title: Strenuous Exercise and Cardiovascular Disease Outcomes.
abstract: OBJECTIVE
  This review summarizes several issues at the forefront of recent controversies involving the appropriate exercise dose including epidemiologic data describing mortality trends in those who engage in high levels of physical activity and recent observational data suggesting adverse cardiovascular outcomes among long-term endurance athletes.
  
  
  RESULTS
  The benefits of habitual and moderate levels of exercise on cardiovascular disease outcomes in the general population have been well established. However, recent data have questioned whether higher doses of physical and athletic activity are associated with adverse cardiovascular outcomes. Specifically in regard to adverse cardiovascular outcomes, the evidence and limitations of the available data associating veteran endurance athletes with an increased risk of atrial fibrillation, exercise-induced arrhythmogenic cardiac remodeling, and accelerated coronary atherosclerosis will be discussed. This review will also provide a conceptual framework in the context of the clinical management of athletic patients and will highlight key areas of future research that may resolve many of these controversial issues.
authors.affiliation: Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Emory University School of Medicine, 1462 Clifton Road, NE, Suite 502, Atlanta, GA, 30322, USA. jonathan.kim@emory.edu.
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA.
authors.forename: Aaron L
authors.initials: AL
authors.lastname: Baggish
mesh_terms: D056352:Athletes; D002318:Cardiovascular Diseases; D015444:Exercise; D006184:Habits; D006801:Humans; D012306:Risk; D013177:Sports
keywords: Cardiac pathology; Cardiovascular outcomes; Dose-response; Exercise; Physical activity