{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T23:04:07Z","timestamp":1782428647300,"version":"3.54.5"},"reference-count":46,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The purpose of this study was to investigate the effects of long-term endurance exercise on cardiac morphology and function, as well as injury indicators, among amateur marathon runners. We recruited 33 amateur runners who participated in a marathon. Participants were divided into experimental and control groups according to their National Athletic Grade. The experimental group included participants with a National Athletic Grade of 2 or better, and the control group included participants who did not have a National Athletic Grade. Cardiac morphology, function, and injury indicators were assessed before and after the participants\u2019 involvement in the Changsha International Marathon. All cardiac morphology and function indicators returned to pre-race levels at 24 h post-race, and left ventricular end-diastolic volume and left ventricular end-systolic volume indicators showed similar trends. Both stroke volume (SV) and percent fractional shortening (%FS) indicators showed similar trends in changes in the measurements before and after the race. SV showed no change between the pre-race and post-race periods. On the other hand, %FS showed a significant increase in the immediate post-race period, followed by restoration of its level at 24 h post-race. Among myocardial injury indicators, serum levels of cardiac troponin I, creatine kinase (CK), creatine kinase-MB (CK-MB), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and N-terminal pro-b-type natriuretic peptide (NT-proBNP) measured before the race, immediately after the race, and 24 h after the race displayed similar trends in changes among CK, CK-MB, LDH, and AST, while NT-proBNP levels did not change. We concluded that high-level amateur marathon runners had greater heart volumes, as well as wall and septal thicknesses, than low-level marathon runners, with differences in heart volume being the most pronounced. Long-term high-intensity endurance exercise caused some damage to the hearts of amateur runners. High-level runners showed better myocardial repair ability, and their levels of myocardial injury markers showed greater decreases at 24 h post-race, while low-level runners had poorer myocardial repair ability.<\/jats:p>","DOI":"10.3390\/ijerph20032600","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:29:03Z","timestamp":1675218543000},"page":"2600","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Effects of Long-Term Endurance Exercise on Cardiac Morphology, Function, and Injury Indicators among Amateur Marathon Runners"],"prefix":"10.3390","volume":"20","author":[{"given":"Jianzhong","family":"Hu","sequence":"first","affiliation":[{"name":"School of Physical Education, Hengyang Normal University, Hengyang 421002, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songqing","family":"Zhou","sequence":"additional","affiliation":[{"name":"School of Physical Education, Hengyang Normal University, Hengyang 421002, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8080-8821","authenticated-orcid":false,"given":"Suryeon","family":"Ryu","sequence":"additional","affiliation":[{"name":"School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaitlyn","family":"Adams","sequence":"additional","affiliation":[{"name":"School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6037-0439","authenticated-orcid":false,"given":"Zan","family":"Gao","sequence":"additional","affiliation":[{"name":"School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Cavigli, L., Zorzi, A., Spadotto, V., Mandoli, G.E., Melani, A., Fusi, C., D\u2019Andrea, A., Focardi, M., Valente, S., and Cameli, M. (2022). The Acute Effects of an Ultramarathon on Atrial Function and Supraventricular Arrhythmias in Master Athletes. J. Clin. Med., 11.","DOI":"10.3390\/jcm11030528"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1038\/s41569-020-0354-3","article-title":"The effects of endurance exercise on the heart: Panacea or poison?","volume":"17","author":"Sharma","year":"2020","journal-title":"Nat. Rev. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/eurheartj\/ehaa605","article-title":"2020 ESC Guidelines on sports cardiology and exercise in patients with cardiovascular disease","volume":"42","author":"Pelliccia","year":"2021","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"342","DOI":"10.1016\/j.ijcard.2006.03.041","article-title":"Biventricular myocardial adaptation to different training protocols in competitive master athletes","volume":"115","author":"Caso","year":"2007","journal-title":"Int. J. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1249\/JSR.0000000000000695","article-title":"Master Endurance Athletes and Cardiovascular Controversies","volume":"19","author":"Tso","year":"2020","journal-title":"Curr. Sport. Med. