The cardiovascular consequences of endurance exercise

Project Information

CARDI-ACHE

Grant agreement ID: 655502

DOI

10.3030/655502

Project closed

EC signature date 7 April 2015

Start date 1 June 2015

End date 1 December 2017

Funded under

• EXCELLENT SCIENCE - Marie Skłodowska-Curie Actions

Total cost

€ 183 454,80

EU contribution

€ 183 454,80

Coordinated by

LIVERPOOL JOHN MOORES UNIVERSITY
United Kingdom

Periodic Reporting for period 1 - CARDI-ACHE (The cardiovascular consequences of endurance exercise)

Reporting period: 2015-06-01 to 2017-05-31

Summary of the context and overall objectives of the project

Regular exercise training is known to improve cardiovascular health and longevity. For this purpose, the World Health Organization recommends adults to perform 150 minute per week of moderate intensity physical activity. Recent studies, however, report that acute and/or lifelong high volumes of vigorous intensity endurance exercise can lead to cardiac mal-adaptations such as increased concentrations of biomarkers that reflect cardiomyocyte damage and presence of scar tissue in the heart of presumably healthy athletes.

CARDI-ACHE aimed to elucidate the clinical relevance of these observations. More specifically, we assessed (1) the prognostic value of exercise-induced cardiac biomarker release, (2) the functional consequences of myocardial scarring was assessed in an athletic population, and (3) the potential association between cardiomyocyte damage and markers of cardiac scar tissue.

These studies are important as the uptake of endurance exercisers is rapidly increasing across Europe and the world and this is set against a backdrop where the popular media frequently cover the potential harmful effects of endurance exercise in a largely unbalanced fashion. These alternative facts may stimulate the general population to continue their unhealthy and sedentary lifestyle and prevent exercise adoption of any sort. Consequently our research seeks to provide important new novel information that has a broad-based impact on individuals undertaking endurance exercise through to public health policy makers.

CARDI-ACHE revealed that exercise-induced increases in cardiac biomarkers are highly variable across individuals, and partially depend on exercise intensity and health status. Adverse event rate was yet too low to perform statistical analyses, but will be repeated in the near future. Presence of myocardial scarring did not affect global cardiac function, although regional dysfunction was observed in co-localized scar tissue. Finally, biomarkers of myocardial scarring significantly increased following exercise, though no association was found with markers for cardiomyocyte damage. Taken together, the cardiac ‘maladaptations’ that are typically observed in lifelong athletes presumably have only minor clinical significance. These findings align with previous studies that report a superior life expectancy in athletes compared to the general population and support the concept that Exercise is Medicine.

Work performed from the beginning of the project to the end of the period covered by the report and main results achieved so far

During the past 2 years of my Marie Curie Fellowship I have been busy undertaking numerous activities related to the CARDI-ACHE project. To this end, I completed a number of preparatory activities including attendance at the LJMU Summer School on Echocardiography in Sport and Exercise Sciences and then I applied for and gained ethical approval for the proposed work at the LJMU Institutional Review Board. Subsequently, I contacted consortium partners for WP-2 and explored the possibility of including various case information in our database. I managed to include 850 individuals with assessment of cardiac biomarkers pre and post-exercise and then invited them to complete an online questionnaire about their cardiovascular health status. I was therefore able to assess mortality/survival prevalence at the start and end of the Fellowship time period. Data were merged in an anonymized database, and statistical analyses are performed once adverse event rate is sufficient and this is likely time-dependent. Exercise-induced increases in a biomarker reflecting cardiomyocyte damage was highly variable across individuals with greater increases observed in individuals with cardiovascular diseases compared to healthy controls. We will continue to revisit this database with on-line CV health questionnaires to assess mortality/survival prevalence. Thus the CARDI-ACHE project will continue prospectively in this area.

I recruited a population of middle aged (45-55 yrs) and older (>65 yrs) athletes with a documented history of lifelong endurance exercise exposure to take part in a study about the athlete’s heart and the presence of cardiac dysfunction and/or myocardial fibrosis. For this purpose I have initiated a collaboration with CMR experts Dr’s Cooper and Fairburn from the Liverpool Heart and Chest Hospital. Extensive cardiac imaging was performed in athletes with and without cardiac scarring (WP-3). This allowed me to compare cardiac structure and function between both sub-groups. I found that global cardiac function was not affected in athletes with cardiac scarring, but regional dysfunction was present in areas with co-localized scar tissue. Finally we are currently analysing follow-up scans in the same athletes addressing the issue of progression, regression or development of new fibrosis over time and more exercise exposure in a sub-sample of these athletes. This data will be reported after completion of on-going CMR and echocardiographic image analysis.

Finally, I’ve selected samples from a cohort of marathon runners to perform biomarker analyses of cardiomyocyte damage and cardiac scarring (WP-4). Laboratory analyses were performed for baseline and post-exercise samples in 82 endurance runners. I found significant increases in both biomarkers but absolute concentrations or changes in biomarker levels for damage and fibrosis were not associated with each other. Hence, the present study did not uncover evidence for a direct link between cardiomyocyte damage and cardiac scarring.

Findings from CARDI-ACHE have been published in several scientific peer-reviewed journals (see project publications). Outcomes were also disseminated via social media and press releases so I could target a larger audience and also the general population. I have had the opportunity to share CARDI-ACHE results at several international conferences and interviews with lay press. Finally, there are numerous outputs and communication opportunities to come to showcase remaining CARDI-ACHE data and disseminate this information to diverse populations.

Progress beyond the state of the art and expected potential impact (including the socio-economic impact and the wider societal implications of the project so far)

The CARDI-ACHE project has attracted significant international attention, and in June 2017 I received the New Investigator Award from the American College of Sports Medicine for my cutting-edge work in cardiovascular physiology. Although my fellowship has officially ended I aim to continue to follow-up the prospective cohort of athletes to study the long-term outcomes of endurance exercise as well as complete the CMR and echocardiographic image analysis in the athlete group. Furthermore, I aim to provide a balanced and evidence based overview of the exercise-induced health benefits and potential risks to non-scientific stakeholders. Therefore I continuously translate my research findings to the general population at different levels. First, I regularly present project findings in laymen presentations on symposia, local meetings or social gatherings. Furthermore, I frequently communicate study results with the general public via websites, newsletters, interviews, social media and press releases. These activities ensure the socio-impact of my research projects and may help to adopt a physical active lifestyle among Europeans.

Endurance exercise is increasingly popular across Europe and the rest of the world

CARDI-ACHE investigated the effect of the performance of endurance exercise on heart health