title: The Exercise Rehabilitation Paradox: Less May Be More?
abstract: BACKGROUND
  Debatably, the most commonly prescribed lifestyle modification for cardiovascular health involves daily exercise training (ET) and physical activity. Exercise has numerous known health benefits on blood pressure, lipid profile, weight loss, and glucose metabolism. However, controversy exists regarding the link between excessive endurance ET and harmful cardiac effects.
  
  
  METHODS
  We review the current literature and discuss the numerous known adverse effects of endurance ET on cardiac function.
  
  
  RESULTS
  Excessive endurance ET may negatively affect cardiac anatomy, play a role in osteoarthritis and coronary artery disease development, and increase the risks of cardiac arrhythmia and sudden cardiac death.
  
  
  CONCLUSIONS
  More ET may not always be better when it comes to endurance ET, and optimal ET dosing regimens are clearly needed.
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA.
authors.forename: Parham
authors.initials: P
authors.lastname: Parto
authors.affiliation: Department of Cardiology, St. Luke's Mid America Heart Institute, Kansas City, MO.
authors.forename: James H
authors.initials: JH
authors.lastname: O'Keefe
authors.affiliation: Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA ; The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Lavie
keywords: Arrest–sudden cardiac; arrhythmias–cardiac; death–sudden cardiac; exercise; exercise therapy