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Impact of Repeated Prolonged Exercise Bouts on Cardiac Function and Biomarkers


Medicine & Science in Sports & Exercise: January 2007 - Volume 39 - Issue 1 - p 83-90
doi: 10.1249/01.mss.0000239395.93578.60
BASIC SCIENCES: Original Investigations

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

Methods: Ten athletes completed a 15.3-mile hill run on three consecutive days and were assessed before, immediately after, 1 h after, and 20 h 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 analyzed for cardiac biomarkers including cardiac troponin T (cTnT).

Results: 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 nonsignificant decrease in systolic blood pressure/end systolic volume (SBP/ESV) ratio. A sustained depression in systolic function 20 h 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) normalized after each 20-h recovery period. A similar pattern of change was observed in Vp. Cardiac troponin T was elevated in four individuals 1 h after bout 1 (range: 0.013-0.125 μg·L−1) but was undetectable thereafter except in one athlete.

Conclusion: 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.

1Centre for Sports Medicine and Human Performance, Brunel University, London, UNITED KINGDOM; 2Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UNITED KINGDOM; 3English Institute of Sport, Bisham Abbey, Marlow, UNITED KINGDOM; 4Napier University, Edinburgh, UNITED KINGDOM; and 5Chemical Pathology, St. Georges Healthcare NHS Trust, London, UNITED KINGDOM

Address for correspondence: Rob Shave, Ph.D., School of Sport and Education, Brunel University, Uxbridge, Middlesex, UB8 3PH, UK; E-mail:

Submitted for publication February 2006.

Accepted for publication July 2006.

©2007The American College of Sports Medicine