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First of all, it is important to distinguish between competitive sports and preventive sports. “Atrial fibrillation is more common among middle-aged and older endurance athletes who have been training for many years” (1) (age in [2]: 51±9 years). In athletes training preventively and at a medium intensity, atrial fibrillation occurs more rarely in those older than 65 years than among athletically inactive persons or active persons exercising at high intensities (3). A U-shaped curve may therefore be assumed with regard to the association between atrial fibrillation and exercise intensity (3). However, the underlying causes are mostly unknown, and several aspects are subject to discussion or speculation, some of which we mentioned in our article. Since it is not possible in the context of competitive sports to conduct randomized controlled trials or interventional investigations in healthy athletes, only well designed and planned prospective longitudinal studies will be able to shed any light on this subject in future.

No age- and weight-related limits exist with regard to the recommended exercise intensity in athletes pursuing preventive exercise. A value given as watts/kg body weight is suitable only for cyclists with the relevant (and expensive) equipment, or exercise on bicycle ergometers. A general threshold value as a percentage of the maximum age-related pulse rate is not advisable since this does not take into consideration individuals’ exercise capacity nor the individual variance of the maximum heart rate. Precise training recommendations for endurance exercise can be deduced from an exercise ECG with individual default values for the heart rate. This is recommended particularly for patients who require an upper heart rate limit as their exercise threshold (for example, participants in cardiac rehabilitation exercise). For healthy preventive athletes, no such heart rates are necessary. They should run at such a speed that they are still able to speak, although occasional intervals of higher intensity are feasible. According to current recommendations, preventive endurance exercise should be undertaken 3–5 times per week, for 30–60 minutes.

DOI: 10.3238/arztebl.2013.0299b

PD Dr. med. J. Scharhag
Innere Medizin III: Kardiologie, Angiologie und Pneumologie
Universitätklinikum Heidelberg, juergen.scharhag@med.uni-heidelberg.de

Prof. Dr. med. H. Löllgen
Praxis für Innere Medizin, Kardiologie, Sportmedizin, Remscheid

Prof. em. Dr. med. W. Kindermann
Institut für Sport- und Präventivmedizin, Universität des Saarlandes

Conflict of interest statement

The authors of all contributions declare that no conflict of interest exists.

1.
Scharhag J, Löllgen H, Kindermann W: Competitive sports and the heart: benefit or risk? Dtsch Arztebl Int 2013; 110(1–2): 14–24. VOLLTEXT
2.
Abdulla J, Nielsen JR: Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 2009; 11: 1156–9. CrossRef MEDLINE
3.
Mozaffarian D, Furberg CD, Psaty BM, Siscovick D: Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008; 118: 800–7 CrossRef
1.Scharhag J, Löllgen H, Kindermann W: Competitive sports and the heart: benefit or risk? Dtsch Arztebl Int 2013; 110(1–2): 14–24. VOLLTEXT
2.Abdulla J, Nielsen JR: Is the risk of atrial fibrillation higher in athletes than in the general population? A systematic review and meta-analysis. Europace 2009; 11: 1156–9. CrossRef MEDLINE
3.Mozaffarian D, Furberg CD, Psaty BM, Siscovick D: Physical activity and incidence of atrial fibrillation in older adults: the cardiovascular health study. Circulation 2008; 118: 800–7 CrossRef
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