Author + information
- David Niederseer, MD, PhD, BSc∗ (, )
- Josef Niebauer, MD, PhD, MBA and
- Christian Schmied, MD
- ↵∗Department of Cardiology, University Heart Center Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
We congratulate Eijsvogels et al. (1) on their balanced review concerning the ongoing debate about the “too much exercise hypothesis,” as they had termed it previously (2). We fully agree that the published studies on potential harm of too much exercise and especially the following media coverage thereof may well have prevented people from engaging in physical activity. Indeed, following the recently published studies, we received critical comments even from colleagues about whether exercise recommendations are still valid.
What is often being neglected, however, is the fact that it has been repeatedly documented that elite athletes that exercise at the highest possible intensities and volumes have a superior life expectancy, as reported (e.g., in former Tour de France cyclists) (3). Considering the fact that athletes are at a greater risk of exercise-induced cardiac death, these findings may appear even more surprising, but can be explained at least in part by the rigorous pre-participation screening that many of these undergo, and which has been shown to reduce the increased incidence of sudden cardiac death (4). Exercise induced sudden cardiac death, however, does not only happen in athletes, but also in nonathletes (5).
In line with the idea of pre-participation screening for athletes, we would therefore like to suggest a similar strategy also for patients and untrained subjects at the verge of engaging in regular physical exercise. Routine health checks are widely used in various countries as a preventive strategy and could be supplemented with a physical examination, past medical and family history and a 12-lead electrocardiogram, to identify potential candidates for sudden cardiac death. Consequently, the dose-dependent mortality-reducing potential of physical activity would likely be even more pronounced.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
- Eijsvogels T.M.H.,
- Molossi S.,
- Lee D.C.,
- Emery M.S.,
- Thompson P.D.
- Marijon E.,
- Tafflet M.,
- Antero-Jacquemin J.,
- et al.