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1177\/2047487318819198","article-title":"Cardiovascular stress biomarker assessment of middle-aged non-athlete marathon runners","volume":"26","author":"Kosowski","year":"2019","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"3031","DOI":"10.1113\/JP271889","article-title":"Influence of exercise intensity and duration on functional and biochemical perturbations in the human heart","volume":"594","author":"Stewart","year":"2016","journal-title":"J. Physiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"998","DOI":"10.1093\/eurheartj\/ehr397","article-title":"Exercise-induced right ventricular dysfunction and structural remodelling in endurance athletes","volume":"33","author":"Burns","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1123\/ijspp.2020-0352","article-title":"Cardiac Biomarkers Following Marathon Running: Is Running Time a Factor for Biomarker Change?","volume":"16","author":"Traiperm","year":"2021","journal-title":"Int. J. Sport. Physiol. Perform."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1016\/j.csm.2015.03.007","article-title":"Cardiovascular Adaptation and Remodeling to Rigorous Athletic Training","volume":"34","author":"Weiner","year":"2015","journal-title":"Clin. Sport. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/j.cjca.2015.11.025","article-title":"Differentiating Exercise-Induced Cardiac Adaptations from Cardiac Pathology: The \u201cGrey Zone\u201d of Clinical Uncertainty","volume":"32","author":"Kim","year":"2016","journal-title":"Can. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1161\/01.CIR.101.3.336","article-title":"The athlete\u2019s heart: A meta-analysis of cardiac structure and function","volume":"101","author":"Pluim","year":"2000","journal-title":"Circulation"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.pcad.2012.01.006","article-title":"Exercise-Induced Cardiac Remodeling","volume":"54","author":"Weiner","year":"2012","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1819","DOI":"10.1249\/MSS.0b013e31821b12eb","article-title":"72-h Kinetics of High-Sensitive Troponin T and Inflammatory Markers after Marathon","volume":"43","author":"Scherr","year":"2011","journal-title":"Med. Sci. Sport. Exerc."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1365-2559.2011.03852.x","article-title":"The fittest person in the morgue?","volume":"60","author":"Sheppard","year":"2012","journal-title":"Histopathology"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1055\/s-0028-1104572","article-title":"Cardiac Injury Markers in Non-elite Marathon Runners","volume":"30","author":"Jassal","year":"2009","journal-title":"Int. J. Sports Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"780","DOI":"10.1136\/bjsm.2009.064089","article-title":"Biological markers of cardiac damage are not related to measures of cardiac systolic and diastolic function using cardiovascular magnetic resonance and echocardiography after an acute bout of prolonged endurance exercise","volume":"45","author":"Wilson","year":"2011","journal-title":"Br. J. Sports Med."},{"key":"ref_18","unstructured":"(2022, December 09). Muscle Thinking. Latest Athlete Rating Standards. Available online: https:\/\/zhuanlan.zhihu.com\/p\/379840263."},{"key":"ref_19","unstructured":"RunChina (2022, December 11). Run China Marathon Website. Available online: https:\/\/www.runchinamarathon.com."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.echo.2018.06.004","article-title":"Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography","volume":"32","author":"Mitchell","year":"2019","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"12259","DOI":"10.1038\/s41598-017-12539-5","article-title":"Morphologically normalized left ventricular motion indicators from MRI feature tracking characterize myocardial infarction","volume":"7","author":"Piras","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"248","DOI":"10.1055\/s-2007-1013081","article-title":"Assessment of left-ventricular function","volume":"46","author":"Schertel","year":"1998","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1727","DOI":"10.1136\/heartjnl-2012-303465","article-title":"Systematic review and meta-analysis of training mode, imaging modality and body size influences on the morphology and function of the male athlete\u2019s heart","volume":"99","author":"Utomi","year":"2013","journal-title":"Heart"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1161\/CIRCULATIONAHA.110.938282","article-title":"Cardiac Arrhythmogenic Remodeling in a Rat Model of Long-Term Intensive Exercise Training","volume":"123","author":"Benito","year":"2011","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"H459","DOI":"10.1152\/ajpheart.00763.2016","article-title":"Severity of structural and functional right ventricular remodeling depends on training load in an experimental model of endurance exercise","volume":"313","author":"Rubies","year":"2017","journal-title":"Am. J. Physiol. Circ. Physiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1155","DOI":"10.1016\/j.ahj.2010.03.036","article-title":"Left atrial volume index in highly trained athletes","volume":"159","author":"Riegler","year":"2010","journal-title":"Am. Heart J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2723","DOI":"10.1161\/CIRCULATIONAHA.110.981571","article-title":"Athlete\u2019s heart and cardiovascular care of the athlete: Scientific and clinical update","volume":"123","author":"Baggish","year":"2011","journal-title":"Circulation"},{"key":"ref_28","first-page":"900","article-title":"Volumetric and functional assessment of the left atrium in young competitive athletes without left ventricular hypertrophy: The MAGYAR-Sport Study","volume":"57","author":"Nemes","year":"2017","journal-title":"J. Sports Med. Phys. Fit."