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It is noteworthy that while these studies concluded that mortality benefits may plateau with the highest levels of exercise, there was no increase in mortality observed with extreme levels of physical activity. In those performing >10 times the recommended minimum physical activity levels, there was no additional mortality benefit. In this analysis, the most robust mortality benefit was observed in those exercising 3 to 5 times minimum physical activity levels (hazard ratio, 0.63 95% confidence interval, 0.59–0.62). ( 11), in which the authors stratified a large cohort of individuals based on levels of physical activity. Similar observations were made by Arem et al.
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Although mortality benefits were similar across all quintiles, there was a blunting of this benefit observed in the highest quintile of running (>176 min The authors found that runners had a 30% lower risk of all-cause death and 45% lower risk of cardiovascular death compared with sedentary individuals. ( 13) separated active runners into quintiles based on running time, distance, frequency, amount, and speed and compared them with nonrunners. Several recent studies examining the relationship between exercise and mortality suggest a reduction or loss of benefit at the highest levels of physical activity, leading to what has been termed a “U-shaped” relationship between exercise and mortality ( 7,11,12). However, for those who routinely exceed moderate exercise levels, recent data have challenged whether favorable outcomes resulting from exercise also apply to these highly active individuals. Regular exercise and physical activity decrease all-cause and cardiovascular mortality ( 3,10). Figure:Įxercise dose response and health benefits with possible pathologic outcomes associated with extreme levels of exercise. In this review, we summarize current cardiovascular controversies as they relate to master endurance athletes ( Fig.) and provide clinical perspectives to assist sports medicine practitioners who routinely care for this unique athletic population. Specifically, long-term and high levels of endurance exercise have been associated with the development of earlier onset atrial fibrillation (AF) ( 6), reduced mortality benefits ( 7), increased coronary artery calcification (CAC) ( 8), and unexplained myocardial fibrosis ( 9). Recently, the debate over the potential negative effects of excess levels of exercise has garnered significant media and scientific attention ( 4,5). Although current guidelines for physical activity state that just 150 min of moderate exercise or 75 min of strenuous exercise per week lead to substantial health benefits ( 3), master endurance athletes routinely exceed this threshold. Participation in recreational endurance exercise in the United States has significantly increased over the past several decades concomitant with parallel increases in estimates of masters level endurance athletes (generally considered >40 years old) ( 1,2).