Competitive Sports and the Heart: Benefit or Risk?

Physicians of the ancient and early modern world often recommended physical exercise as a means of staying healthy. Today, various medical specialty societies recommend exercise and athletic activity to maintain and preserve health, on the basis of strong evidence from numerous single studies and meta-analyses (1). On the other hand, ever since the “athlete’s heart” was described more than 100 years ago (e1), there has been concern that prolonged and intense athletic activity might confer certain risks, while exercise-induced cardiac changes have been interpreted as a potential sign of damage (e2, e3). The question whether sport has a net positive or negative effect on health was already debated in 1912 at the first sports-medicine conference in Germany (e4). Among physicians, those with no special training or experience in sports medicine tend to view athlete’s heart as a potentially dangerous condition and to think that the associated cardiac enlargement and ECG changes indicate an increased cardiac risk. Reindell et al. (2), and later Kindermann (3), interpreted the radiological, electrocardiographic, and hemodynamic changes seen in healthy athletes as physiological adaptations of the heart; yet the recurring reports of cardiac events, and even sudden cardiac death, among athletes (4, e5) continue to sustain the debate over the potential pathological effects of sports on the heart, rare as they may be (e6). Strong evidence Various medical specialty societies recommend exercise and athletic activity to maintain and preserve health, on the basis of strong evidence from numerous single studies and meta-analyses.