Pathological remodelling of the athlete’s heart

Engaging in regular physical activity affords significant health benefits, while a lack of exercise is associated with increased cardiovascular morbidity and mortality. The amount of physical activity required to achieve these benefits is relatively modest, equating to 20–30 minutes of moderate intensity exercise per day. Most athletes far exceed these recommendations and now perform athletic feats previously considered insurmountable. Studies in veteran athletes have demonstrated favourable outcomes such as reduced incidence of cardiac disease and a greater lifespan. However, in asymptomatic athletes concealing underlying cardiac disease, intense exercise may be associated with sudden cardiac death. Despite the devastating and highly visible effects of life-threatening arrhythmias, exercise has retained its reputation as a prolonger of life as it is not the primary cause of death but merely a trigger for such catastrophes. More recent studies, however, have suggested that the effects of regular intense exercise may result in adverse remodelling in otherwise healthy hearts. This article will explore this concept and whether chronic intensive exercise can adversely impact cardiovascular health.