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'Paracelcus' rediscovered: searching for the right dose of physical training.

Schmied C - Open Heart (2014)

View Article: PubMed Central - PubMed

Affiliation: Clinic of Cardiology, University Heart Center , Zurich , Switzerland.

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‘All things are poison and nothing is without poison, only the dose makes a thing not a poison’... When Phillipus Aureolus Theofrastus Bombastus von Hohenheim—better known as ‘Paracelsus’—a Swiss German Renaissance physician, botanist, astrologer and philosopher coined this well-known quote about 500 years ago, he might not have thought about dose-dependent ‘toxic’ effects of regular sport... As such, postrace dilation and decreased function of the right ventricle have been demonstrated impressively in cyclists, recently... As a relevant part of the population competes at marathon events, these athletes have been in the focus of various surveys conducted recently; although marathon runners show a relevant postrace increase of cardiac biomarkers (eg, troponin I, troponin T, B-type natriuretic peptide), sometimes associated with transient dilation of the right atrium and particularly of the right ventricle and reduction of right ventricular ejection fraction, cardiovascular MRI suggests that this is not a result of serious ischaemic or inflammatory injury to any cardiac chamber... Not only after the ‘RACER’ study, a large survey in North-American marathon runners, that demonstrated a decreased risk for sudden cardiac arrest within the first half of a marathon run compared to the second half, the debate is going on whether half-marathon harbours a justifiable risk for sportive individuals... Yet another unsolved issue is the question which individuals are particularly prone to acute structural, functional or biochemical response to high physical efforts: in a current meta-analysis including 16 studies of 939 marathon runners with elevated postrace troponin-T (cTn) levels, the pooled OR for converting from a normal prerace to an elevated postrace cTn was 51.84 (95% CI 16 to 168, I=66%, p<0.001)... Multiple studies have pointed out increases in cardiac troponin and natriuretic peptides, as well as left and right ventricular dysfunctionality following an intense prolonged exercise... The term ‘cardiac ‘fatigue’ has often been used to express relatively prompt and, particularly, complete cardiac recovery... However, as aforementioned, the cut-off between acute and chronic cardiac adaptations lies within a grey-zone, particularly if focusing on right ventricular function that is more frequently and more profoundly affected... Probably, these muscle and heart-specific microRNAs not only have a potential role as biomarkers of aerobic capacity but also as markers for cardiac adaptations and even for the individual cardiac risk in athletes... Thus, at the bottom line, what would be of real impact is the question whether regular training (and competition) of an individual who performs on a relatively moderate level (eg, as half-marathon racers) provokes less longtime adverse effects on the athlete's heart... However, to answer this question, randomised studies in larger cohorts are needed that observe not only acute, but long-time, effects of regular physical training at different levels.

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Related in: MedlinePlus

The ‘Triangle of Coumel’ illustrating the interplay between different factors that promote and preserve atrial fibrillation, particularly in an athlete (adapted from Mont et al3).
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OPENHRT2013000027F1: The ‘Triangle of Coumel’ illustrating the interplay between different factors that promote and preserve atrial fibrillation, particularly in an athlete (adapted from Mont et al3).

Mentions: Although quite much is known about the minimal efforts of physical exercise that have to be provided to gain health benefits, so far no ‘upper limit’ has been defined.1 However, adverse longtime effects of regular strenuous endurance training (eg, in cross-country skiers and bicycle racers) could be defined: as such, a multitude of studies proved an increased rate of atrial fibrillation in endurance athletes at an older age compared with age-matched controls.23 The underlying morphological substrates are miscellaneous, consisting of inflammation, fibrosis and cavity dilation (figure 1).3


'Paracelcus' rediscovered: searching for the right dose of physical training.

Schmied C - Open Heart (2014)

The ‘Triangle of Coumel’ illustrating the interplay between different factors that promote and preserve atrial fibrillation, particularly in an athlete (adapted from Mont et al3).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4195919&req=5

OPENHRT2013000027F1: The ‘Triangle of Coumel’ illustrating the interplay between different factors that promote and preserve atrial fibrillation, particularly in an athlete (adapted from Mont et al3).
Mentions: Although quite much is known about the minimal efforts of physical exercise that have to be provided to gain health benefits, so far no ‘upper limit’ has been defined.1 However, adverse longtime effects of regular strenuous endurance training (eg, in cross-country skiers and bicycle racers) could be defined: as such, a multitude of studies proved an increased rate of atrial fibrillation in endurance athletes at an older age compared with age-matched controls.23 The underlying morphological substrates are miscellaneous, consisting of inflammation, fibrosis and cavity dilation (figure 1).3

View Article: PubMed Central - PubMed

Affiliation: Clinic of Cardiology, University Heart Center , Zurich , Switzerland.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

‘All things are poison and nothing is without poison, only the dose makes a thing not a poison’... When Phillipus Aureolus Theofrastus Bombastus von Hohenheim—better known as ‘Paracelsus’—a Swiss German Renaissance physician, botanist, astrologer and philosopher coined this well-known quote about 500 years ago, he might not have thought about dose-dependent ‘toxic’ effects of regular sport... As such, postrace dilation and decreased function of the right ventricle have been demonstrated impressively in cyclists, recently... As a relevant part of the population competes at marathon events, these athletes have been in the focus of various surveys conducted recently; although marathon runners show a relevant postrace increase of cardiac biomarkers (eg, troponin I, troponin T, B-type natriuretic peptide), sometimes associated with transient dilation of the right atrium and particularly of the right ventricle and reduction of right ventricular ejection fraction, cardiovascular MRI suggests that this is not a result of serious ischaemic or inflammatory injury to any cardiac chamber... Not only after the ‘RACER’ study, a large survey in North-American marathon runners, that demonstrated a decreased risk for sudden cardiac arrest within the first half of a marathon run compared to the second half, the debate is going on whether half-marathon harbours a justifiable risk for sportive individuals... Yet another unsolved issue is the question which individuals are particularly prone to acute structural, functional or biochemical response to high physical efforts: in a current meta-analysis including 16 studies of 939 marathon runners with elevated postrace troponin-T (cTn) levels, the pooled OR for converting from a normal prerace to an elevated postrace cTn was 51.84 (95% CI 16 to 168, I=66%, p<0.001)... Multiple studies have pointed out increases in cardiac troponin and natriuretic peptides, as well as left and right ventricular dysfunctionality following an intense prolonged exercise... The term ‘cardiac ‘fatigue’ has often been used to express relatively prompt and, particularly, complete cardiac recovery... However, as aforementioned, the cut-off between acute and chronic cardiac adaptations lies within a grey-zone, particularly if focusing on right ventricular function that is more frequently and more profoundly affected... Probably, these muscle and heart-specific microRNAs not only have a potential role as biomarkers of aerobic capacity but also as markers for cardiac adaptations and even for the individual cardiac risk in athletes... Thus, at the bottom line, what would be of real impact is the question whether regular training (and competition) of an individual who performs on a relatively moderate level (eg, as half-marathon racers) provokes less longtime adverse effects on the athlete's heart... However, to answer this question, randomised studies in larger cohorts are needed that observe not only acute, but long-time, effects of regular physical training at different levels.

No MeSH data available.


Related in: MedlinePlus