Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review

While the interest and participation in general endurance training and recreational sports competitions have continuously increased in recent decades, the number of recreational master-level endurance athletes has additionally multiplied. Athletes, active men and women older than 40 years of age, wh...

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Main Authors: Othmar Moser, Stefan J. Schunk, Volker Schöffl, Janis Schierbauer, Paul Zimmermann
Format: Article
Language:English
Published: MDPI AG 2025-07-01
Series:Life
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Online Access:https://www.mdpi.com/2075-1729/15/7/1095
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author Othmar Moser
Stefan J. Schunk
Volker Schöffl
Janis Schierbauer
Paul Zimmermann
author_facet Othmar Moser
Stefan J. Schunk
Volker Schöffl
Janis Schierbauer
Paul Zimmermann
author_sort Othmar Moser
collection DOAJ
description While the interest and participation in general endurance training and recreational sports competitions have continuously increased in recent decades, the number of recreational master-level endurance athletes has additionally multiplied. Athletes, active men and women older than 40 years of age, who participate in competitive athletics are usually referred to by the term master athletes (MAs). Previous research revealed the significant benefits of regular moderate physical activity, i.e., its positive influence on cardiovascular risk factors and cardiovascular health; however, recent data have raised concerns that long-term endurance exercise participation is associated with cardiac remodeling and potential adverse cardiovascular outcomes. Previous research also indicated potential structural, functional, and electrical remodeling in MAs due to prolonged and repeated exposure to high-intensity endurance exercise—a condition known as athlete’s heart. In this review, we focus on the association between extreme levels of endurance exercise and potential cardiovascular controversies, such as arrhythmogenesis due to new-onset atrial fibrillation, accelerated coronary artery atherosclerosis, and exercise-induced cardiac remodeling. Additionally, the exercise-dependent modulation of immunological response, such as proteomic response and cytokine alterations, is discussed. Furthermore, we discuss the impact of nutritional supplements in MAs and their potential benefits and harmful interactions. We aim to provide sports medicine practitioners with knowledge of these contemporary longevity controversies in sports cardiology and to highlight the importance of shared decision making in situations of clinical uncertainty.
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spelling doaj-art-05fe523d833c4242aa381328d2ffe53e2025-08-20T03:07:58ZengMDPI AGLife2075-17292025-07-01157109510.3390/life15071095Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative ReviewOthmar Moser0Stefan J. Schunk1Volker Schöffl2Janis Schierbauer3Paul Zimmermann4Division of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95447 Bayreuth, GermanyDepartment of Internal Medicine IV, Nephrology and Hypertension, Saarland University, 66421 Homburg/Saar, GermanyInterdisciplinary Center of Sportsmedicine Bamberg, Klinikum Bamberg, 96049 Bamberg, GermanyDivision of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95447 Bayreuth, GermanyDivision of Exercise Physiology and Metabolism, BaySpo-Bayreuth Center of Sport Science, University of Bayreuth, 95447 Bayreuth, GermanyWhile the interest and participation in general endurance training and recreational sports competitions have continuously increased in recent decades, the number of recreational master-level endurance athletes has additionally multiplied. Athletes, active men and women older than 40 years of age, who participate in competitive athletics are usually referred to by the term master athletes (MAs). Previous research revealed the significant benefits of regular moderate physical activity, i.e., its positive influence on cardiovascular risk factors and cardiovascular health; however, recent data have raised concerns that long-term endurance exercise participation is associated with cardiac remodeling and potential adverse cardiovascular outcomes. Previous research also indicated potential structural, functional, and electrical remodeling in MAs due to prolonged and repeated exposure to high-intensity endurance exercise—a condition known as athlete’s heart. In this review, we focus on the association between extreme levels of endurance exercise and potential cardiovascular controversies, such as arrhythmogenesis due to new-onset atrial fibrillation, accelerated coronary artery atherosclerosis, and exercise-induced cardiac remodeling. Additionally, the exercise-dependent modulation of immunological response, such as proteomic response and cytokine alterations, is discussed. Furthermore, we discuss the impact of nutritional supplements in MAs and their potential benefits and harmful interactions. We aim to provide sports medicine practitioners with knowledge of these contemporary longevity controversies in sports cardiology and to highlight the importance of shared decision making in situations of clinical uncertainty.https://www.mdpi.com/2075-1729/15/7/1095master athletecardiovascular riskatrial fibrillationcoronary artery atherosclerosiscardiac remodelingnutritional supplements
spellingShingle Othmar Moser
Stefan J. Schunk
Volker Schöffl
Janis Schierbauer
Paul Zimmermann
Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
Life
master athlete
cardiovascular risk
atrial fibrillation
coronary artery atherosclerosis
cardiac remodeling
nutritional supplements
title Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
title_full Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
title_fullStr Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
title_full_unstemmed Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
title_short Cardiovascular Remodeling and Potential Controversies in Master Endurance Athletes—A Narrative Review
title_sort cardiovascular remodeling and potential controversies in master endurance athletes a narrative review
topic master athlete
cardiovascular risk
atrial fibrillation
coronary artery atherosclerosis
cardiac remodeling
nutritional supplements
url https://www.mdpi.com/2075-1729/15/7/1095
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