Erick Carlson, MD presents "Exercise and the Heart" at the March 4 -6, 2016 Cardiac and Thoracic Surgery Associates, Cardiovascular Summit at The Westin Riverfront Resort and Spa.

1. Exercise and Your Heart
Erik Carlson, M.D.

2. 70 yo AAM no previous C/V disease history and really no
medical issues presents given an abnormal ECG.
Plays singles tennis most days of the week for about 60-90
minutes per session.
Also cycles several days per week and has been doing this for
decades.
No family Hx of C/V disease and never smoked.
He feels well with no symptoms. PE is normal. BP
131/79mmHg.

5. 50 yo endurance athlete, no PMHx, referred for
echocardiogram following finding of a “murmur” by
internist.
ECHO:
LVEF of 45-50% - Normal LVEF >51%
LV size 5.8 cm – Normal 5.8 cm
LV wall thickness 1.2 cm – Normal being 1.0 cm of less.
Diastolic function normal
LV mass 128g/m2 – Upper limits of normal 115g/m2
Right ventricle is mild to moderately dilated but normal systolic function
Right atrium - severely dilated
Left atrium - mildly dilated

6. J Am Coll Cardiol. 2015;65(5):493-502. doi:10.1016/j.jacc.2014.10.064
Between 1990 and 2013, the number of participating athletes who completed
running races in the United States increased significantly to ∼20 million per year;
54% were older than 35 years of age.

7. Physiologic Response to Exercise
• HR and Stroke Volume (21 L/min; 35L/min)
• SBP
• DBP

8. Physiologic Response to Exercise
Rev Esp Cardiol. 2012;65:14-21 - Vol. 65 Num.01

9. 0 1 2 3 4 5 6
Weightlifting
X-skiing
Soccer
Cycling
Rowing
Average
Physiologic Cardiac Hypertrophy among 947 Elite Level
Athletes.
Pellicchia, et al. NEJM 1991 325:295-301.
Thickness (cm)
LV-size (cm)

10. Findings That Suggest Pathologic LVH
1. Pathologic Q-waves
2. LVH greater than 15 mm
3. Presence of diastolic dysfunction
- Reduced longitudinal motion (Septal E prime velocity less than 8 cm/s)
- E/e' > 15
4. Smaller left ventricular cavity diameter in end-diastole
<45 mm
5. Presence of late gadolinium enhancement (LGE) by CMR

11. Exercise is a Good Thing…right?
In 1953, Morris et al published the findings from a study
showing that bus conductors in London, who spent their
working hours walking the length of the buses as well as
climbing up and down the stairs of the English double-
decker buses to collect fares, experienced half the
coronary heart disease (CHD) mortality rates of their
driver counterparts, who spent their day sitting behind
the wheel.
Coronary heart-disease and physical activity of work. Lancet. 1953; 265: 1053–1057.

12. Cardiac Biomarkers with Prolonged Exercise
Ironman Australia – 2001
Am Heart J. 150 2005:1128-1134
Br J Sports Med. 40 2006:605-609
• 86% had cTnT>0.01mcg/dL
• 16% had cTnT >0.10mcg/dL
• Decrease in RV ejection
fraction
• Elevations in BNP

13. Distribution by age of sports-related sudden deaths (SDs) in the overall population
(blue) and among young competitive athletes (red) in a nationwide, 5-year study in
France, showing that the vast majority occurred in those 35 years of age and older.
J Am Coll Cardiol. 2015;65(5):493-502. doi:10.1016/j.jacc.2014.10.064

14. The Greater the Frequency of Weekly Exertion, the Greater the
Reduction in Relative Risk of MI
A clear dose-response effect of exertion on the relative risk of MI was demonstrated. MI = myocardial infarction
J Am Coll Cardiol. 2015;65(5):493-502.

15. Date of download: 1/29/2016 Copyright © The American College of Cardiology. All rights reserved.
From: Sudden Cardiac Death in the Older Athlete
J Am Coll Cardiol. 2015;65(5):493-502. doi:10.1016/j.jacc.2014.10.064

16. Outside Magazine December 2013

17. 50 yo endurance athlete, no PMHx, referred for
echocardiogram following finding of a “murmur” by
internist.
ECHO:
LVEF of 45-50% - Normal LVEF >51%
LV size 5.8 cm – Normal 5.8 cm
LV wall thickness 1.2 cm – Normal being 1.0 cm of less.
Diastolic function normal
LV mass 128g/m2 – Upper limits of normal 115g/m2
Right ventricle is mild to moderately dilated but normal systolic function
Right atrium - severely dilated
Left atrium - mildly dilated

18. 70 yo AAM no previous C/V disease history and really no
medical issues present for an abnormal ECG.
Plays singles tennis most days of the week for about 60-90
minutes per session.
Also cycles several days per week and has been doing this for
decades.
No family Hx of C/V disease and never smoked.
He feels well with no symptoms. PE is normal. BP
131/79mmHg.

20. Take Home Messages
1. Cardiac physiologic changes start to occur with 5-7 hours of moderate to high
intensity activity per week and can occur within 90 days of training.
2. Long-standing, high intensity exercise (yearly marathons, ironman distance
triathlons) are associated with temporary increases in biomarker production (i.e.
troponin, BNP) as well as right ventricle dilation and dysfunction.
3. Leisure running, even 5 to 10 min per day at slow speeds (<6 miles/h), is
associated with substantial mortality benefits.
4. There is likely a “sweet spot” with exercise in which additional duration, intensity
likely provides no additional health benefits.
5. The benefits of exercise (40-60% reduction in mortality) far outweighs the very,
very small risks of sudden cardiac death.