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Preparticipation Evaluation of Novice, Middle-Age, Long-Distance Runners


Medicine & Science in Sports & Exercise: January 2013 - Volume 45 - Issue 1 - p 130–137
doi: 10.1249/MSS.0b013e31826c5552

Purpose The purpose of this study was to assess the cardiovascular health and risk profile in middle-age men making an entry to participate for their first time in a long-distance race.

Methods Male first-time participants, 45 yr and older, in the world’s largest cross-country running race, the Lidingöloppet, were evaluated with a medical history and physical examination, European systematic coronary risk evaluation (SCORE), 12-lead ECG, echocardiography, and blood tests. Further diagnostic workup was performed when clinically indicated.

Results Of 265 eligible runners, 153 (58%, age 51 ± 5 yr) completed the study. Although the 10-yr fatal cardiovascular event risk was low (SCORE, 1%; interquartile range, 0%–1%), mild abnormalities were common, for example, elevated blood pressure (19%), left ventricular hypertrophy (6%), and elevated LDL cholesterol (5%). ECG changes compatible with the “athlete’s heart” were present in 82%, for example, sinus bradycardia (61%) and/or early repolarization (32%). ECG changes considered training unrelated were found in 24%, for example, prolonged QTc-interval (13%), left axis deviation (5.3%), and left atrial enlargement (4%). In 14 runners (9%), additional diagnostic workup was clinically motivated, and 4 runners (2%) were ultimately discouraged from vigorous exercise because of QTc intervals >500 ms (n = 2), symptomatic atrioventricular block (n = 1), and cardiac tumor (n = 1). The physician examination and the ECG identified 12 of the 14 participants requiring further evaluation.

Conclusions Cardiovascular evaluation of middle-age men, including a physician examination and a 12-lead ECG, appears useful to identify individuals requiring further testing before vigorous exercise. The additional yield of routine echocardiography was small.

1Department of Cardiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, SWEDEN; and 2Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, SWEDEN

Address for correspondence: Philip Aagaard, MD, Department of Cardiology, Karolinska Institutet, N3:05, Karolinska University Hospital, 171 76 Stockholm, Sweden; E-mail:

Submitted for publication May 2012.

Accepted for publication July 2012.

©2013The American College of Sports Medicine