Marathon Run: Cardiovascular Adaptation and Cardiovascular Risk

Hans-Georg Predel


Eur Heart J. 2014;35(44):3091-3098. 

In This Article


Running a full-distance Marathon is a great challenge for the entire human organism. Though there is evidence that EE delivers beneficial health effects and a significant increase in life expectancy, the strain imposed on the cardiopulmonary system is extremely high. Long-term excessive EE may cause adverse functional and morphological cardiac adaptations, especially in the continuously growing cohort of middle-aged amateur runners. These athletes who exercise at extremely high doses and intensities should, therefore, be aware that there is a potentially increased risk for cardiovascular complications. However, further investigations to identify the optimal individual dose and intensity of long-term EE are warranted. Presently, regarding the large number of middle-aged male amateur marathon runners, the recommendations of the current ESC guidelines for Physical Activity and Public Health should be observed. Thorough medical screening—including ECG—of the cardiovascular system in association with professional analysis and planning of the training is essential to avoid acute and long-term cardiovascular complications in young elite as well as in middle-aged and older endurance athletes. For the detection of CAD in the cohort of the middle-aged and older endurance athletes, an additional exercise test with ECG should be performed. Further studies are warranted to profoundly understand the acute and long-term effects of intensive EE, such as marathon running, on the cardiovascular system in order to identify individuals at risk and to develop individualized training recommendations. Finally, it seems to be prudent to advise the middle-aged or older endurance athlete to content himself with a 'half-marathon' performed with 'full pleasure'. Such an approach will offer the best perspective for experiencing the fascination of marathon running and simultaneously delivering positive health effects to the cardiovascular system and the entire human body.