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The positive effects of regular participation in physical activity are well documented.
Meeting the minimum physical activity guidelines reduces the risk of many diseases,
and physically active individuals generally live longer, healthier lives than inactive
] recommend 2.5–5h/week of moderate-intensity exercise or 1.25–2.5h/week of vigorous-intensity
exercise (a metabolic equivalent of 8–17 MET-h/week). However, the health status of
individuals who markedly exceed the minimum recommendations remains a matter of debate. One major concern pertains
to the possible mal-adaptation of the cardiovascular system that would predispose
athletes to a greater risk of all-cause and cardiovascular morbidity and mortality,
raising the question whether excessive volumes of exercise could be “too much of a
good thing” [
]. Specifically, the reverse J-curve represents the fact that mild-to-moderate volume
and intensity exercise (in accordance with physical activity guidelines) seems to
improve cardiovascular health compared with inactivity, while cardiovascular risk
in individuals who perform a large volume of exercise may increase again. Such a concern
is far from trivial because the participation in ultra-endurance events has steadily
increased over the last decades. In 2017, more than 300,000 men and women participated
in ultra-marathons alone, and several thousand more took part in other long-distance
] in some endurance athletes have alarmed medical professionals and indicated the
need for further data on the health risks associated with excessive amounts of endurance
exercise. On the other hand, readers of this journal will be interested to note that
several studies have reported an increased coronary artery calcium score (CACS) in
middle-aged athletes, but with more stable atherosclerotic plaques and a similar or
reduced morbidity and mortality compared with less active, age-matched individuals
]. Yet, the story seems far from over because some humans are pushing the boundaries
of exercise further, and the effects of extreme volumes of exercise on cardiovascular
adaptation and health remain poorly understood.
Ultrasonographic strain imaging is superior to conventional non-invasive measures of vascular stiffness in the detection of age-dependent differences in the mechanical properties of the common carotid artery.
Recent studies suggest that long-term endurance training may be damaging to the heart, thus increasing cardiovascular disease (CVD) risk. However, studies utilizing cardiac imaging are conflicting and lack measures of central and peripheral vascular structure and function, which are also independently predictive of CVD events.