Exercise and Heart Disease

From Athletes and Arrhythmias to Hypertrophic Cardiomyopathy and Congenital Heart Disease

Abbas Zaidi; Sanjay Sharma


Future Cardiol. 2013;9(1):119-136. 

In This Article


Regular physical activity results in a variety of favorable effects on cardiovascular and general health, with incremental benefits evident with increasing exercise dose. This phenomenon is seen in healthy individuals and in patients with established cardiovascular disease, for example, in the cardiac rehabilitation setting. In contrast, vigorous exertion may provoke cardiac instability and ventricular arrhythmia in susceptible individuals, such that the majority of sudden deaths in young athletes occur in those harboring inherited or congenital cardiac disorders. Preparticipation screening has the potential to detect such individuals, in whom abstinence from competitive sports may be mandated. Debate still exists regarding the optimal strategy for screening, although ECG-based protocols have now been endorsed by many of the international sports governing bodies. The issue of screening is complicated by the physiological remodeling evident in the hearts of healthy athletes, which may create a diagnostic overlap with pathological conditions. Borderline cases must be evaluated on a case-by-case basis with knowledge of the individual athlete's demographic and sporting profile. Recent attention has focused on the concept that chronic endurance exercise may lead to adverse cardiac remodeling and arrhythmogenesis in previously healthy individuals, although this has yet to be convincingly demonstrated in large cohorts. Thus, the overwhelming health benefits of regular, moderate exercise must continue to be emphasized to the general population.