Funding
This study is funded by the Indonesia Endowment Fund for Education (grant number 201803220412678).
Team
Inarota Laily https://orcid.org/0000-0002-3744-0099
Tom G.H. Wiggers https://orcid.org/0000-0002-8581-8834
Niels van Steijn
Evert Verhagen https://orcid.org/0000-0001-9227-8234
Adrianus J. Bakermans https://orcid.org/0000-0001-9291-9441
Harald Jorstad https://orcid.org/0000-0003-3617-3256
Background
Regular participation in physical activity is associated with numerous health benefits. However, it is unclear what the upper limits of healthy physical exercise are and whether exceeding a certain amount of exercise may have detrimental effects on the cardiovascular system or general health.
Marathon running is a classic example of a popular sports activity. In the last three decades, the number of recreational marathon runners has markedly increased, with middle-aged men constituting the largest group. Importantly, this is also the age group where the atherosclerotic cardiovascular disease becomes clinically apparent.
Several phenomena that point to potentially detrimental cardiac effects of running have been reported, such as elevated biomarkers for myocardial injury (troponin T and I, NT-proBNP), and reductions in left- and right ventricular systolic and diastolic function directly after marathon completion. Most studies on cardiac effects of marathon running are cross-sectional or retrospective, do not include state-of-the-art imaging investigations such as cardiovascular magnetic resonance imaging (MRI) coupled with functional assessments and do not include recovery follow-up. Furthermore, COVID-19 in athletes is associated with myocardial abnormalities, such as inflammation and fibrosis, but no studies have reported the effects of marathon running after recovery from COVID-19.
Objectives
Our exploratory prospective cohort study in middle-aged men who train for and participate in their first marathon, including a subset of participants who recovered from COVID-19, aims to comprehensively investigate potentially detrimental cardiac changes during marathon training and participation.
The primary outcomes are cardiac morphological changes from before initiating marathon training up to 1 month after completion of the marathon: 1) 4 months before the marathon, 2) pre-marathon (2 weeks before the marathon), 3) post-marathon (<24 hours post-marathon), and 4) recovery (4 weeks after the marathon).
Secondary outcomes include changes in other cardiac and non-cardiac parameters: 1) quantitative parameter mapping of the myocardium with MRI, 2) cardiac morphology and function with echocardiography, 3) VO2max, 4) electrocardiogram (ECG) characteristics, and 5) circulating cardiac biomarkers: high sensitivity troponin-T (hs-TnT), high sensitivity troponin-I (hs-TnI), and N-terminal pro-B-type natriuretic peptide (NT-proBNP).