Whether sports participation is healthy or detrimental for the individual is a matter of dosage

Netherlands Heart Journal, Feb 2018

J. L. R. M. Smeets

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Whether sports participation is healthy or detrimental for the individual is a matter of dosage

Neth Heart J Whether sports participation is healthy or detrimental for the individual is a matter of dosage J. L. R. M. Smeets 0 1 2 0 Host DAS-CAM, Maastricht University Medical Centre , Maastricht , The Netherlands 1 Radboud University Medical Centre , Nijmegen , The Netherlands 2 J. L. R. M. Smeets Adaptation from Paracelsus: “Whether wine is a nourishment, medicine or poison is a matter of dosage”. cardiovascular problems such as atrial fibrillation remains to be determined. Today, we are confronted with the fact that young athletes, without cardiovascular risk factors or cardiovascular disease are affected by atrial fibrillation, often referred to as 'lone atrial fibrillation'. Is there a relation between the level of exercise and the occurrence of atrial fibrillation? In a cohort study of more than 50,000 long-distance cross-country skiers Andersen et al. found a higher incidence of atrial fibrillation in participants who performed a higher number of races and had faster finishing times. This clearly suggests that a high and prolonged level of exercise is related to the development of atrial fibrillation [3]. - That regular strenuous physical exercise is an excellent, effective and ‘cheap’ method in the primary and secondary prevention of cardiovascular disease has been well established. Even in the presence of cardiovascular risk factors and/or cardiovascular disease with or without atrial fibrillation, regular physical exercise improves the health and diminishes the burden of arrhythmias in the individual. Early studies proving this concept mainly involved the male part of the population, later the positive effect was also confirmed in pre- and post-menopausal females. There is, however, much discussion regarding the optimal level (frequency, duration and intensity) of exercise for maximal beneficial effect. Study results show that the higher the level of aerobic physical activity, the better the decrease in cardiovascular risk profile, in male and female athletes. The aerobic physical activity was expressed in specific time slots per week (7 h per week spread over several days) or METS (metabolic equivalent (MET) is amount of oxygen consumed per kg body weight per minute; in rest +3.5 ml O2) to determine the level that would effectively reduce cardiovascular risk, including arrhythmias such as atrial fibrillation [ 1, 2 ]. In the last decade, more vigorous exercise has become ‘fashionable’. Marathon runs are very popular and obstacle races in extreme conditions (wet, ice, mud) have gained in popularity. For 2018, nearly 3,500 races are scheduled worldwide in the ‘ultra’ running category, clearly exceeding the marathon distance. Whether this extreme physical load could cause Now, endurance sport can be recognised as a cause of cardiovascular disease in specific atrial fibrillation as well [ 4 ]. In this issue, Guasch et al. discuss the mechanisms of atrial fibrillation in athletes: what we know and what we do not know [ 4 ]. What exactly do we know about the mechanism that initiates and perpetuates atrial fibrillation in an apparently normal heart? Why do some athletes develop atrial fibrillation whereas others performing the same amount of exercise do not? What is the normal behaviour of blood pressure during exercise? Which causative factors might be identified which promote or even cause atrial fibrillation in endurance sport? Guasch et al. clearly analyse the different components that might be involved in the initiation and maintenance of atrial fibrillation in athletes [ 4 ]. Left atrial dilatation is well recognised as a causative factor for atrial fibrillation. Pressure overload, together with some genetic components in the individual, ischaemia and fibrosis formation due to the acute pressure moment with inflammatory reaction can lead to this atrial dilatation and morphologic changes in the atrium and thus to the development of atrial fibrillation. However, an individual approach of the athlete is needed, considering all potential causes for the initiation of atrial fibrillation and avoiding the process leading to irreversible damage and thus to persistence of atrial fibrillation. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 1. Malmo V , Nes BM , Amundsen BH , et al. Aerobic interval training reduces the burden of atrial fibrillation in the short term: a randomized trial . Circulation . 2016 ; 133 : 466 - 73 . 2. Eckel RH , Jakicic JM , Ard JD , et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association task force on practice guidelines . J Am Coll Cardiol . 2013 ; 63 : 2960 - 84 . 3. Andersen K , Farahmand B , Ahlbom A , et al. Risk of arrhythmias in 52 755 long-distance cross-country skiers: a cohort study . Eur Heart J . 2013 ; 34 : 3624 - 31 . 4. Guasch E , Mont L , Sitges M. Mechanisms of atrial fibrillation in athletes: what we know and what we do not know . Neth Heart J . 2018 ; 26 . https://doi.org/10.1007/s12471-018-1080-x 5. D 'Souza A , Bucchi A , Johnsen AB , et al. Exercise training reduces resting heart rate via downregulation of the funny channel HCN4 . Nat Commun . 2014 ; 5 : 3775 . 6. Karjalainen J , Kujala UM , Kaprio J , et al. Lone atrial fibrillation in vigorously exercising middle aged men: case-control study . BMJ . 1998 ; 316 : 1784 - 5 . 7. Sanchis L , Sanz-De La Garza M , Bijnens B , et al. Gender influence on the adaptation of atrial performance to training . Eur J Sport Sci . 2017 ; 1391 : 1 - 7 . 8. Guasch E , Mont L . Exercise, sex and atrial fibrillation: arrhythmogenesis beyond Y-chromosome? Heart . 2015 ; 101 : 1607 - 9 .

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J. L. R. M. Smeets. Whether sports participation is healthy or detrimental for the individual is a matter of dosage, Netherlands Heart Journal, 2018, 113-114, DOI: 10.1007/s12471-018-1083-7