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1125","DOI":"10.1177\/2047487320911850","article-title":"Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete\u2019s heart","volume":"28","author":"Fiorentini","year":"2021","journal-title":"Eur. J. Prev. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"882077","DOI":"10.3389\/fcvm.2022.882077","article-title":"Longitudinal Associations between Cumulative Physical Activity and Change in Structure and Function of the Left Side of the Heart: The Troms\u00f8 Study 2007\u20132016","volume":"9","author":"Heitmann","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2152","DOI":"10.1161\/CIRCULATIONAHA.114.010775","article-title":"Cardiac Remodeling in Response to 1 Year of Intensive Endurance Training","volume":"130","author":"Perhonen","year":"2014","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1001\/jama.2010.982","article-title":"Causes of sudden death during the triathlon","volume":"304","author":"Constantini","year":"2010","journal-title":"JAMA"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1001\/jama.2010.368","article-title":"Sudden death during the triathlon","volume":"303","author":"Harris","year":"2010","journal-title":"JAMA"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1268","DOI":"10.1136\/hrt.2009.189621","article-title":"Lower than expected desmosomal gene mutation prevalence in endurance athletes with complex ventricular arrhythmias of right ventricular origin","volume":"96","author":"Robberecht","year":"2010","journal-title":"Heart"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"i44","DOI":"10.1136\/bjsports-2012-091162","article-title":"Ventricular arrhythmias associated with long-term endurance sports: What is the evidence?","volume":"46","author":"Heidbuchel","year":"2012","journal-title":"Br. J. Sports Med."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1056\/NEJMoa1106468","article-title":"Cardiac Arrest during Long-Distance Running Races","volume":"366","author":"Kim","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1056\/NEJMc1111015","article-title":"Acute Coronary Thrombosis in Boston Marathon Runners","volume":"366","author":"Albano","year":"2012","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1042\/CS20100206","article-title":"Magnetic resonance imaging of myocardial injury and ventricular torsion after marathon running","volume":"120","author":"Hanssen","year":"2011","journal-title":"Clin. Sci."},{"key":"ref_39","first-page":"615","article-title":"Cardiac Damage Biomarkers and Heart Rate Variability Following a 118-Km Mountain Race: Relationship with Performance and Recovery","volume":"18","author":"Hernando","year":"2019","journal-title":"J. Sport. Sci. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e01913","DOI":"10.1016\/j.heliyon.2019.e01913","article-title":"Blood cardiac biomarkers responses are associated with 24 h ultramarathon performance","volume":"5","author":"Hohl","year":"2019","journal-title":"Heliyon"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.jshs.2021.11.001","article-title":"Exercise and cardiovascular protection: Update and future","volume":"10","author":"Xiao","year":"2021","journal-title":"J. Sport Health Sci."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jshs.2021.06.004","article-title":"Cardiorespiratory fitness measured with cardiopulmonary exercise testing and mortality in patients with cardiovascular disease: A systematic review and meta-analysis","volume":"10","author":"Ezzatvar","year":"2021","journal-title":"J. Sport Health Sci."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.jshs.2021.09.004","article-title":"The relationships between step count and all-cause mortality and cardiovascular events: A dose\u2013response meta-analysis","volume":"10","author":"Sheng","year":"2021","journal-title":"J. Sport Health Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.jshs.2021.02.004","article-title":"What\u2019s new in the 2020 World Health Organization Guidelines on Physical Activity and Sedentary Behavior?","volume":"10","author":"Pratt","year":"2021","journal-title":"J. Sport Health. Sci."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.jshs.2021.05.001","article-title":"Exercise attenuates bone mineral density loss during diet-induced weight loss in adults with overweight and obesity: A systematic review and meta-analysis","volume":"10","author":"Mesinovic","year":"2021","journal-title":"J. Sport Health Sci."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Gao, Z., and Lee, J.E. (2022). Promoting Physical Activity and Reducing Sedentary Behavior to Prevent Chronic Diseases during the COVID Pandemic and Beyond. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164666"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2600\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:20:17Z","timestamp":1760120417000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2600"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":46,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032600"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032600","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}