrointestinal temperature (TGI) data from the first race could improve our previously established predictive model for finish TGI in the second race. Methods: We measured TGI before and immediately after both races in 58 participants and determined correlation coefficients. Finish TGI in the second race was predicted using a linear regression analysis including age, BMI, pre-race fluid intake, TGI increase between baseline and the start of the race and finish TGI in the first race. Results: Under cool conditions (WBGT 11–12°C), TGI was comparable between both races at baseline (37.6±0.4°C vs. 37.9±0.4°C; p=0.24) and finish (39.4±0.6°C vs. 39.4±0.6°C; p=0.83). Finish TGI correlated significantly between both races (r=0.50; p<0.001). The predictive model (p<0.001) could predict 32.2% of the finish TGI in the second race (vs. 17.1% without finish TGI in race 1). Conclusion: Our findings demonstrate that the use of previously obtained thermoregulatory responses results in higher predictability of finish core body temperatures in future races, enabling better risk assessment for those athletes that are most likely to benefit from preventive measures

Precooling and percooling (cooling during exercise) both improve performance in the heat: A meta-analytical review

Background 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. Methods 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. Results 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). Conclusions 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

The binding study advice in medical education: a 2-year experience.

To improve the effectiveness of higher education, Dutch universities implemented the binding study advice at medical faculties. Accordingly, medicine students of Radboud University need to gain ≥ 42 out of 60 European Credit Transfer System (ECTS) credits to obtain a positive binding study advice and to continue their study programme. In case of a negative advice, the student is obliged to terminate the study, and he/she cannot register for the same study programme in the Netherlands within the next three years. The purpose of this manuscript is to evaluate the effect of implementation of the binding study advice on study outcomes. First, the binding study advice did not impact on student performance, as the average ECTS credits were comparable before and after its introduction. Second, study progress improved 8 % with 93 % of the students obtaining access to the second year of the study programme after binding study advice implementation. Third, the binding study advice did not impact propaedeutic graduation rates. These data demonstrate that the implementation of the binding study advice in medical faculties has only a small impact on study outcomes. The high performance levels of medical students compared with peers at other faculties are likely to contribute to these findings and suggest a 'ceiling effect' in the potential improvement of study outcomes at medical faculties

Changes in BNP and cardiac troponin I after high-intensity interval and endurance exercise in heart failure patients and healthy controls

Exercise training represents a cornerstone of contemporary cardiac rehabilitation. Recently, high-intensity interval training (HIT) has been popularized for heart failure (HF) patients (1) and may serve as a superior mode of exercise compared to traditional endurance exercise training. However, there is controversy regarding the safety (2) and the direct effects of HIT on the heart. Previous studies have demonstrated that an acute bout of exercise leads to an increase in cardiac troponin (cTn), a biomarker for cardiac injury, and B-type natriuretic peptide (BNP), a marker for cardiomyocyte stress (3,4). Exercise-induced elevation in these biomarkers is related to exercise intensity and duration (4,5), and may occur to a larger extend in patients with cardiovascular risk factors (6). To date, no previous study: 1. compared changes in cTn and BNP between endurance exercise and HIT, and 2. explored differences in exercise-induced changes in cTn and BNP between HF patients and controls

Benefits of lifelong exercise training on left ventricular function after myocardial infarction.

