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Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study
  1. Julia Schoenfeld1,2,
  2. Michael Johannes Schindler1,
  3. Bernhard Haller3,
  4. Stefan Holdenrieder4,
  5. David Christopher Nieman5,
  6. Martin Halle1,2,
  7. André La Gerche6,
  8. Johannes Scherr7
  1. 1Preventive Sports Medicine and Sports Cardiology, University Hospital Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
  2. 2Deutsches Zentrum für Herz- und Kreislauf-Forschung (DZHK) e.V. (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Bavaria, Germany
  3. 3Institute of Medical Informatics, Statistics and Epidemiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Bavaria, Germany
  4. 4Department of Laboratory Medicine, German Heart Center at Munich Technical University, Munich, Bayern, Germany
  5. 5Human Performance Laboratory, Appalachian State University and North Carolina Research Campus, Kannapolis, North Carolina, USA
  6. 6Department of Medicine, St. Vincent’s Hospital, University of Melbourne, Melbourne, Victoria, Australia
  7. 7University Center for Preventive and Sports Medicine, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
  1. Correspondence to Professor Johannes Scherr; johannes.scherr{at}balgrist.ch

Abstract

Introduction Prolonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area.

Methods and analysis In this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography.

Discussion This longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years.

Trial registration number NCT04166903.

  • exercise
  • heart
  • marathon
  • cardiovascular
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsem-2020-000786

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    Footnotes

    • JScho and MJS contributed equally.

    • Contributors All authors contributed to the conception and design of the work. BH, JScho, MJS and JSche developed the sample size calculation and the statistical analysis plan. JScho, JSche and MJS drafted the manuscript. All authors read and gave the final approval and agreed to be accountable for all aspects of the work, ensuring integrity and accuracy.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement No data are available. No data are currently available.