Communicated by Michael Lindinger.
The cardiac consequences of undertaking endurance exercise are the topic of recent debate. The purpose of this review is to provide an update on a growing body of literature, focusing on left ventricular (LV) function following prolonged endurance exercise over 2 h in duration which have employed novel techniques, including myocardial speckle tracking, to provide a more comprehensive global and regional assessment of LV mechanics.
Prospective studies were filtered independently following a pre-set criteria, resulting in the inclusion of 27 studies in the analyses. A random-effects meta-analysis was used to determine the weighted mean difference and 95% confidence intervals (CI) of LV functional and mechanical data from pre-to-post-exercise. Narrative commentary was also provided where volume of available evidence precluded meta-analysis.
A significant overall reduction in LV longitudinal strain (Ɛ) n = 22 (− 18 ± 1 to − 17 ± 1%; effect size (d) − 9: − 1 to − 0.5%), strain rate n = 10 (SR; d − 0.9: − 0.1.3 to − 0.5 l/s) and twist n = 5 (11.9 ± 2.2 to 8.7 ± 2.2°, d − 1: − 1.6 to − 0.3°) was observed following strenuous endurance exercise (range 120–1740 min) (P < 0.01). A smaller number of studies (n = 4) also reported a non-significant reduction in global circumferential and radial Ɛ (P > 0.05).
The meta-analysis and narrative commentary demonstrated that a reduction in LV function and mechanics is evident following prolonged endurance exercise. The mechanism(s) responsible for these changes are complex and likely multi-factorial in nature and may be linked to right and left ventricular interaction.
Banks L, Sasson Z, Busato M, Goodman JM (2010) Impaired left and right ventricular function following prolonged exercise in young athletes: influence of exercise intensity and responses to dobutamine stress. J Appl Physiol (1985) 108:112–119 CrossRef
Banks L, Sasson Z, Esfandiari S, Busato GM, Goodman JM (2011) Cardiac function following prolonged exercise: influence of age. J Appl Physiol (1985) 110:1541–1548 CrossRef
Dawson EA, Whyte GP, Black MA, Jones H, Hopkins N, Oxborough D, Gaze D, Shave RE, Wilson M, George KP, Green DJ (2008) Changes in vascular and cardiac function after prolonged strenuous exercise in humans. J Appl Physiol (1985) 105:1562–1568 CrossRef
Douglas PS, O’Toole ML, Katz SE (1998) Prolonged exercise alters cardiac chronotropic responsiveness in endurance athletes. J Sports Med Phys Fitness 38:158–163 PubMed
Eysmann SB, Gervino E, Vatner DE, Katz SE, Decker L, Douglas PS (1996) Prolonged exercise alters beta-adrenergic responsiveness in healthy sedentary humans. J Appl Physiol (1985) 80:616–622 CrossRef
Lord R, George K, Somauroo J, Stembridge M, Jain N, Hoffman MD, Shave R, Haddad F, Ashley E, Jones H, Oxborough D (2016) Alterations in cardiac mechanics following ultra-endurance exercise: insights from left and right ventricular area-deformation loops. J Am Soc Echocardiogr 29:879–887.e871 CrossRefPubMed
Neilan TG, Januzzi JL, Lee-Lewandrowski E, Ton-Nu TT, Yoerger DM, Jassal DS, Lewandrowski KB, Siegel AJ, Marshall JE, Douglas PS, Lawlor D, Picard MH, Wood MJ (2006a) Myocardial injury and ventricular dysfunction related to training levels among nonelite participants in the Boston marathon. Circulation 114:2325–2333 CrossRefPubMed
Notomi Y, Popovic ZB, Yamada H, Wallick DW, Martin MG, Oryszak SJ, Shiota T, Greenberg NL, Thomas JD (2008) Ventricular untwisting: a temporal link between left ventricular relaxation and suction. Am J Physiol Heart Circ Physiol 294:H505–513 CrossRef
Oxborough D, Birch K, Shave R, George K (2010a) “Exercise-induced cardiac fatigue"—a review of the echocardiographic literature. Echocardiogr J Cardiovasc Ultrasound Allied Tech 27:1130–1140
Oxborough D, Shave R, Warburton D, Williams K, Oxborough A, Charlesworth S, Foulds H, Hoffman MD, Birch K, George K (2011) Dilatation and dysfunction of the right ventricle immediately after ultraendurance exercise: exploratory insights from conventional two-dimensional and speckle tracking echocardiography. Circ Cardiovasc Imaging 4:253–263 CrossRefPubMed
Saltin B, Stenberg J (1964) Circulatory response to prolonged severe exercise. J Appl Physiol 19:833–838 CrossRef
Scott JM, Esch BT, Haykowsky MJ, Isserow S, Koehle MS, Hughes BG, Zbogar D, Bredin SS, McKenzie DC, Warburton DE (2007) Sex differences in left ventricular function and beta-receptor responsiveness following prolonged strenuous exercise. J Appl Physiol (1985) 102:681–687 CrossRef
Stewart GM, Yamada A, Haseler LJ, Kavanagh JJ, Koerbin G, Chan J, Sabapathy S (2015) Altered ventricular mechanics after 60 min of high-intensity endurance exercise: insights from exercise speckle-tracking echocardiography. Am J Physiol Heart Circ Physiol 308:H875–883 CrossRef
- Left ventricular function and mechanics following prolonged endurance exercise: an update and meta-analysis with insights from novel techniques
Rachel N. Lord
David L. Oxborough
Bryony A. Curry
Keith P. George
- Springer Berlin Heidelberg