Background Endurance exercise training induces cardio-protective effects, but athletes are not exempted from a myocardial infarction. Evidence from animal studies suggests that exercise training attenuates pathological left ventricular remodelling following myocardial infarction. We tested the hypothesis that lifelong exercise training is related to attenuated pathological left ventricular remodelling after myocardial infarction as evidenced by better left ventricular systolic function in veteran athletes compared to sedentary peers. Design This was a cross-sectional study. Methods Sixty-five males (60 ± 6 years) were included and allocated to four groups based on lifelong exercise training volumes: (a) athletes ( n = 18), (b) post-myocardial infarction athletes (athletes + myocardial infarction, n = 20), (c) sedentary controls ( n = 13), and (d) post-myocardial infarction controls (sedentary controls + myocardial infarction, n = 14). Athletes were lifelong (≥20 years) highly physically active (≥30 metabolic equivalent of task (MET)-h/week), whereas sedentary controls did not meet the exercise guidelines (<10 MET-h/week) for the past 20 years. left ventricular systolic function, diastolic function and wall strain were measured using echocardiography. Results Cardiac enzyme markers (creatine-kinase, creatinine, aspartate transaminase and lactate dehydrogenase) following myocardial infarction and infarct location did not differ between athletes + myocardial infarction and sedentary controls + myocardial infarction. Left ventricular ejection fraction was significantly higher in athletes (61% ± 4), athletes + myocardial infarction (58% ± 4) and sedentary controls (57% ± 6) compared to sedentary controls + myocardial infarction (51% ± 7; p < 0.01). Left ventricular circumferential strain was superior in athletes (-19% (-21% to -17%), athletes + myocardial infarction (-16% (-20% to -12%)), and sedentary controls (-15% (-18% to -14%) compared to sedentary controls + myocardial infarction (-13% (-15% to -8%), p < 0.01). Diastolic function parameters did not differ across groups. Conclusion These findings suggest that lifelong exercise training may preserve left ventricular systolic function and possibly attenuates or minimises the deleterious effects of pathological post-myocardial infarction left ventricular remodelling in veteran athletes

Altered core and skin temperature responses to endurance exercise in heart failure patients and healthy controls.

BACKGROUND: Exercise training represents a central aspect of rehabilitation of heart failure patients. Previous work on passive heating suggests impaired thermoregulatory responses in heart failure patients. However, no previous study directly examined thermoregulatory responses to an exercise bout, that is, active heating, as typically applied in rehabilitation settings in heart failure. DESIGN: Cross-sectional observational study to compare changes in core body temperature (Tcore) and skin temperature (Tskin) during exercise between heart failure patients and controls. METHODS: Fourteen heart failure subjects (65 ± 7 years, 13:1 male:female) and 14 healthy controls (61 ± 5 years, 12:2 male:female) were included. Tcore (telemetric temperature pill) and Tskin (skin thermistors) were measured continuously during a 45-min cycle exercise at comparable relative exercise intensity. RESULTS: Tcore increased to a similar extent in both groups (controls 1.1 ± 0.4℃, heart failure patients 0.9 ± 0.3℃, 'time*group': p = 0.15). Tskin decreased during the initial phase of exercise in both groups, followed by an increase in Tskin in controls (1.2 ± 1.0℃), whilst Tskin remained low in HF patients (-0.3 ± 1.4℃) ('time*group': p  0.05). CONCLUSION: Heart failure patients and controls show comparable exercise-induced increase in Tcore, whilst heart failure patients demonstrate altered Tskin responses to exercise and attenuated elevation in Tskin per increase in Tcore. These impaired thermoregulatory responses to exercise are, at least partly, explained by the lower absolute workload and lower physical fitness level in heart failure patients

Impact of prolonged walking exercise on cardiac structure and function in cardiac patients versus healthy controls.

BACKGROUND AND DESIGN: Previous studies have demonstrated that endurance exercise can cause an acute transient decrease in cardiac function in healthy subjects. Whether this also occurs in cardiac patients is unknown. We investigated the impact of prolonged single day and three-day walking exercise on cardiac function and cardiac biomarkers between cardiac patients and healthy controls in an observational study. METHODS: We recruited 10 cardiac patients (nine males, one female, 68 ± 5 years) and 10 age- and sex-matched healthy control subjects (nine males, one female, 68 ± 4 years) to perform 30 or 40 km of walking exercise per day for three consecutive days. Cardiac function was examined using echocardiography and cardiac biomarkers (cardiac troponin and B-type natriuretic peptide) with blood samples. Data were collected before walking and directly after walking on day 1 and day 3. RESULTS: Post-exercise early systolic tissue contraction velocity of the left ventricle (p = 0.005) and global longitudinal left ventricle strain (P = 0.026) were increased in both groups compared with baseline. Post-exercise right ventricle peak early diastolic tissue filling velocity and systolic blood pressure/left ventricle end-systolic volume ratio decreased in both groups (p = 0.043 and p = 0.028, respectively). Post-exercise cardiac troponin levels increased (p = 0.045) but did not differ across groups (p = 0.60), whereas B-type natriuretic peptide levels did not change (p = 0.43). CONCLUSION: This study suggests that stable cardiac patients are capable of performing three days of prolonged walking exercise without clinically significant acute overall deterioration in cardiac function or more pronounced increase in cardiac biomarkers compared with healthy controls