What is the Impact of Repeated Prolonged Exercise Bouts on Cardiac Function & Biomarkers?

Research Paper Title

English: A Wiggers diagram, showing the cardia...
English: A Wiggers diagram, showing the cardiac cycle events occuring in the left ventricle. (Photo credit: Wikipedia)

Impact of Repeated Prolonged Exercise Bouts on Cardiac Function and Biomarkers.


This study examined the impact of repeated bouts of prolonged (<60 min) exercise on left ventricular function and cardiac biomarkers.


Ten athletes completed a 15.3-mile hill run on three consecutive days and were assessed before, immediately after, 1 hour after, and 20 hour after each bout. Six of the athletes completed a fourth bout. Left ventricular (LV) function was examined echocardiographically using two-dimensional M-mode, Doppler, and flow propagation velocity (Vp). Venous blood samples were analysed for cardiac biomarkers including cardiac troponin T (cTnT).


Ejection fraction (EF) significantly decreased (P = 0.027) after the third exercise bout compared with baseline (mean +/- SD: 56.3 +/- 4.4 vs 51.3 +/- 5.9%), accompanied by a non-significant decrease in systolic blood pressure/end systolic volume (SBP/ESV) ratio. A sustained depression in systolic function 20 hour after bout 3 also persisted in the subset who completed a fourth bout, yet this did not reach clinical levels. Significant (P < 0.01) reductions in early to late diastolic filling (E:A) ratio pre- to post-bout 1 (mean +/- SD: 1.9 +/- 0.5 vs 1.4 +/- 0.3) and pre- to post-bout 3(2.0 +/- 0.5 vs 1.3 +/- 0.4) normalised after each 20-hour recovery period. A similar pattern of change was observed in Vp. Cardiac troponin T was elevated in four individuals 1 hour after bout 1 (range: 0.013-0.125 [mu]g[middle dot]L-1) but was undetectable thereafter except in one athlete.


Repeated bouts of prolonged exercise induce short-term reductions in diastolic filling and a cumulative decrease in systolic function, yet these alterations seem to have minimal clinical or functional impact. Elevated cTnT after the initial bout, but not thereafter, may represent an adaptive response to prolonged exercise.

Source: Middleton, N., Shave, R., George, K., Whyte, G.P., Simpson, R.J., Florida-James, G. & Gaze, D. (2007) Impact of Repeated Prolonged Exercise Bouts on Cardiac Function and Biomarkers. Medicine & Science in Sports & Exercise. 39 (1), pp.83-90.


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